Category:
Ankle; Basic Sciences/Biologics
Introduction/Purpose:
Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment modality that is utilized in the treatment of chronic Achilles ...tendinopathy (AT).
The purpose of this study was to retrospectively assess outcomes following ESWT for both NAT and IAT at greater than 1-year follow-up, and to identify potential predictors of outcomes.
Methods:
Chart review was conducted to identify patients who underwent ESWT for AT with a minimum of 1-year follow-up. Data collected and assessed included: patient demographics, pathological characteristics, treatment characteristics, Victorian Institute of Sports Assessment-Achilles (VISA-A) and visual analog scale (VAS) scores and failures. Linear regression was performed to identify potential predictors of outcomes. Survival analysis was conducted using Kaplan Meier curves.
Fifty-two cases of IAT and 34 cases of NAT were included. The mean follow-up in the NAT cohort was 22.3±10.2 months and the mean follow-up time in the IAT cohort was 26.8±15.8 months.
Results:
Improvements in VISA-A and VAS scores were observed in the NAT cohort at 6 months follow-up and at final follow-up (p < 0.01). Improvements in VISA-A scores and VAS scores were recorded in the IAT cohort at 6 months follow-up which subsequently deteriorated at final follow-up. In the NAT cohort, the failure rate at 6 months follow-up was 11.8% which increased to 29.4% at final follow-up. In the IAT cohort, the failure rate at 6 months follow-up was 32.7% which increased to 59.6% at final follow-up. Predictors of poor outcomes in the NAT cohort included pre-ESWT subjective clinical score, male, presence of cardiovascular risk factor, and increasing MRI severity. Predictors of poor outcomes in the IAT cohort included pre-ESWT subjective clinical score and increasing MRI severity.
Conclusion:
This study found that superior subjective clinical outcomes together with a lower failure rate maintained over 1 year in the NAT cohort compared to the IAT cohort. This may implicate ESWT as a temporising treatment in IAT and a longer term solution in patients with NAT.
Category:
Ankle Arthritis
Introduction/Purpose:
The purpose of this systematic review and meta-analysis was to compare the volume of blood loss, transfusion rates and complication rates between ...patients who were administered tranexamic acid (TXA) versus patients who were not administered TXA during total ankle arthroplasty (TAA).
Methods:
During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies comparing outcomes between patients who were administered TXA versus patients who were not administered TXA during TAA. Data regarding surgical characteristics, subjective clinical outcomes, total blood loss, intra-operative blood loss, total complications and wound complications rates were extracted and analysed. In total, 5 comparative clinical studies were included in this review.
Results:
194 patients received TXA and 187 patients did not receive TXA during TAA. There was a statistically significant reduced volume of total blood loss in favor of patients who received TXA compared to patients who did not receive TXA during TAA (SMD:-0.7832; p< 0.0001). A statistically significant reduced volume of intra-operative blood loss between the TXA cohort and the control cohort was also observed in favor of the TXA cohort (SMD:-1.14; p< 0.0001. A statistically significant reduced volume of hemoglobin loss was found in favor of patients who received TXA compared to the control cohort (SMD: -0.9548; p< 0.02). A higher transfusion rate was found in the control cohort (1.1%) compared to the TXA cohort. No difference in complication rates was observed between the cohorts.
Conclusion:
This systematic review and meta-analysis found that patients who received peri-operative TXA had statistically significant reduced total blood volume loss, intra-operative blood volume loss, hemoglobin loss together with no statistically significant difference in complication rates following TAA. Further randomised control trials with improved data collection are necessary to elucidate the optimal dosage, frequency and role of TXA in the peri-operative setting for TAA.
Category:
Ankle Arthritis
Introduction/Purpose:
End-stage ankle osteoarthritis is a debilitating pathology and is most commonly preceded by trauma. Surgical intervention via ankle arthrodesis or ...ankle arthroplasty is the mainstay management option. Heterotopic ossification (HO) is a common finding following joint arthroplasty. However, no consensus regarding the impact of heterotopic ossification on clinical outcomes following total ankle arthroplasty has been reached to date. The purpose of this systematic review and meta- analysis was to evaluate the prevalence and clinical outcomes of heterotopic ossification following total ankle arthroplasty.
Methods:
During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies reporting heterotopic ossification following TAA. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, failure rates and complications were extracted and analysed.
Results:
Twenty-seven studies with 2639 patients (2695 ankles) at a weighed mean follow-up time of 52.8 ± 26.9 months were included. The pooled prevalence rate was 45% (0.25; 0.66). The implant with the highest rate of HO was the INBONE I (100%) and BOX (100%) implants. The most common modified Brooker staging was grade 1 (120 patients, 33.9%). Random effects models of standardized mean differences found no difference in AOFAS, VAS and ROM between patients with HO and patients without HO. Random effects models of correlation coefficients found no correlation between AOFAS, VAS and ROM and the presence of HO. The surgical intervention rate for symptomatic HO was 10.5%.
Conclusion:
This systematic review and meta-analysis found that HO is a common finding following TAA that is not associated with inferior clinical outcomes. Surgical intervention was required only for moderate-severe, symptomatic HO following TAA. This study is limited by the significant heterogeneity and low level and quality of evidence of the included studies. Further higher quality studies are warranted to determine the precise prevalence and impact of HO on outcomes following TAA.
Category:
Ankle; Basic Sciences/Biologics
Introduction/Purpose:
The purpose of this systematic review was to evaluate the clinical and radiological outcomes together with the complication rates and ...failure rates at short-term follow-up following Particulated Juvenile Allograft Cartilage (PJAC) for the management of osteochondral lesions of the talus (OLT).
Methods:
During November 2022, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following PJAC for the management of OLTs. Data regarding study characteristics, patient demographics, lesion characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. In addition, the level of evidence and quality of evidence for each individual study was also assessed.
Results:
Twelve studies were included. In total, 241 patients underwent PJAC for the treatment of OLT at a weighted mean follow-up of 29.0±24.9 months. The weighted mean lesion size was 138.3±59.6 mm2 and 69.4% of OLTs were located at the medial talar dome. Prior surgical intervention was recorded in 7 studies, the most common of which was microfracture (65.9%). Concentrated bone marrow aspirate was utilized in 66 patients (27.3%). The weighted mean AOFAS score improved from a pre- operative score of 58.5±3.2 to a post-operative score of 83.9±5.3. The weighted mean post-operative MOCART score was 48.2±3.3. The complication rate was 16.5%, the most common of which was graft hypertrophy (7.0%). Thirty failures (12.4%) were observed at a weighted mean time of 9.8±9.6 months following the index procedure.
Conclusion:
This systematic review demonstrated a moderate improvement in subjective clinical outcomes following PJAC for the treatment of OLT at short term follow-up. However, post-operative MOCART scores were reported as poor. In addition, a moderate complication rate (16.5%) and a moderate failure rate (12.4%) was observed, calling into question the efficacy of PJAC for the treatment of large OLTs. Further studies are warranted to identify the optimal role of PJAC in the management of OLTs.
Category:
Ankle; Sports
Introduction/Purpose:
Chronic ankle instability occurs in 15-20% of patients with ankle sprains who do not recover following conservative management and typically requires ...surgical intervention. There is recent interest in Anterior Talofibular Ligament (ATFL) Repair techniques that may improve outcomes and expedite recovery. Evidence for the use of suture-tape as an internal in ATFL Repair is limited in the literature. The purpose of this study was to retrospectively assess outcomes and return to sport following ATFL Repair with and without suture-tape (ST) augmentation at greater than 1-year follow-up.
Methods:
Chart review was conducted to identify patients who underwent Anterior Talofibular Ligament (ATFL) Repair with a minimum of 1-year follow-up. Data collected and assessed included: patient demographics, pathological characteristics, treatment characteristics, Foot and Ankle Outcome Score (FAOS), visual analog scale (VAS) scores, return to sport (RTS), complications, and failures. Linear regression was performed to identify potential predictors of outcomes.
Results:
Eighteen cases of ATFL repair augmented with suture-tape (ST) and 20 cases of ATFL repair alone were included. The mean follow-up in the ST cohort was 20.8 ± 7.9 months and the mean follow-up time in the ATFL repair alone cohort was 25.3 ± 13.2 months. Improvements in FAOS and VAS scores were observed in both cohorts at final follow-up (p < 0.01). No statistically significant difference in FAOS and VAS scores at final follow up was found between the 2 cohorts. The mean time to RTS was 8.6 ± 3.3 weeks in the ST cohort and 13.3 ± 2.7 weeks in the ATFL repair alone cohort (p < 0.01). No statistically significant difference in complication rates nor failure rates was observed between the 2 cohorts.
Conclusion:
This retrospective study found that ATFL Repair with and without suture-tape augmentation produced comparable subjective clinical outcomes, complication rates and failure rates at short-term follow-up. A superior mean time to RTS was found in the ST cohort. The early results of this surgical technique are promising, but further studies with larger patient cohorts and longer follow-up times are needed to determine the optimal role of suture-tape augmentation of ATFL repair.
Category:
Other; Ankle
Introduction/Purpose:
The purpose of this systematic review was to evaluate the clinical and radiological outcomes at short-term follow-up following peroneal tendoscopy for the ...treatment of peroneal tendon disorders.
Methods:
During October 2022, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following peroneal tendoscopy for the treatment of peroneal tendon disorders. Data regarding patient demographics, pathological characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed.
Results:
Nine studies were included. In total, 264 patients (269 tendons) underwent peroneal tendoscopy for the treatment of peroneal tendon disorders at a weighted mean follow-up of 30.5±11.4 months. The peroneal tendon disorders included: peroneal tendon tear (89 patients), peroneal tenosynovitis (85 patients), low lying muscle belly (54 patients) and peroneal tendon subluxation (17 patients). The weighted mean AOFAS score improved from a pre-operative score of 76.0 to a weighted mean post-operative score of 96.0. The complication rate was 3.8%, the most common of which was persistent lateral ankle pain (1.1%). Two failures (0.007%) were reported, both of which underwent repeat peroneal tendoscopy, tenosynovectomy and low lying muscle belly resection.
Conclusion:
This systematic review demonstrated improvement in subjective clinical outcomes together with a low complication rate and low failure rate at short-term follow-up following peroneal tendoscopy for the treatment of peroneal tendon disorders. However, the level of evidence was low and the quality of evidence was poor. In addition, there was significant heterogeneity between the included studies. Further higher quality studies are warranted to determine the optimal role of peroneal tendoscopy for the management of peroneal tendon disorders.
Category:
Lesser Toes; Other
Introduction/Purpose:
The purpose of this systematic review was to evaluate the clinical and radiological outcomes together with the complication rates and failure rates ...following surgical intervention for Freiberg's Infraction.
Methods:
During December 2022, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following surgical intervention for the management of Freiberg's Infraction. Data regarding study characteristics, patient demographics, lesion characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. In addition, the level of evidence and quality of evidence for each individual study was also assessed.
Results:
Eighteen studies were included. In total, 299 patients (302 feet) underwent surgical intervention for the management of Freiberg's Infraction at a weighted mean follow-up of 49.9±45.1 months. The distribution of patients by Smillie's (SI-V) classification was recorded in as follows: SI (0 patients), SII (20 patients), SIII (42 patients), SIV (69 patients), SV (54 patients). The most common surgical procedure was dorsal closing wedge metatarsal osteotomy. The weighted mean AOFAS score improved from a pre-operative score of 60.3±9.0 to a post-operative score of 84.3±24. The weighted mean total ROM improved from 46.4±11.7° pre-operatively to 66.2±15.1° post-operatively. The weighted mean time to osseous union was 7.4±3.6. The complication rate was 5.2%, the most common of which was pain. Four failures (1.6%) were observed.
Conclusion:
This systematic review found improvements in subjective and objective clinical outcomes together with a low complication rate following surgical intervention for Freiberg's infraction at mid-term follow-up. However, the level and quality of evidence of the included studies were low and there was marked heterogeneity and under-reporting of data between the included studies. Although surgical intervention appears to is the mainstay treatment option for Freiberg's infraction, further higher quality comparative studies are warranted to determine the optimal surgical technique for Freiberg's infraction.
Category:
Ankle; Basic Sciences/Biologics
Introduction/Purpose:
The purpose of this systematic review was to evaluate the clinical outcomes, complication rates and failure rates at short-term ...follow-up following hyaluronic acid (HA) injection for the management of various soft tissue foot and ankle pathologies.
Methods:
During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following HA injection for the management of various soft tissue foot and ankle pathologies. Data regarding study characteristics, patient demographics, pathological characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. In addition, the level of evidence and quality of evidence for each individual study was also assessed.
Results:
Studies examining outcomes following HA injection included the following pathologies: Achilles tendinopathy (AT) (6 studies, 126 patients, weighted mean follow-up of 2.9 months), plantar fasciitis (PF) (2 studies, 54 patients, 4.3), lateral ankle sprains (LAS) (2 studies, 119 patients, follow-up of 11.4 months) and Morton's neuroma (MN) (1 study, 83 patients, follow-up of 12 months). Seven different HA formulations were utilised across 10 studies. Weighted mean pain and functional scores improved significantly in all 4 cohorts. The complication rates for the AT cohort, PF cohort, LAS cohort and MN include: 3.2%, 1.9%, 2.5% and 20.5%, respectively. The failure rates for the AT cohort, PF cohort, LAS cohort and MN include: 1.6%, 0%, 0% and 0%, respectively.
Conclusion:
This systematic review demonstrated improvements in subjective clinical outcomes together with low complication and failure rates following HA injections for various soft tissue foot and ankle pathologies at short term follow-up. However, the heterogeneity between the studies, low number of high quality studies and short-term follow-up limits the generation of any robust conclusions. Further research is warranted to assess the optimal role of HA in the management of foot and ankle soft tissue pathologies.
Category:
Midfoot/Forefoot; Other
Introduction/Purpose:
The purpose of this systematic review was to evaluate outcomes following intra-articular 1st MTPJ hyaluronic acid injection for the management ...of hallux rigidus.
Methods:
During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies evaluating outcomes in patients who underwent intra-articular 1st MTPJ hyaluronic acid injection for the management of hallux rigidus. Data regarding injection characteristics, subjective clinical outcomes, failure rates and complications were extracted and analysed.
Results:
In total, 5 studies were included in this review. In total, 209 patients underwent intra-articular 1st MTPJ hyaluronic acid injection for the management of hallux rigidus at a weighted mean follow-up of 4.4 ± 1.4 months. The weighted mean VAS improved from a pre-injection score of 6.4 ± 0.3 to a post-injection score of 2.8 ± 0.4. A 10.1% complication rate was noted, the most common of which was transient 1st MTPJ swelling. One infection (0.5%) was reported. A symptomatic recurrence rate of 18.6% was observed at a weighted mean time of 7.3 ± 4.2 months
Conclusion:
This systematic review demonstrated that intra-articular 1st MTPJ hyaluronic acid injection for the management of hallux rigidus led to a reduction in pain and a moderate complication rate at short-term follow-up. In addition, intra-articular 1st MTPJ hyaluronic acid injection for the management of hallux rigidus produced a symptomatic recurrence rate of 18.6% at approximately 7.3 months, suggesting that HA provides short-term relief. The lack of quality comparative studies limits the generation of robust conclusions, reinforcing the need for further research to identify the optimal role of HA in the management of hallux rigidus.
Category:
Midfoot/Forefoot; Other
Introduction/Purpose:
The purpose of this systematic review was to evaluate outcomes following polyvinyl alcohol hydrogel implant for the management of hallux ...rigidus.
Methods:
During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies evaluating outcomes in patients who underwent polyvinyl alcohol hydrogel implant for the management of hallux rigidus. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, failure rates and complications were extracted and analysed. In total, 15 studies were included in this review.
Results:
In total, 1536 patients (1578 feet) underwent polyvinyl alcohol hydrogel implant for the management of hallux rigidus at a weighted mean follow-up of 39.4 ± 17.3 months. The weighted mean VAS score improved from a pre-operative score of 6.2 ± 1.3 to a post-operative score of 3.0 ± 1.6. There was limited data regarding improvements in range of motion. The complication rate was 15.7% and the failure rate was 9%.
Conclusion:
This systematic review demonstrated improvement in subjective clinical outcomes following PVA hydrogel implant for the management of hallux rigidus. A moderate complication rate and failure rate was noted at short term follow-up. Further studies with longer follow-up periods are warranted to elucidate the precise outcomes following PVA hydrogel implant for the management of hallux rigidus.
