Foot & ankle international最新文献

{"title":"Reliability of Dynamometric Measurements for Ankle Muscle Strength: A Systematic Review.","authors":"Cristina Jiménez-Ávila, Andrés Felipe Villaquiran-Hurtado, Daniel Jerez-Mayorga, Guido Contreras-Diaz","doi":"10.1177/10711007251339483","DOIUrl":"10.1177/10711007251339483","url":null,"abstract":"<p><strong>Background: </strong>Strength assessment is crucial for enhancing physical fitness, health, and injury prevention, particularly for the ankle joint, which is frequently injured in athletic activities. Despite technological advances, the reliability of dynamometric measurements for ankle strength varies because of differences in test procedures, equipment, and methodologies. This systematic review aimed to (1) examine the reliability of dynamometric strength measurements for ankle muscles in healthy individuals and athletes, (2) identify the most valid and reliable positions for strength measurement, and (3) determine the most reliable velocities for assessing ankle muscle strength.</p><p><strong>Methods: </strong>A comprehensive search of 4 electronic databases (Web of Science, SCOPUS, EBSCO, and PubMed) identified 556 studies, of which 13 met the inclusion criteria for this meta-analysis. The reliability of the measurements was assessed using intraclass correlation coefficients (ICCs). Data extraction and analysis followed PRISMA guidelines, with methodologic quality evaluated using the Critical Appraisal Tool and the Quality Appraisal tool for Reliability Studies.</p><p><strong>Results: </strong>Most studies assessed ankle movements in a seated position, reporting ICC values between 0.42 and 0.97, with the majority showing good to excellent reliability (0.78-0.99). Dorsiflexion and plantarflexion movements demonstrated high reliability, whereas inversion and eversion showed greater variability (ICC 0.47-0.96). The most reliable velocities for isokinetic assessments were between 40 and 90 degrees/second. Eccentric and concentric strength measurements also exhibited good to excellent reliability.</p><p><strong>Conclusion: </strong>Dynamometric measurements of ankle strength are generally reliable, especially in seated positions and at specific velocities (40-90 degrees/second). Standardizing assessment protocols can improve measurement consistency and accuracy, enhancing their utility in injury prevention and rehabilitation programs.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"925-940"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113059","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":"Anatomy of the Peroneal Artery and its Role in Foot and Ankle Surgery.","authors":"Alejandro Ordas-Bayon, Clara Simón de Blas, Manuel Rodríguez-Vegas, Matija Krkovic, Teresa Vázquez, Paloma Aragones Maza","doi":"10.1177/10711007251343522","DOIUrl":"10.1177/10711007251343522","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study is to detail the terminal distribution of the peroneal artery, which may be at risk in a number of surgical procedures. Five per cent of the population presents with a dominant peroneal artery (arteria peronea magna), which is responsible for the entire foot vascularization.</p><p><strong>Methods: </strong>Anatomic dissection of 54 specimens from 44 cadaveric donors was performed. Twenty belonged to women and 24 to men, whereas 10 lacked traceability data. Mean age of the donors was 75.01 ± 16.14 (range 38-101) years. Ten donors had bilateral extremities.</p><p><strong>Results: </strong>Six types on the terminal distribution of the peroneal artery were identified: type 1 (40.7%), terminal division into anterior perforating branch and posterior peroneal artery (bifurcation); type 2 (14.8%), proximal anterior perforating branch, distal bifurcation; type 3A (18.5%), terminal trifurcation into anastomosis, anterior perforating branch and posterior peroneal artery; type 3B (5.6%), terminal trifurcation where the anastomotic branch bows to join both posterior peroneal and posterior tibial arteries; type 3C (13%), proximal anterior perforating branch, distal trifurcation; type 3D (3.7%), proximal anterior perforating and anastomotic branches, distal trifurcation. Two specimens (3.7%) were nonclassifiable. The mean distance to the most distal anterior perforating branch was 69.37 ± 22.09 mm (from 35.69 to 146.40), whereas the mean diameter was 2.35 ± 0.71 mm (range 0.91-4.24). The most distal anastomosis branched off at 64.80 ± 21.49 mm (from 49.52 to 99.93). Horizontal distances from the fibula to the peroneal artery were, at 5 cm, 0.83 ± 1.21 mm (0-5.76); at 10 cm, 1.24 ± 1.16 mm (range 0-4.96); and at 15 cm, 1.63 ± 1.34 mm (0-5.2). No differences were found for side or gender. Three dominant peroneal arteries were found (5.56%), with a mean diameter of 3.78 ± 0.88 mm. These findings provide the most detailed classification to date and support incorporating peroneal artery mapping into preoperative planning for high-risk procedures.</p><p><strong>Conclusion: </strong>Narrow proximity to the fibula, variation in branching, and dominance patterns suggest that identifying the peroneal vascular bundle intraoperatively is critical to avoid vascular complications. When performing posterior approaches to the ankle, it may be helpful to identify the peroneal vascular bundle and perform the necessary dissections and implant placement as distal as possible to avoid its injury.</p><p><strong>Clinical relevance: </strong>Understanding the anatomy of the peroneal artery, its branches and anatomical variations, with special mention of the dominant peroneal artery (arteria peronea magna), may help to avoid iatrogenic injury to the peroneal vascular bundle during the varied and increasing number of foot and ankle surgical procedures performed, such as posterior open reduction internal fixation of ankle fractu","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"862-872"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340780","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":"Midterm Survivorship of 106 Infinity Total Ankle Replacements: A Case Series From 2 Non-designer UK Centers.","authors":"Mark Dahill, Milos Kostusiak, Michael Dean, Adrian Hughes, Rajesh Kakwani, An Murty, David Townshend, Ian Sharpe","doi":"10.1177/10711007251341313","DOIUrl":"10.1177/10711007251341313","url":null,"abstract":"<p><strong>Background: </strong>The Infinity Total Ankle System is the total ankle replacement (TAR) with market leading share in the United Kingdom and has been implanted in patients since 2014. We report the longest prospective series of Infinity TAR, with mean 8-year survivorship data from 2 nondesigner centers in the United Kingdom. This is a dual-center, prospective, observational study. The primary aims were to assess survivorship and complications of the Infinity TAR. The secondary aims were to assess functional and radiologic outcomes.</p><p><strong>Methods: </strong>A total of 102 patients, comprising 106 primary TARs, were recruited into the study. Revision TAR and conversion from ankle arthrodesis were excluded from the study. Survivorship, complication, and patient-reported outcome measure score data were collected prospectively, during preoperative and annual, postoperative appointments. Plain weightbearing radiographs were assessed by 2 nonmasked authors for Canadian Orthopaedic Foot and Ankle Society (COFAS) grade, coronal and sagittal deformity, and formation of periimplant lucencies.</p><p><strong>Results: </strong>Mean follow-up time was 98 months (range 83-113). Four patients were lost to follow-up, and 12 patients died. Twelve patients underwent secondary surgeries: 8 revision TAR and 4 nonrevision reoperations. The current survivorship of the remaining 90 patients is 91.1% (95% CI, 83.0%-95.4%). Fifteen patients (14%) had complications of surgery. The most common reason for revision surgery was unexplained pain (5 of 8 patients). Manchester-Oxford Foot Questionnaire scores improved from 60 to 22 (<i>P</i> < .01). EQ-5D-5L scores improved from 0.420 to 0.696 (<i>P</i> < .01). The revision rate for this series is 9% at 8 years with a proven deep infection rate of 1%. Lucencies (35% of patients) were mostly asymptomatic.</p><p><strong>Conclusion: </strong>This prospective series of 106 modern fixed-bearing TAR shows an 8-year survivorship of 91%. The fixed-bearing Infinity TAR appears to be a safe, effective intervention in the treatment of end-stage ankle osteoarthritis and gives significant improvement in disease-specific and general health status outcomes.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"855-861"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499924","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":"Biplane Chevron Osteotomy in Hallux Valgus: Biomechanical Effects of Lateral and Plantar Displacement Under Simulated Standing Load.","authors":"Dong Ma, Yining Wang, Chujiang Xu, Jingxing Dai, Zhengkuan Feng, Wanqi Yu, Guangwei Xu, Jin Xiao, Shizhen Zhong, Jun Ouyang, Lei Qian","doi":"10.1177/10711007251344255","DOIUrl":"10.1177/10711007251344255","url":null,"abstract":"<p><strong>Background: </strong>Plantar displacement during chevron osteotomy may improve load distribution in hallux valgus, but biomechanical evidence is limited. This study evaluates how lateral and plantar displacement affect contact properties in the first metatarsophalangeal (MTP-1) and the first tarsometatarsal (TMT-1) joints under standing load.</p><p><strong>Methods: </strong>Twelve cadaveric feet with hallux valgus and 4 normal specimens were tested under simulated standing load. Biplane osteotomy was performed with lateral displacement (2, 4, 6 mm) and plantar displacement (0, 2, 4 mm). Joint contact metrics were measured using Tekscan sensors.</p><p><strong>Results: </strong>Lateral displacement significantly affected contact force and peak pressure at both joints (<i>P</i> < .01). Interaction effects between lateral and plantar displacement were also significant (<i>P</i> < .01). A combination of 4-mm lateral and 2-4-mm plantar displacement most closely approximated contact pressures seen in the normal group.</p><p><strong>Conclusion: </strong>Lateral displacement of 4 mm with 2-4 mm plantar shift optimizes contact pressure restoration in cadaveric hallux valgus feet. These findings offer biomechanical guidance but require clinical validation.</p><p><strong>Clinical relevance: </strong>Understanding how lateral and plantar displacement affect joint biomechanics provides a foundational framework for refining surgical planning in biplane chevron osteotomy. By identifying displacement combinations that approximate normal joint pressures, this study offers biomechanical guidance to help reduce postoperative complications such as transfer metatarsalgia. However, clinical studies are needed to determine whether these biomechanical findings translate into improved outcomes in patients with hallux valgus.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"903-913"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531948","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":"10.1177/10711007251351597","url":null,"abstract":"","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"836-837"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","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":"Clinical Characteristics, Complications, and Implant Survivorship Following Revision Total Ankle Arthroplasty: A Large Single-Center Study.","authors":"Alexandra N Krez, Albert T Anastasio, Billy I Kim, Bruno N Valan, Kevin A Wu, James K DeOrio, James A Nunley, Mark E Easley, Samuel B Adams","doi":"10.1177/10711007251343536","DOIUrl":"10.1177/10711007251343536","url":null,"abstract":"<p><strong>Background: </strong>As total ankle arthroplasty (TAA) rises in popularity nationwide, the incidence of revision TAA continues to increase. This study evaluates patient demographics, surgical techniques, complications, and implant survivorship following revision TAA.</p><p><strong>Methods: </strong>This was a single-center, retrospective review of revision TAAs performed between September 2007 and September 2022. Patients with a follow-up period of less than 1 year were excluded from the study. Demographic, surgical, and implant data were analyzed. Primary outcomes were prevalence of complications and implant failure.</p><p><strong>Results: </strong>Seventy-eight patients underwent a revision TAA. The mean age at revision was 64.2 years, with a follow-up of 4.5 years. Loosening (65.5%) was the primary indication, and both components were removed in 89.7% of cases. The most common implants for revision TAA were Inbone II (71.8%) and Inbone I (16.7%). Reoperation and rerevision rates were 37.2% and 21.8%, respectively, with infection being the leading cause. The 1- and 3-year implant survivorship rates were 94% and 88%, respectively.</p><p><strong>Conclusion: </strong>Revision TAA remains a viable salvage procedure but carries a moderate complication rate, highlighting the importance of careful patient selection, surgical planning, and long-term monitoring.</p>","PeriodicalId":94011,"journal":{"name":"Foot & ankle international","volume":" ","pages":"838-844"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499921","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":"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}