Peroneal Tendon Disorders Roster, Brent; Michelier, Patrick; Giza, Eric
Clinics in sports medicine,
10/2015, Letnik:
34, Številka:
4
Journal Article
Recenzirano
Peroneal tendon pathology is often found in patients complaining of lateral ankle pain and instability. Conditions encountered include tendinosis; tendinopathy; tenosynovitis; tears of the peroneus ...brevis, peroneus longus, and both tendons; subluxation and dislocation; and painful os peroneum syndrome. Injuries can be acute as a result of trauma or present as chronic problems, often in patients with predisposing structural components such as hindfoot varus, lateral ligamentous instability, an enlarged peroneal tubercle, and a symptomatic os peroneum. Treatment begins with nonoperative care, but when surgery is required, reported results and return to sport are in general very good.
Category:
Hindfoot
Introduction/Purpose:
Distraction arthrodesis of the subtalar joint is performed to restore height and correct deformity in the case of subtalar joint arthrosis, malalignment of ...the rear foot, calcaneal fracture, or other pathologies. Historically, autograft or allograft bone blocks were used to restore natural alignment and improve hindfoot function. Although successful use has been reported, complications associated with donor site morbidity and size limitation for autograft, as well as additional complications including nonunion, graft collapse, and loss of alignment are common. Recently, innovative advancements have enabled the use of 3D printed porous titanium implants for use, improving the union rates and reduced risk of subsidence and graft collapse.
Methods:
6 patients with subtalar collapse and anterior ankle impingement were indicated for distraction subtalar arthrodesis. Surgery was performed with a lateral approach for the distraction arthrodesis using an off the shelf 3D printed subtalar wedge and a nitinol pseudoelastic fusion rod for stabilization and fixation. Patients were followed 6 months post op for fusion and alignment. Fusion was confirmed at 3 months with CT scans and alignment was monitored with weightbearing ankle X-rays.
Results:
3D wedge incorporation and sustained correction of height and alignment was maintained over time at the subtalar joint. There were no nonunions, 2 patients reports skin healing issues due to tension on the skin with wound closure. These healed with local wound care. Improvement in preoperative to postoperative tibiotalar sagittal plane alignment was observed in all patients.
Conclusion:
The use of a 3D printed titanium wedge for distraction Arthrodesis of the subtalar joint is a safe procedure and useful procedure in short-term follow-up. This procedure does provide improvement in the patients alignment and fusion occurs with in 3 months of surgery.
Category:
Hindfoot; Basic Sciences/Biologics
Introduction/Purpose:
Augment® Bone Graft is a mixture of rhPDGF-BB, beta-TCP and bovine collagen which has received FDA approval for use as a substitute ...for autografts during hindfoot and/or ankle arthrodesis. Although a recent meta analysis demonstrated that the rhPDGF-BB and beta-TCP mixture has comparable CT fusion rates and radiographic union rates to those of autografts, these studies excluded patients with prior joint site arthrodesis. In our study, we specifically use Augment® Injectable Bone Graft (AIBG) which has only very recently received labeling change approval. The goals of our study are to assess fusions rates in patients who receive AIBG during hindfoot and/or ankle arthrodesis, and then subsequently compare fusion rates between primary vs. revision hindfoot and/or ankle arthrodesis as primary outcomes.
Methods:
We prospectively enrolled patients aged 18-85 who underwent subtalar, calcaneocuboid, talonavicular, and/or ankle arthrodesis from one of two academic surgeons including both primary and revisions fusions. The patients received AIBG and were excluded if any other graft material was used. Demographic data and patient reported outcomes were collected preoperatively and at follow-up visits including Visual Analog Pain Scale (VAS), Foot Function Index (FFI), Foot and Ankle Ability Measure (FAAM) Sports Subscale, and Veterans Rand 12 (VR-12) physical and mental subscores. Patients were followed at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. The primary outcome measure was fusion rate via CT scan at 4 months with secondary outcomes consisting of the patient reported outcome data and rate of revisions.
Results:
62 patients met inclusion criteria, 50 patients had a 4-month postoperative CT scan to assess for fusion with 78% of the CT scans (39 out of 50) demonstrating fusion at that time. There were only 3 revision fusion patients, with 1 of the 3 failing to fuse. 54 of the patients were followed through their 6 month visits, 44 patients through 1 year, and 24 patients were seen for their 2-year follow-up visit. All patient reported outcomes demonstrated improvement from preoperatively to final follow-up with VAS scores improving from 5.52 to 3.21, FFI improving from 57.87 to 35.64, FAAM-sports improving from 18.65 to 29.30, VR-12 Physical improving from 28.67 to 35.18, and VR-12 Mental improving from 44.27 to 47.74.
Conclusion:
This prospective study demonstrates that Augment® Injectable Bone Graft is an acceptable alternative to allograft for either primary or revision hindfoot arthrodesis procedures with 78% of patients achieving fusion on a 4-month postoperative CT scan and with steady noted improvement in multiple validated patient-reported outcome measures.
Category:
Hindfoot; Other
Introduction/Purpose:
Subtalar arthrodesis has traditionally been performed using fixation made of titanium or stainless steel. While these devices can provide initial ...compression, the compressive loads can be lost soon after surgery as bone settling or resorption occurs at the joint spaces. The DynaNail® Mini is a subtalar arthrodesis intramedullary nail that allows for compression during surgery and has a stretched nitinol element that attempts to contract but is held by talus and calcaneus screws providing sustained dynamic compression across the joint. There is minimal clinical data evaluating the effects of sustained compression devices on isolated subtalar arthrodesis. The goal of this study was to prospectively follow patients undergoing subtalar arthrodesis with the DynaNail® Mini and evaluate its clinical efficacy via fusion rate and patient reported outcomes.
Methods:
We prospectively enrolled patients aged 18-85 who underwent subtalar arthrodesis with the DynaNail® Mini from one of two academic surgeons. Demographic data and patient reported outcomes were collected preoperatively and at follow-up visits including Visual Analog Pain Scale (VAS), Foot Function Index (FFI), Foot and Ankle Ability Measure (FAAM) Sports Subscale, and Veterans Rand 12 (VR-12) physical and mental subscores. Patients were followed at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. The primary outcome measure was fusion rate via CT scan at 4 months with secondary outcomes consisting of the patient reported outcome data and rate of revisions.
Results:
21 patients met inclusion criteria, 14 patients had a 4-month postoperative CT scan to assess for fusion with 78.6% of the CT scans (11 out of 14) demonstrating fusion at that time. 20 of the patients were followed through their 6 month visits, 16 patients through 1 year, and 16 patients were seen for their 2-year follow-up visit. All patient reported outcomes demonstrated improvement from preoperatively to final follow-up with VAS scores improving from 5.69 to 3.84, FFI improving from 56.43 to 37.88, FAAM-sports improving from 20.31 to 30.47, VR-12 Physical improving from 28.70 to 34.41, and VR-12 Mental improving from 43.64 to 49.81.
Conclusion:
This prospective study demonstrates that patients undergoing subtalar arthrodesis with the DynaNail® Mini demonstrate favorable clinical outcomes that are comparable to existing methods of subtalar arthrodesis with 78.6% of patients achieving fusion on a 4-month postoperative CT scan and with steady noted improvement in multiple validated patient-reported outcome measures.
Background:
Secondary surgical repair of ankle ligaments is often indicated in cases of chronic lateral ankle instability. Recently, arthroscopic Broström techniques have been described, but ...biomechanical information is limited. The purpose of the present study was to analyze the biomechanical properties of an arthroscopic Broström repair and augmented repair with a proximally placed suture anchor. It was hypothesized that the arthroscopic Broström repairs would compare favorably to open techniques and that augmentation would increase the mean repair strength at time zero.
Methods:
Twenty (10 matched pairs) fresh-frozen foot and ankle cadaveric specimens were obtained. After sectioning of the lateral ankle ligaments, an arthroscopic Broström procedure was performed on each ankle using two 3.0-mm suture anchors with #0 braided polyethylene/polyester multifilament sutures. One specimen from each pair was augmented with a 2.9-mm suture anchor placed 3 cm proximal to the inferior tip of the lateral malleolus. Repairs were isolated and positioned in 20 degrees of inversion and 10 degrees of plantarflexion and loaded to failure using a dynamic tensile testing machine. Maximum load (N), stiffness (N/mm), and displacement at maximum load (mm) were recorded.
Results:
There were no significant differences between standard arthroscopic repairs and the augmented repairs for mean maximum load and stiffness (154.4 ± 60.3 N, 9.8 ± 2.6 N/mm vs 194.2 ± 157.7 N, 10.5 ± 4.7 N/mm, P = .222, P = .685).
Conclusions:
Repair augmentation did not confer a significantly higher mean strength or stiffness at time zero.
Clinical Relevance:
Mean strength and stiffness for the arthroscopic Broström repair compared favorably with previous similarly tested open repair and reconstruction methods, validating the clinical feasibility of an arthroscopic repair. However, augmentation with an additional proximal suture anchor did not significantly strengthen the repair.
Diagnosis and Treatment of Acute Achilles Tendon Rupture Chiodo, Christopher P; Glazebrook, Mark; Bluman, Eric Michael ...
Journal of the American Academy of Orthopaedic Surgeons,
08/2010, Letnik:
18, Številka:
8
Journal Article
Recenzirano
Odprti dostop
This clinical practice guideline is based on a series of systematic reviews of published studies in the available literature on the diagnosis and treatment of acute Achilles tendon rupture. None of ...the 16 recommendations made by the work group was graded as strong; most are graded inconclusive; four are graded weak; two are graded as moderate strength; and two are consensus statements. The two moderate-strength recommendations include the suggestions for early postoperative protective weight bearing and for the use of protective devices that allow for postoperative mobilization.
A select 10-30% of patients with recurrent lateral ankle sprains develop chronic ankle instability (CAI). Patients with chronic ankle instability describe a history of the ankle “giving way” with or ...without pathological laxity on examination. Evaluation includes history, identification of predisposing risk factors for recurrent sprains, and the combination of clinical tests (eg, laxity tests) with imaging to establish the diagnosis. There are a variety of nonoperative strategies to address chronic ankle instability, which include rehabilitation and taping or bracing to prevent future sprains. Patients who fail conservative treatment are candidates for surgery. The anatomic approaches (eg, modified Broström) are preferred to nonanatomic procedures since they recreate the ankle’s biomechanics and natural course of the attenuated ligaments. There is a growing interest in minimally invasive procedures via ankle arthroscopy that also address the associated intra-articular disorders. This article provides a review of chronic lateral ankle instability consisting of relevant anatomy, associated disorders, evaluation, treatment methods, and complications.
Level of Evidence:
Level V, expert opinion.
Category:
Ankle Arthritis; Hindfoot
Introduction/Purpose:
Tibiotalocalcaneal (TTC) arthrodesis is a common surgical technique used in the treatment of various hindfoot pathologies. Large osseus ...defects are particularly challenging with a high rate of graft collapse and nonunion when using autograft or allograft. Porous tantalum has emerged as a favorable osteoconductive material to address sizeable hindfoot defects. The purpose of this study was to review the radiographic outcomes and complications associated with tantalum spacer augmentation in hindfoot arthrodesis.
Methods:
A retrospective review was performed of all patients who underwent a hindfoot arthrodesis augmented with a metal spacer (Trabecular MetalTM) from 2012 to 2020 at a single institution. Patients endif–>18 years of age who had a large, hindfoot osseus defect were included in the study. Surgeries were performed by two fellowship-trained foot and ankle orthopaedic surgeons. The primary outcomes assessed were presence of radiographic union, post-operative complications, and return to the operating room.
Results:
Fourteen patients were identified who underwent hindfoot arthrodesis with the use of a Trabecular MetalTM augment. Two of the 14 patients were lost to follow-up resulting in a total of 12 patients with an average age of 59 years (range, 42 - 74). The average length of follow-up was 26 months (range, 4 - 56). Four patients had plain radiographs at final follow-up compared to 7 patients who had CT scans performed. Nine patients underwent TTC fusion with a retrograde intramedullary nail (MedShape DynaNail) and three patients underwent isolated subtalar (ST) fusion. Ten of 12 fusions were augmented using reamer irrigator aspirator (RIA) autograft and two patients received autograft from either the tibia or fibula. Of the 12 patients, 10 achieved radiographic evidence of union for a union rate of 83%. There were three patients who required reoperations: one hypertrophic nonunion, one surgical site infection, and one symptomatic hardware.
Conclusion:
Tantalum provides a great structural option for patients undergoing TTC or ST fusion in the setting of large hindfoot bony defects. This method combined with the use of autograft and adequate biomechanical stabilization can produce reliable results. Functional outcomes are needed to capture the utility of this technique in attaining longterm clinical results.
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