Novel Radiographic Indexes for Elbow Stability Assessment: Part B—Preliminary Clinical Study

Abstract Introduction The coronoid process plays a key-role in preserving elbow stability. Currently, there are no radiographic indexes conceived to assess the intrinsic elbow stability and the joint congruency. The aim of this study is to present new radiological parameters, which will help assess the intrinsic stability of the ulnohumeral joint and to define normal values of these indexes in a normal, healthy population. Methods Four independent observers (two orthopaedic surgeons and two radiologists) selected lateral view X-rays of subjects with no history of upper limb disease or surgery. The following radiographic indexes were defined: trochlear depth index (TDI); anterior coverage index (ACI); posterior coverage index (PCI); olecranon–coronoid angle (OCA); radiographic coverage angle (RCA). Inter-observer and intra-observer reproducibility were assessed for each index. Results 126 subjects were included. Standardized lateral elbow radiographs (62 left and 64 right elbows) were obtained and analysed. The mean TDI was 0.46 ± 0.06 (0.3–1.6), the mean ACI was 2.0 ± 0.2 (1.6–3.1) and the mean PCI was 1.3 ± 0.1 (1.0–1.9). The mean RCA was 179.6 ± 8.3° (normalized RCA: 49.9 ± 2.3%) and the mean OCA was 24.6 ± 3.7°. The indexes had a high-grade of inter-observer and intra-observer reliability for each of the four observers. Significantly higher values were found for males for TDI, ACI, PCI and RCA. Conclusion The novel radiological parameters described are simple, reliable and easily reproducible. These features make them a promising tool for radiographic evaluation both for orthopaedic surgeons and for radiologists in the emergency department setting or during outpatient services. Level of evidence Basic Science Study (Case Series). Clinical relevance The novel radiological parameters described are reliable, easily reproducible and become handy for orthopaedic surgeons as well as radiologists in daily clinical practice.

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Arthroscopic-Guided Balloon Tibioplasty in Schatzker III Tibial Plateau Fracture

Joints ◽

10.1055/s-0039-1697607 ◽

2018 ◽

Vol 06 (04) ◽

pp. 220-227 ◽

Cited By ~ 1

Author(s):

Fabrizio Cuzzocrea ◽

Eugenio Jannelli ◽

Alessandro Ivone ◽

Simone Perelli ◽

Alberto Fioruzzi ◽

...

Keyword(s):

Ct Scan ◽

Tibial Plateau ◽

Case Series ◽

Clinical Score ◽

Joint Surface ◽

X Rays ◽

Level Of Evidence ◽

Significant Difference ◽

The Mean

Abstract Purpose The study aims to present the results at a mean 28-months follow-up of arthroscopic-guided balloon tibioplasty and to spot some technical tricks and some practice using tools and materials. Methods The study relates to six patients with tibial plateau fractures type Schatzker III with tibial plateau depression more than 4 mm at preoperative computed tomography scan (CT-scan). The follow-up period ranged from 22 to 33 months, with a mean of 28 months. No patients were lost to follow-up. The patients were evaluated clinically using the Rasmussen score system and Lysholm score systems at 6 to 12 and 24 months, postoperatively. Radiographic evaluations (standard X-rays) were done preoperatively at 1, 3, and 12 months postoperatively while a CT-scan with 3D reconstruction was performed preoperatively, at the first day and 6 months, postoperatively. Results The mean Rasmussen clinical score at 6 months postoperatively was 26.3 while at 1-year postoperatively the mean Rasmussen clinical score was 28.33. At 2-year postoperatively the mean Rasmussen clinical score was 28.83. Statistically significant difference was found in 6-months and 2-years results (p < 0.05). CT-scan achieved the first postoperative day showed the recovery of approximately 70% of the area of the interested tibial plateau, restoring of the joint surface without articular bone free fragments. Conclusion The described surgical procedure, if correctly performed with proper indications (Schatzker III), respect the principles mentioned above and the clinical and radiological results confirm our purpose. Level of Evidence This is a therapeutic case series, level IV study.

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Radiographic evaluation of the tibiotarsal joint in patients with ipsilateral triple arthrodesis

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.897 ◽

2019 ◽

Vol 13 (1) ◽

pp. 35-41

Author(s):

Bruno De Carvalho Marques ◽

Isnar Moreira Castro Junior

Keyword(s):

Initial Period ◽

Case Series ◽

Onset Time ◽

Radiographic Evaluation ◽

Triple Arthrodesis ◽

Level Of Evidence ◽

Radiographic Findings ◽

Evolution Time ◽

Kellgren And Lawrence ◽

The Mean

Objective: This study radiographically evaluated the tibiotarsal joints of patients receiving ipsilateral triple arthrodesis and analyzed the effects of this procedure over the short and medium terms. Methods: A total of 150 triple arthrodesis procedures were performed between 2010 and 2015, and 56 patients (62 operated feet) participated in this study. The ankles were radiographically evaluated at the following time points: the initial or preoperative period, 1 year after the operation, and 3 to 5 years after the operation. The presence of arthrosis according to the Kellgren and Lawrence (K&L) scale and the onset time of secondary arthrosis worsening were observed. Results: During the initial period, 31 ankles (50%) presented with no clear signs of arthrosis. Tibiotarsal arthrosis presented with a worsening of 1 degree in 13 ankles 1 year after surgery (28.3%). Three to 5 years after surgery, a 1-degree worsening of 21 ankles (55.2%) was observed; 15.8% (n=6) of the ankles had a worsening of arthrosis greater than or equal to 2 degrees; and 11 ankles (29%) had no worsening or onset of tibiotarsal arthrosis. The worsening or onset of tibiotarsal arthrosis occurred an average of 22 months after the procedure. The mean postoperative evolution time was 32.4 months for those who presented with an arthrosis worsening of only 1 degree. Those who presented with a worsening of tibiotarsal arthrosis of 2 or more degrees had an average postoperative evolution time of 43.7 months. Conclusion: Radiographic findings strengthen the concept of arthrosis formation following triple arthrodesis in the tibiotarsal joint, even over the short and medium terms. Level of Evidence IV; Therapeutic Studies; Case Series.

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Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121994550 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712199455

Author(s):

Nicola Maffulli ◽

Francesco Oliva ◽

Gayle D. Maffulli ◽

Filippo Migliorini

Keyword(s):

Surgical Management ◽

Revision Surgery ◽

Case Series ◽

Sports Participation ◽

Patellar Tendinopathy ◽

Symptom Duration ◽

Level Of Evidence ◽

Training Time ◽

The Mean

Background: Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms. Purpose: To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded. Results: The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points ( P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure. Conclusion: Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.

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A Novel Retensioning Technique for Arthroscopic Repair of PASTA Lesions: A Clinical and Radiologic Outcome Study of 24 Shoulders

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120986884 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712098688

Author(s):

Su Cheol Kim ◽

Jong Ho Jung ◽

Sang Min Lee ◽

Jae Chul Yoo

Keyword(s):

Constant Score ◽

Case Series ◽

Tendon Healing ◽

Shoulder Abduction ◽

Level Of Evidence ◽

Simple Shoulder Test ◽

Shoulder Range Of Motion ◽

Functional Scores ◽

The Mean

Background: There is no consensus on the ideal treatment for partial articular supraspinatus tendon avulsion (PASTA) lesions without tendon damage. Purpose: To introduce a novel “retensioning technique” for arthroscopic PASTA repair and to assess the clinical and radiologic outcomes of this technique. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was performed on 24 patients whose PASTA lesion was treated using the retensioning technique between January 2011 and December 2015. The mean ± SD patient age was 57.6 ± 7.0 years (range, 43-71 years), and the mean follow-up period was 57.6 ± 23.4 months (range, 24.0-93.7 months). Sutures were placed at the edge of the PASTA lesion, tensioned, and fixed to lateral-row anchors. After surgery, shoulder range of motion (ROM) and functional scores (visual analog scale [VAS] for pain, VAS for function, American Shoulder and Elbow Surgeons [ASES] score, Constant score, Simple Shoulder Test, and Korean Shoulder Score) were evaluated at regular outpatient visits; at 6 months postoperatively, repair integrity was evaluated using magnetic resonance imaging (MRI). Results: At 12 months postoperatively, all ROM variables were improved compared with preoperative values, and shoulder abduction was improved significantly (136.00° vs 107.08°; P = .009). At final follow-up (>24 months), the VAS pain, VAS function, and ASES scores improved, from 6.39, 4.26, and 40.09 to 1.00, 8.26, and 85.96, respectively (all P < .001). At 6 months postoperatively, 21 of the 24 patients (87.5%) underwent follow-up MRI; the postoperative repair integrity was Sugaya type 1 or 2 for all of these patients, and 13 patients showed complete improvement of the lesion compared with preoperatively. Conclusion: The retensioning technique showed improved ROM and pain and functional scores as well as good tendon healing on MRI scans at 6-month follow-up in the majority of patients. Thus, the retensioning technique appears to be reliable procedure for the PASTA lesion.

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Loss of Correction After Chevron Osteotomy for Hallux Valgus as a Function of Preoperative Deformity

Foot & Ankle International ◽

10.1177/1071100718807699 ◽

2018 ◽

Vol 40 (3) ◽

pp. 287-296 ◽

Cited By ~ 8

Author(s):

Gerhard Kaufmann ◽

Stefanie Sinz ◽

Johannes M. Giesinger ◽

Matthias Braito ◽

Rainer Biedermann ◽

...

Keyword(s):

Hallux Valgus ◽

Case Series ◽

X Rays ◽

Retrospective Case ◽

Level Of Evidence ◽

Loss Of Correction ◽

Chevron Osteotomy ◽

Significant Correction ◽

Preoperative Deformity

Background: Recurrence is relatively common after surgical correction of hallux valgus. Multiple factors are discussed that could have an influence in the loss of correction. The aim of this study was to determine preoperative radiological factors with an influence on loss of correction after distal chevron osteotomy for hallux valgus. Methods: Five hundred twenty-four patients who underwent the correction of a hallux valgus by means of distal chevron osteotomy at our institution between 2002 and 2012 were included. We assessed weightbearing x-rays at 4 time points: preoperatively, postoperatively, and after 6 weeks and 3 months. We investigated the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), joint congruity, and the position of the sesamoids. Results: At all points of the survey, significant correction of the IMA and HVA was detected. The IMA improved from 12.9 (± 2.8) to 4.5 (± 2.4) degrees and the HVA from 27.5 (± 6.9) to 9.1 (± 5.3) degrees. Loss of correction was found in both HVA and IMA during follow-up with a mean of 4.5 and 1.9 degrees, respectively. Loss of correction showed a linear correlation with preoperative IMA and HVA, and a correlation between preoperative DMAA and sesamoid position. Conclusion: The chevron osteotomy showed significant correction for HVA, IMA, and DMAA. Preoperative deformity, in terms of IMA, HVA, DMAA, and sesamoid position, correlated with the loss of correction and could be assessed preoperatively for HVA and IMA. Loss of correction at 3 months persisted during the follow-up period. Level of Evidence: Level IV, retrospective case series.

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Prospective, Multicenter, Clinical and Radiographic Evaluation of a Biointegrative, Fiber-Reinforced Implant for Proximal Interphalangeal Joint Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011420966311 ◽

2020 ◽

Vol 5 (4) ◽

pp. 247301142096631

Author(s):

Luke D. Cicchinelli ◽

Jurij Štalc ◽

Martinus Richter ◽

Stuart Miller

Keyword(s):

Adverse Events ◽

Prospective Trial ◽

Case Series ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Radiographic Evaluation ◽

Fiber Reinforced ◽

Level Of Evidence ◽

Surgery Patient ◽

Patient Reported

Background: A novel biointegrative implant was developed for proximal interphalangeal joint (PIPJ) arthrodesis to treat hammertoe deformity. Composed of continuous reinforcing mineral fibers bound by bioabsorbable polymer matrix, the implant demonstrated quiescent, gradual degradation with complete elimination at 104 weeks in animal models. This prospective trial assessed the implant’s safety, clinical performance, and fusion rate of PIPJ arthrodesis for hammertoe correction. Methods: Twenty-five patients (mean age 63.9±7.5 years) who required PIPJ arthrodesis were enrolled at 3 centers. Outcomes included radiographic joint fusion, adverse events, pain visual analog scale (VAS) score, Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) score, and patient satisfaction. Patients were evaluated 2, 4, 6, 12, and 26 weeks postoperatively. Results: Twenty-two patients (88%) achieved radiographic fusion at 26 weeks. All joints (100%) were considered clinically stable, with no complications or serious adverse events. Pain VAS improved from 5.3±2.5 preoperatively to 0.5±1.4 at 26 weeks postoperatively. FAAM-ADL total scores and level of functioning improved by mean 19.5±19.0 points and 24.4±15.7 percentage points, respectively, from preoperation to 26 weeks postoperation. Improvements in pain VAS and FAAM scores surpassed established minimal clinically important differences. All patients were very satisfied (84%) or satisfied (16%) with the surgery. Patient-reported postoperative results greatly exceeded (72%), exceeded (20%), or matched (8%) expectations. Conclusion: This prospective, multicenter, first-in-human clinical trial of a novel biointegrative fiber-reinforced implant in PIPJ arthrodesis of hammertoe deformity demonstrated a favorable rate of radiographic fusion at 12 and 26 weeks, with no complications and good patient-reported clinical outcomes. Level of Evidence: Level IV, prospective case series.

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Postarthroscopy Imaging in Femoroacetabular Impingement: Persistent Pain May Be Due to an Insufficient Correction of Preoperative Abnormalities

Joints ◽

10.1055/s-0037-1601411 ◽

2017 ◽

Vol 05 (01) ◽

pp. 021-026 ◽

Cited By ~ 1

Author(s):

Cosimo Tudisco ◽

Salvatore Bisicchia ◽

Sandro Tormenta ◽

Amedeo Taglieri ◽

Ezio Fanucci

Keyword(s):

Case Series ◽

Persistent Pain ◽

Retrospective Case ◽

Level Of Evidence ◽

Mean Values ◽

Center Edge ◽

Patient Groups ◽

The Mean ◽

Magnetic Resonance Imaging Mri

Purpose The purpose of this study was to evaluate the effect of correction of abnormal radiographic parameters on postoperative pain in a group of patients treated arthroscopically for femoracetabular impingement (FAI). Methods A retrospective study was performed on 23 patients affected by mixed-type FAI and treated arthroscopically. There were 11 males and 12 females with a mean age of 46.5 (range: 28–67) years. Center-edge (CE) and α angles were measured on preoperative and postoperative radiographic and magnetic resonance imaging (MRI) studies and were correlated with persistent pain at follow-up. Results The mean preoperative CE and α angles were 38.6 ± 5.2 and 67.3 ± 7.2 degrees, respectively. At follow-up, in the 17 pain-free patients, the mean pre- and postoperative CE angle were 38.1 ± 5.6 and 32.6 ± 4.8 degrees, respectively, whereas the mean pre- and postoperative α angles at MRI were 66.3 ± 7.9 and 47.9 ± 8.9 degrees, respectively. In six patients with persistent hip pain, the mean pre- and postoperative CE angles were 39.8 ± 3.6 and 35.8 ± 3.1 degrees, respectively, whereas the mean pre- and postoperative α angles were 70.0 ± 3.9 and 58.8 ± 2.6 degrees, respectively. Mean values of all the analyzed radiological parameters, except CE angle in patients with pain, improved significantly after surgery. On comparing patient groups, significantly lower postoperative α angles and lower CE angle were observed in patients without pain. Conclusion In case of persistent pain after arthroscopic treatment of FAI, a new set of imaging studies must be performed because pain may be related to an insufficient correction of preoperative radiographic abnormalities. Level of Evidence Level IV, retrospective case series.

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Minimally Invasive Double-Button Fixation of Displaced Lateral Clavicular Fractures in Athletes

The American Journal of Sports Medicine ◽

10.1177/0363546516666816 ◽

2016 ◽

Vol 45 (2) ◽

pp. 462-467 ◽

Cited By ~ 6

Author(s):

Maximiliano Ranalletta ◽

Luciano A. Rossi ◽

Hugo Barros ◽

Francisco Nally ◽

Ignacio Tanoira ◽

...

Keyword(s):

Minimally Invasive ◽

Closed Reduction ◽

Functional Outcomes ◽

Constant Score ◽

Case Series ◽

Return To Sport ◽

Return To Play ◽

Short Version ◽

Level Of Evidence ◽

The Mean

Background: Early union and a rapid return to prior function are the priorities for young athletes with lateral clavicular fractures. Furthermore, it is essential to avoid nonunion in this subgroup of patients, as this is frequently associated with persistent pain, restriction of movement, and loss of strength and endurance of the shoulder. Purpose: To analyze the time to return to sport, functional outcomes, and complications in a group of athletes with displaced lateral clavicular fractures treated using closed reduction and minimally invasive double-button fixation. Study Design: Case series; Level of evidence, 4. Methods: A total of 21 athletes with displaced lateral clavicular fractures were treated with closed reduction and minimally invasive double-button fixation between March 2008 and October 2013. Patients completed a questionnaire focused on the time to return to sport and treatment course. Functional outcomes were assessed with the Constant score and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Pain was evaluated with the visual analog scale (VAS). Radiographs were reviewed to identify radiographic union, malunion, and nonunion. Results: Of the 21 study patients, 20 returned to sport after treatment; 100% returned to the same level. The mean time to return to play was 78 days (range, 41-120 days). Four patients (20%) returned to sport less than 6 weeks after surgery, 14 (70%) returned between 6 and 12 weeks after surgery, and 2 (10%) returned after 12 weeks. The mean Constant score was 89.1 ± 4.2 (range, 79-100), the mean QuickDASH score was 0.4 ± 2.6 (range, 0-7.1), and the mean VAS pain score was 0.4 ± 1.0 (range, 0-3) at final follow-up (mean, 41 months). The only complication was asymptomatic nonunion. Hardware removal was not necessary in any patient. Conclusion: Closed reduction and minimally invasive double-button fixation of displaced lateral clavicular fractures in athletes was successful in terms of returning to the previous level of athletic activity regardless of the type of sport, with excellent clinical results and a low rate of complications.

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Is Allograft Reconstruction of the Medial Ulnar Collateral Ligament of the Elbow a Viable Option for Nonelite Athletes? Outcomes at a Mean of 8 Years

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120959141 ◽

2020 ◽

Vol 8 (10) ◽

pp. 232596712095914

Author(s):

Justin C. Kennon ◽

Erick M. Marigi ◽

Chad E. Songy ◽

Chris Bernard ◽

Shawn W. O’Driscoll ◽

...

Keyword(s):

Clinical Outcomes ◽

Case Series ◽

Ulnar Collateral Ligament ◽

Ulnar Neuropathy ◽

Complication Rates ◽

Collateral Ligament ◽

Level Of Evidence ◽

Functional Scores ◽

The Mean

Background: The rate of elbow medial ulnar collateral ligament (MUCL) injury and surgery continues to rise steadily. While authors have failed to reach a consensus on the optimal graft or anchor configuration for MUCL reconstruction, the vast majority of the literature is focused on the young, elite athlete population utilizing autograft. These studies may not be as applicable for the “weekend warrior” type of patient or for young kids playing on high school leagues or recreationally without the intent or aspiration to participate at an elite level. Purpose: To investigate the clinical outcomes and complication rates of MUCL reconstruction utilizing only allograft sources in nonelite athletes. Study Design: Case series; Level of evidence, 4. Methods: Patient records were retrospectively analyzed for individuals who underwent allograft MUCL reconstruction at a single institution between 2000 and 2016. A total of 25 patients met inclusion criteria as laborers or nonelite (not collegiate or professional) athletes with a minimum of 2 years of postoperative follow-up. A review of the medical records for the included patients was performed to determine survivorship free of reoperation, complications, and clinical outcomes with use of the Summary Outcome Determination (SOD) and Timmerman-Andrews scores. Statistical analysis included a Wilcoxon rank-sum test to compare continuous variables between groups with an alpha level set at .05 for significance. Subgroup analysis included comparing outcome scores based on the allograft type used. Results: Twenty-five patients met all inclusion and exclusion criteria. The mean time to follow-up was 91 months (range, 25-195 months), and the mean age at the time of surgery was 25 years (range, 12-65 years). There were no revision operations for recurrent instability. The mean SOD score was 9 (range, 5-10) at the most recent follow-up, and the Timmerman-Andrews scores averaged 97 (range, 80-100). Three patients underwent subsequent surgical procedures for ulnar neuropathy (n = 2) and contracture (n = 1), and 1 patient underwent surgical intervention for combined ulnar neuropathy and contracture. Conclusion: Allograft MUCL reconstruction in nonelite athletes demonstrates comparable functional scores with many previously reported autograft outcomes in elite athletes. These results may be informative for elbow surgeons who wish to avoid autograft morbidity in common laborers and nonelite athletes with MUCL incompetency.

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Clinical and functional outcomes of tarsal coalition resection to correct rigid flat foot

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2021.v15.1537 ◽

2021 ◽

Vol 15 (2) ◽

pp. 115-119

Author(s):

Rodrigo Guimarães Huyer ◽

Mário Sérgio Paulillo Cillo ◽

Carlos Daniel Cândido Castro Filho ◽

Hallan Douglas Bertelli ◽

Marcelo Morelli Girondo ◽

...

Keyword(s):

Case Series ◽

Categorical Variables ◽

Continuous Variables ◽

Tarsal Coalition ◽

Retrospective Case ◽

Aofas Score ◽

Level Of Evidence ◽

Flat Foot ◽

Flat Feet ◽

The Mean

Objective: This study used the AOFAS score to assess the clinical functional results of patients who underwent tarsal coalition resection. Methods: This was a retrospective case series of patients who underwent tarsal coalition resection to correct rigid flat foot. Clinical and functional assessment was performed with the AOFAS score before and 6 months after surgical treatment. Descriptive analysis was performed for 7 patients (11 operated feet) using measurements of position and dispersion (mean, standard deviation, minimum, median and maximum value) for continuous variables and frequency tables (absolute and relative) for categorical variables. Results: The mean patient age was 10 years, 7 months, and the majority (71.43%) were male. The most affected joint was the calcaneonavicular. The right side was affected in 54.55% of the cases. The most frequent type of coalition was osseous (81.82% of the cases). The mean pre- and postoperative AOFAS scores were 32.7 and 70.2 points, respectively, which was a significant increase. Conclusion: The increased scores after coalition resection was considered the main change between the two assessments. Thus, it can be concluded that in rigid flat feet without severe hind- or forefoot deformities for which conservative treatment failed, bar resection should be the surgical procedure of choice. Level of Evidence IV; Therapeutic Studies; Case Series.

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