Search Results (43)

Introduction: Rotational ankle instability (RAI), involving combined medial and lateral ligament insufficiency, is an increasingly recognized clinical entity. While open surgery has traditionally been the mainstay for treating deltoid ligament injuries, recent developments in arthroscopic techniques offer a minimally invasive alternative. This systematic review aimed to evaluate the current evidence on the arthroscopic management of medial and rotational ankle instability, focusing on surgical techniques, clinical outcomes, and complications. Methods: A systematic literature search was conducted following PRISMA guidelines using the PubMed, Scopus, and Web of Science databases. The search strategy included the following terms: ((rotation instability) OR (deltoid) OR (medial ankle instability)) AND (ankle arthrosc*). Eligible studies included adult patients undergoing arthroscopic repair of medial ankle instability with a mean 26.4 months follow-up and reported clinical outcomes. Ten studies met the inclusion criteria, encompassing 336 patients and 346 ankles. Results: The mean patient age was 32.6 ± 5.0 years, with 80.6% being male. MRI was the primary diagnostic tool across most studies. Ankle sprains were the most common cause of instability. Lateral ligament insufficiency was frequently associated with medial injuries, reported in all studies evaluating this parameter. All patients underwent prior conservative treatment (mean duration: 5.6 months). Surgical management involved all-inside arthroscopic repair using knotless suture anchors. Additional procedures were performed in 90% of studies, including osteophyte resection (33.3%) and microfracture (22.2%). The mean follow-up period was 26.4 months. The mean postoperative AOFAS score was 95.3, with return to sport generally achieved between 3 and 5 months. Complications were minimal, primarily consisting of superficial wound issues and transient nerve irritation; no major complications or revision surgeries were reported. Discussion: Arthroscopic management of medial and rotational ankle instability is associated with excellent functional outcomes, low complication rates, and early return to sport. Compared to open procedures, arthroscopic techniques offer advantages including reduced soft tissue trauma, fewer wound complications, and the ability to address concomitant intra-articular lesions in a single session. Although technically demanding, this approach is particularly beneficial in athletic populations. However, high-quality prospective studies are still needed to validate these findings and establish long-term comparative outcomes with open reconstruction techniques. Full article

Background: Knee joint immobilization is common after surgery or injury. Whether remaining physically active during immobilization preserves muscle strength and size has not been studied. Objectives: This observational study examined correlations between muscle strength, size, and physical activity (PA) levels during one week of knee joint immobilization. Methods: Nine healthy adults (five males, four females) immobilized their left knee and ambulated with crutches for one week. Ankle accelerometers monitored compliance and tracked PA. Isometric and concentric isokinetic peak torque at 30°/s and 180°/s and vastus lateralis (VL) cross-sectional area (CSA) were assessed before and after immobilization. Bivariate correlations were used to examine relationships between time spent in sedentary, light, moderate, and vigorous PA, and changes in isometric and concentric isokinetic peak torque, as well as VL CSA. Results: After immobilization, isometric strength declined by 17.1%. Concentric isokinetic peak torque declined by 5.5% at 30°/s and 2.3% at 180°/s. VL CSA declined by 6.7%. There were weak correlations between strength measures and PA levels (r = −0.497–0.574; p = 0.106–0.709). For CSA, an unexpected pattern was found in which greater sedentary time was correlated with decreased atrophy (r = 0.701; p = 0.035), but light (r = −0.673; p = 0.047) and moderate (r = −0.738; p = 0.023) PA levels were correlated with increased atrophy. Vigorous PA had weak correlations with CSA (r = −0.321; p = 0.399). Conclusions: Contrary to our hypothesis, increased PA levels were not correlated with the preservation of strength and were correlated with greater declines in CSA during knee joint immobilization. Full article

Objectives: This study aims to compare the postoperative clinical outcomes of using non-elastic compression bandages versus elastic bandages after lateral ankle ligament repair. Methods: This retrospective study analyzed a total of 110 patients who underwent repair surgery for chronic lateral ankle ligament injuries. Based on the postoperative bandaging method, patients were divided into two groups: the non-elastic compression bandage group (Group NECB, 55 cases) and the elastic bandage group (Group EB, 55 cases). A comparison was made between the two groups of patients regarding postoperative ankle joint swelling, pain scores (VAS scores), ankle function (AOFAS Ankle–Hindfoot Scale), range of motion of the ankle joint, the incidence of perioperative complications (including subcutaneous ecchymosis, wound seepage, and events requiring loosening of the bandage due to pain), and the status of return to work postoperatively. Results: There were no significant differences between the two groups in terms of early postoperative ankle joint swelling or increased circumference (0.53 ± 1.47 cm vs. 1.08 ± 1.84 cm, p = 0.095) or VAS scores at 1 day (3.84 ± 2.14 vs. 3.63 ± 2.03, p = 0.595), 7 days (2.20 ± 1.89 vs. 1.78 ± 1.67, p = 0.216), 14 days (1.45 ± 1.56 vs. 0.97 ± 1.23, p = 0.075), or 3 months (1.27 ± 1.50 vs. 1.38 ± 1.76, p = 0.744). Both groups demonstrated comparable functional recovery based on AOFAS scores at 3 months (89.89 ± 8.08 vs. 90.05 ± 9.50, p = 0.926), ROM in all measured directions (p > 0.05), and return to work status (p = 0.567). However, the incidence of complications was significantly lower in Group NECB (3.6%) compared to Group EB (30.9%). The reported complications in Group EB were mainly related to postoperative subcutaneous ecchymosis and discomfort requiring bandage loosening. Conclusions: There is no difference between non-elastic compression bandaging with cotton padding and elastic bandaging in postoperative swelling, pain, and functional recovery. However, in reducing the incidence of postoperative skin adverse events, using non-elastic compression bandages with cotton padding proves to be more ideal as a bandaging method after lateral ankle ligament repair. Full article

Background: Continuous Compression Implants (CCIs) are low-profile implants made of nitinol and titanium. They offer multiple benefits in comparison to plate and screw fixation for foot and ankle indications, and they are designed in such a way that they continuously and dynamically compress the opposed bony surfaces throughout the entire healing process. Methods: In this study, we present our experience on the use of those nitinol implants for midfoot and hindfoot surgery. Furthermore, we elaborate on the advantages and downsides of using this internal fixation method and highlight common pitfalls which could lead to undesirable clinical outcomes. We also demonstrate our proposed surgical technique on how to use CCIs in a reproducible and reliable way and present surgical tips which could help reduce surgical time when utilising these implants. We also make surgical recommendations on their use and present the underlying biomechanics, which could provide a better understanding of the rationale behind using them in the field of foot and ankle surgery. Last but not least, we presented the early clinical and radiological results of a series of patients who underwent primary midfoot fusion for Lisfranc injury between 2020 and 2023. Results: With a minimum follow-up of 9 months, satisfactory clinical and radiological union was noted in all those patients. The mean difference between pre- and post-operative MOxFQ scores was −37.7 (95% CI was 16.9 to 58.5; p = 0.03). The mean post-operative VAS pain at rest was 3.2 (SD = 2.3). No major complications were noted. Conclusions: CCI internal fixation is a safe, reproducible, and reliable method when it comes to foot and ankle conditions, but it requires appropriate pre-operative planning, surgical training, and careful implantation. Full article

Background: Syndesmotic fixation is a standard treatment for tibiofibular syndesmosis injury, especially in ankle fractures, but the necessity of routine screw removal remains debated. This study evaluates the impact of routine removal on functional outcomes, complication rates, and recovery, aiming to clarify its clinical relevance. Methods: This retrospective observational study included 330 patients treated surgically for tibiofibular syndesmosis injuries at a single institution from 2016 to 2024. Patients were categorized into three groups: no removal, routine removal, and removal for clinical indications. Functional outcomes were assessed using the Olerud–Molander Ankle Score (OMAS), and complications, including infections and prolonged pain, were recorded. Statistical analyses evaluated differences between groups. Results: Of the 170 patients who completed follow-up, no significant differences in OMASs were found between the groups (p = 0.646). Complications were more frequent in reoperated patients (9% vs. 2% for non-reoperated), but routine removal did not improve functional outcomes. Younger patients showed better OMASs, highlighting age as a key factor in recovery. Fixation and fracture types had no significant impact on outcomes. Conclusions: Routine syndesmosis screw removal offers no significant functional benefits, as demonstrated by comparable OMASs across groups (median OMAS: 85 for non-reoperated, 80 for routinely reoperated, and 80 for indication-based reoperated patients). However, routine removal is associated with a higher complication rate. A selective approach focusing on clinical indications is recommended to minimize unnecessary surgeries and optimize patient outcomes. Future research should focus on redefining evidence-based management strategies for syndesmotic fixation. Full article

Background and Objectives: The sural nerve (SN) is a pure sensory nerve that supplies the lateral aspect of the ankle and foot. Its anatomical variability has been extensively documented, with multiple classifications describing its different formation patterns. The SN is commonly used for nerve grafting and is a critical structure in lower-limb surgeries. Due to its superficial course, it is vulnerable to iatrogenic injuries, particularly in procedures involving the Achilles tendon. The presence of anatomical variations in SN formation and trajectory has significant implications for surgical planning, diagnostics, and nerve conduction studies. Understanding these formation variations is essential to minimize surgical complications and optimize clinical outcomes. Materials and Methods: A pilot cross-sectional cadaveric study was conducted on nine formalin-fixed adult cadavers at the Department of Anatomy, Histology, and Anthropology, Vilnius University Faculty of Medicine, Lithuania. Standard dissection techniques were employed to examine the formation and trajectory of the SN. Morphometric parameters, including nerve diameter and length, were measured using an RS PTO Digital Caliper with 0.01 mm precision. Variations in SN formation were classified according to the system proposed by P.K. Ramakrishnan et al. Statistical analyses were performed using SPSS 26.0 and RStudio, with a significance threshold set at p ≤ 0.05. Results: The most prevalent SN formation variation observed in the Lithuanian cadaveric sample was Type 3, which was found in 8 out of 18 limbs (44.4%), while Type 6 was not identified. Additionally, a symmetric formation was observed bilaterally in 5 out of the 9 cadavers (55.6%). The SN was significantly thicker in two-contributor formations (3.17 mm) compared to single-contributor formations (1.93 mm, p = 0.001). The SN was also significantly longer in two-contributor formations (25.80 cm) than in single-contributor formations (18.96 cm, p = 0.016). No significant differences in SN morphology were found between left and right lower limbs. Conclusions: This study highlights the substantial anatomical variability of the SN in the Lithuanian population. The findings suggest a correlation between SN diameter and formation type, which may have clinical implications for nerve grafting and surgical planning. The predominance of Type 3 formation and the observed symmetry rate provide valuable anatomical insights for lower limb surgeries. Further large-scale studies are necessary to establish population-specific SN variations and their relevance in clinical practice. Full article

Background: Ankle fractures are among the most common injuries requiring surgical intervention. Standard radiographs are typically used for postoperative assessment; however, some patients continue to experience residual symptoms despite satisfactory radiographic outcomes. Weight-bearing computed tomography (WBCT), though not yet widely integrated into clinical practice, offers potential advantages in evaluating lower-limb deformities, injuries, and arthritis. This study explores the utility of WBCT for the midterm assessment following ankle fracture fixation and compares its findings with those obtained from standard radiographs. Methods: In this retrospective case study, we analyzed the correlations between the functional outcome scores approximately one year post-surgery and parameters assessed using WBCT. Pearson’s correlation coefficient was used to evaluate these correlations, and a t-test was performed to assess their statistical significance, with a threshold p-value of 0.05. Additionally, Spearman’s rank correlation coefficient was calculated as a supplementary descriptive measure, without significance testing. These correlations were then compared with those obtained from standard ankle radiographic views (anteroposterior, lateral, and mortise). Results: Several correlations were identified between WBCT parameters and functional scales, with certain parameters demonstrating high statistical significance (p < 0.05). Overall, the correlations observed for WBCT were stronger than those for standard radiographs. Conclusions: Although the study cohort was limited, the findings suggest that WBCT may provide additional insights beyond conventional radiography. Further research with larger patient groups is needed to establish its clinical relevance. Full article

Background: Arthroscopic deltoid ligament (DL) repair is a recently introduced technique, with few studies currently comparing the outcomes of open and arthroscopic deltoid repairs. This study compares the clinical and radiologic outcomes of patients who underwent either open or arthroscopic DL repair. Methods: Forty-one patients underwent surgical repair for a ruptured DL by a single surgeon at the study site hospital between 2013 and 2022. Clinical outcomes were assessed using the Foot and Ankle Outcome Score (FAOS), the American Orthopedic Foot and Ankle Society (AOFAS) Ankle–Hindfoot Scale, and a visual analog scale (VAS). Radiologic outcomes were evaluated through anterior talar translation and talar tilt tests, with stress radiography conducted at 6 months and 1 year post-surgery. Results: No significant differences in sex ratio, age, or direction of injury were observed between the groups. Additionally, there were no significant differences in clinical and radiologic outcomes between the groups. However, both clinical and radiologic outcomes showed significant improvement after surgery compared to preoperative conditions in both groups. Conclusions: Considering the benefits of arthroscopic surgery, arthroscopic deltoid repair can be regarded as a suitable option for treating DL injuries. Full article

Background: Intra-articular calcaneal fracture (CF) treatment is associated with a high risk of complications, but closed reduction and internal fixation (CRIF) is a minimally invasive alternative for treatment. Methods: Forty-eight patients treated with CRIF and CALCAnail^® due to intra-articular CF between 2016 and 2021 were analyzed to check union time, complication rate, and functionality after the intervention. Functional and pain outcomes were assessed, including the Maryland Foot Score (MFS), American Orthopedic Foot & Ankle Society (AOFAS) scale questionnaires, and the numerical pain scale (NRS) at mid-term follow-ups 2–5 years after the intervention. Results: Intervention increased median Böhler’s angle from 21.5° to 32° (p < 0.01). The median bone union time was 12 weeks. The risk of malunion was higher in patients with Sanders type 4 (RR = 2.28; 95% CI 1.11–4.72) and those operated on later than the 2nd day after injury (RR = 2.1; 95% CI 1.08–4.09). Patients with at least one of the comorbidities (nicotinism, diabetes, obesity) had a higher risk of intensive pain (NRS > 3) 2–5 years after surgery (RR = 1.69; 95% CI 1.06–2.68), and 84% were satisfied with their treatment. Other complications included complex regional pain syndrome in two patients (4%), malunion in three (6%), and surgical site infection in two (4%). The MFS had a median score of 85 points, while that of the AOFAS was 82 points. Conclusions: CRIF, with the use of the CALCAnail^® implant, allows doctors to restore anatomical relationships around the subtalar joint, resulting in good clinical and functional results. Full article

Background/Objectives: Surgical management of chronic lateral ankle instability has traditionally been performed using an open technique. Arthroscopic-assisted and all-arthroscopic techniques have gained popularity as they have achieved strong clinical outcomes. However, they rely on the surgeon’s arthroscopic skills and familiarity with arthroscopic anatomy. Recently, a minimally invasive percutaneous technique without arthroscopic assistance has been developed that incorporates the benefits of arthroscopy, such as minimal soft tissue disruption, without the additional requirements of performing an arthroscopic technique. The aim of the current study is to describe the minimally invasive percutaneous technique for chronic lateral ankle instability and report on its clinical outcomes. Methods: Fifty-four consecutive patients without intra-articular ankle pathology underwent lateral ligament repair for chronic ankle instability with a percutaneous technique at a single institution by a fellowship-trained foot and ankle surgeon. Foot Function Index (FFI) score was recorded pre-operatively and post-operatively at final follow-up. All patients had a minimum follow-up of 12 months. Post-operative complications and patient satisfaction were also recorded. Results: A significant improvement (p < 0.001) in FFI compared to pre-operative values (from 55, SD 4.1, to 10, SD 1.9) was observed. A single patient required a return to the operating room for open revision with allograft reconstruction following a fall 2.5 months post-operatively. There were no other complications including infection or nerve injury. The overall rate of satisfaction after surgery was 98.1%, with one patient dissatisfied due to excessive ankle stiffness. Conclusions: The described minimally invasive percutaneous Brostrom procedure is safe and effective for the treatment of chronic lateral ankle instability without intra-articular ankle pathology. Full article

Background/Objectives: An early accelerated rehabilitation is generally recommended after surgery for acute Achilles tendon ruptures (ATRs). The modified side-locking loop suture (MSLLS) is a surgical technique that provides high tensile strength to the repaired Achilles tendon and allows for a safe, early accelerated rehabilitation protocol without requiring postoperative immobilization. However, there are no reports investigating the clinical outcomes of the MSLLS technique with early accelerated rehabilitation for ATRs. To clarify the effectiveness of the MSLLS technique with an early accelerated rehabilitation protocol for ATR in athletes. Methods: We retrospectively analyzed 27 athletes (Tegner activity score ≥ 6) who underwent surgical treatment using the MSLLS technique for ATR between April 2017 and August 2022. All patients underwent an early accelerated rehabilitation protocol without immobilization. Outcome measures included the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score taken preoperatively and one year postoperatively, the time required to perform 20 continuous double-leg heel raises (DHR) and single-leg heel raises (SHR), the time to return to the original sport, and the presence of any complications. Results: The mean AOFAS score significantly improved from 37.2 ± 9.7 preoperatively to 96.3 ± 5.3 one year postoperatively. The mean time to be able to perform 20 continuous DHR and SHR was 7.7 ± 1.2 weeks and 11.3 ± 1.6 weeks, respectively. All patients were able to return to their original sport at their pre-injury level in an average of 22.7 ± 3.7 weeks without complication. Conclusions: The MSLLS technique in conjunction with an early accelerated rehabilitation protocol for ATR in athletes produced satisfactory results, with all patients able to return to their original sport at their preinjury level without complication. Full article

Background: This study aimed to evaluate post-operative lower limb function following second-generation mechanically aligned medial pivot (MP) TKA implantation. Standard gait analysis was performed to collect kinematic and kinetic data, which were then compared with physiological data from the literature obtained using the same evaluation methodology as the present study. The hypothesis was that this TKA would not fully restore normal knee and adjacent joint motion during walking. Methods: Our cohort comprised 15 patients consecutively enrolled from September 2019 to December 2022 who underwent primary TKA with the second-generation MP Evolution Knee System (MicroPort Orthopaedics Inc., Arlington, TN, USA). Pre-operatively and 6 months post-surgery, gait analysis during level walking was performed on all patients, as well as clinical evaluations using the Knee Society Score (KSS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Visual Analogue Scale (VAS). Results: The clinical scores improved significantly (p < 0.001) after surgery (pre-/post-operative KSS functional, KSS clinical, VAS, and KOOS: 51.7 ± 17.3/84 ± 18.4, 45.3 ± 16.2/74.1 ± 12.6, 6.9 ± 1.8/2.0 ± 1.9, and 33.9 ± 11.8/69.1 ± 16.5, respectively). The statistical parametric mapping (SPM) analysis between the post-operative and reference control data revealed significant differences in the initial and final 20% of the gait cycle for the rotation of the knee in the frontal and transverse planes and for the rotation of the ankle in the sagittal plane. Conclusions: This study shows that new-generation MP TKA with mechanical alignment does not fully restore normal gait biomechanics, particularly in knee rotational movements, indicating a need for improved surgical techniques and prosthetic designs. Full article

Background: Up to 75% of calcaneal fractures are intra-articular fractures, which may severely impair foot function and lead to disability. Methods: We retrospectively analyzed 21 patients with intra-articular calcaneal fractures who had been treated with the Ilizarov method in the period 2021–2022. The mean patient age was 47 years (range 25–67 years). We analyzed the following functional parameters: foot function with a revised foot function index (FFI-R) questionnaire and the level of physical activity, with the University of California Los Angeles (UCLA) activity scale, a visual analog scale (VAS), and a Grimby physical activity level scale; and ankle range of motion. Results: We observed a significant improvement in the UCLA activity scores and Grimby activity score at long-term follow-up. Functional outcomes based on the FFI-R questionnaires showed an improvement, from 292 points prior to surgery to 127 points at follow-up, p = 0.013. The post-treatment follow-up measurements revealed a median dorsiflexion at the treated ankle joint of 20 degrees, whereas that at the intact ankle was 40 degrees, p = 0.007. The plantar flexion showed asymmetry, with a median 15 degrees at the treated ankle and 30 degrees at the intact ankle, p = 0.007. The median range of inversion at the ankle joint was 5 degrees in the treated limb and 15 degrees in the intact limb, p = 0.039. Conclusions: Patients with calcaneal fractures treated with the Ilizarov method are recommended to have a longer and more intensive rehabilitation. The range of ankle motion in the treated limb was limited in comparison with that in the intact limb; however, this did not greatly affect the patients’ return to their earlier, pre-injury level of physical activity. Full article

Background and Objectives: Lateral ankle injuries are commonly encountered injuries, and the open modified Broström operation (OMBO) is the primary treatment option. Recently, an arthroscopic modification of the Broström operation (AMBO) was developed; many studies have shown that there are no significant differences in clinical and radiological outcomes between the two surgical methods. However, no studies have been conducted comparing the two surgical methods in terms of return to play (RTP) time. This study assesses the time to RTP and the functional clinical outcomes. Materials and Methods: Sixty patients were enrolled from January 2012 to July 2014. They were segregated into two cohorts: the AMBO group comprised 30 patients, while the OMBO group comprised another 30 patients. Each participant underwent standardized treatment and rehabilitation regimens and RTP time was measured using seven questions that explored the times to return of painless walking, running, jumping, squatting, climbing stairs, and rising up on the heels and toes. We compared the time intervals from the onset of instability to the date of surgery. Clinical outcomes were evaluated before the surgery, 6 weeks after surgery, and 6 months after surgery. The assessments included the American Orthopedic Foot & Ankle Society (AOFAS) ankle–hindfoot score, the pain visual analog scale (VAS) score, subjective satisfaction with rehabilitation, and activity level. Results: In terms of RTP, AMBO was associated with a shorter interval to walking without pain (7.07 ± 2.96 weeks) relative to OMBO (11.03 ± 8.58 weeks). No disparities were observed in the time to return to play (RTP) between OMBO and AMBO. While there were no discrepancies in the 6-month postoperative AOFAS or VAS scores, the 6-week postoperative VAS score was notably lower in the AMBO group compared to the OMBO group. AMBO provided a faster RTP in terms of two of the seven questions in a group exhibiting high-level physical activity. The rate of subjective satisfaction with rehabilitation was higher for AMBO than for OMBO. Conclusions: Aside from walking, the duration to return to play and the clinical outcomes were similar between AMBO and OMBO treatments for lateral ankle instability. AMBO is a good treatment option and should be carefully considered for athletes with lateral ankle instability. AMBO demonstrated positive outcomes in a group with higher activity levels compared to others, particularly in terms of time to RTP, subjective satisfaction, and postoperative pain. Full article

Background: Wagstaffe fracture constitutes an indirect injury to the AITFL and can precipitate syndesmotic instability. The prevailing fixation methods often involve the use of mini-screws or K-wires, with absorbable suture repair reserved for cases with small or comminuted fragments exhibiting instability. In this study, we devised a mini-plate fixation method capable of securing the fracture fragment irrespective of its size or condition. Methods: A retrospective chart review was conducted on patients who underwent surgery for ankle fractures between May 2022 and October 2023. The surgical technique involved direct fixation of the Wagstaffe fracture using mini-plate fixation. Radiologic evaluation was performed using postoperative CT images, and clinical outcomes were assessed using the OMAS and VAS. Results: Fourteen patients with an average age of 62.5 years were included. Most fractures were associated with the supination-external rotation type. The average preoperative OMAS significantly improved from 5.95 to 83.57 postoperatively. The average VAS score decreased from 7.95 preoperatively to 0.19 postoperatively. Conclusions: The mini-plate technique for Wagstaffe fractures exhibited dependable fixation strength, effective fracture reduction, a minimal complication rate, and judicious surgical procedure duration. Full article