Snowboarder's Talus Fracture

2005 ◽  
Vol 33 (6) ◽  
pp. 871-880 ◽  
Author(s):  
Victor Valderrabano ◽  
Thomas Perren ◽  
Christian Ryf ◽  
Paavo Rillmann ◽  
Beat Hintermann
Keyword(s):  
Surgical Treatment ◽  
Subtalar Joint ◽  
External Rotation ◽  
Sport Activity ◽  
Treatment Algorithm ◽  
Activity Level ◽  
Talus Fracture ◽  
Level Of Evidence ◽  
Lateral Process

Background Fracture of the lateral process of the talus is a typical snowboarding injury. Basic data are limited, particularly with respect to treatment and outcome. Hypothesis As the axial-loaded dorsiflexed foot becomes externally rotated and/or everted, fracture of the lateral process of the talus occurs. Primary surgical treatment may improve the outcome of this injury, reducing the risk of secondary subtalar joint osteoarthritis. Study Design Cohort study; Level of evidence, 2. Methods We recorded details of the treatment and evaluation of 20 patients (8 female and 12 male; age at trauma, 29 years [range, 17-48 years]) who sustained a lateral process of the talus fracture while snowboarding. The injury pathomechanism was documented. The patients were treated either nonsurgically or surgically based on a fracture-type treatment algorithm. The evaluation at most recent follow-up (mean, 42 months [range, 26-53 months]) included clinical and functional examination, follow-up of sport activity, and radiological assessment (radiograph, computed tomography scan). Results The injury mechanism included axial impact (100%), dorsiflexion (95%), external rotation (80%), and eversion (45%). Using the American Orthopaedic Foot and Ankle Society hindfoot score, the patients obtained a mean of 93 points; the surgically treated group (n = 14) scored higher (97 points) than did the nonoperative group (n = 6; 85 points) (P <. 05). Degenerative disease of the subtalar joint was found in 3 patients (15%; operative, 1 patient; nonoperative, 2 patients). All but 4 (20%, all after nonsurgical treatment) patients reached the same sport activity level as before injury. Conclusion The snowboarding-related lateral process of the talus fracture represents a complex hindfoot injury. In type II fractures, primary surgical treatment has led to achieving better outcomes, reducing sequelae, and allowing patients to regain the same sports activity level as before injury.

Anterior Cruciate Ligament Reconstruction versus Nonoperative Treatment: Better Function and Less Secondary Meniscectomies But No Difference in Knee Osteoarthritis—A Meta-Analysis

Cartilage ◽  
2021 ◽  
Vol 13 (1_suppl) ◽  
pp. 1658S-1670S
Author(s):  
Marco Cuzzolin ◽  
Davide Previtali ◽  
Stefano Zaffagnini ◽  
Luca Deabate ◽  
Christian Candrian ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Nonoperative Treatment ◽  
Activity Level ◽  
Level Of Evidence ◽  
Knee Oa ◽  
Anterior Cruciate ◽  
The Impact

Objectives The impact of anterior cruciate ligament (ACL) reconstruction on knee osteoarthritis (OA) is still unclear. The aim of the current meta-analysis was to compare surgical treatment versus nonoperative management of ACL tears to assess the impact of these approaches on knee OA development at a 5 and 10 years of follow-up. Design A meta-analysis was performed after a systematic literature search (May 2021) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Both randomized and nonrandomized comparative studies with more than 5 years of follow-up were selected. Influence of the treatment was assessed in terms of knee OA development, subjective and objective clinical results, activity level, and risk of further surgeries. Risk of bias and quality of evidence were assessed following the Cochrane guidelines. Results Twelve studies matched the inclusion criteria, for a total of 1,004 patients. Level of evidence was rated low to very low. No difference was documented in terms of knee OA development, Tegner score, subjective International Knee Documentation Committee (IKDC), and Lysholm scores. A significant difference favoring the surgical treatment in comparison with a nonsurgical approach was observed in terms of objective IKDC score ( P = 0.03) and risk of secondary meniscectomy ( P < 0.0001). The level of evidence was considered very low for subjective IKDC, low for knee OA development, objective IKDC, number of secondary meniscectomies, and Lysholm score, and moderate for post-op Tegner score. Conclusions The meta-analysis did not support an advantage of ACL reconstruction in terms of OA prevention in comparison with a nonoperative treatment. Moreover, no differences were reported for subjective results and activity level at 5 and 10 years of follow-up. On the contrary, patients who underwent surgical treatment of their ACL tear presented important clinical findings in terms of better objective knee function and a lower rate of secondary meniscectomies when compared with conservatively managed patents. Protocol Registration: CRD420191156483 (PROSPERO)

Treatment of Isolated Peroneus Longus Tears and a Review of the Literature

2013 ◽  
Vol 7 (2) ◽  
pp. 113-118 ◽  
Author(s):  
Dariusch Arbab ◽  
Markus Tingart ◽  
Daniel Frank ◽  
Mona Abbara-Czardybon ◽  
Hazibullah Waizy ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Algorithm ◽  
Ankle Pain ◽  
Level Of Evidence ◽  
Peroneus Longus Tendon ◽  
Lateral Ankle ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Tendon Tears

Background. Isolated peroneus longus tendon tears are rare and represent a frequently overlooked source of lateral ankle pain and dysfunction. Only few cases of isolated peroneus longus tendon tears have been reported and a common treatment algorithm does not exist. The purpose of this study was to give an overview of the literature and to present our experience of 6 consecutive cases that have been treated successfully by operation and immobilizing cast. Methods. A comprehensive chart review was performed to compile each patient’s age, sex, onset of symptoms, time between first symptoms and diagnosis, surgical findings, surgical treatment, length of follow-up, and outcome. The average patient age was 48 years (range 20-63 years). Results. Acute tears occurred in 4 cases, and 2 patients reported about a chronic onset of symptoms. The cause for acute tears was an acute inversion ankle sprain in all cases. Diagnosis was made after an average of 11 months (range 0.75-24 months). There were 2 complete tears, and other 4 were incomplete. An os peroneum was present in 2 cases. In 5 of 6 cases, the results after surgical treatment were excellent or good after a mean follow-up of 28.6 months (range 12-78 months). Conclusion. This study indicates that lateral ankle pain may be due to isolated acute or chronic peroneus longus tendon tears. Thorough clinical and radiological diagnosis is necessary to detect this uncommon injury in time. Patients with acute onset of symptoms and short time between symptoms and diagnosis tend to fare better than the chronic tears and delayed diagnosis. Surgical intervention yields successful and predictable results. Level of Evidence: Level III: Retrospective comparative study

Suture Anchor Augmentation for Acute Unstable Isolated Ankle Syndesmosis Disruption in Athletes

2021 ◽  
pp. 107110072110151
Author(s):  
Jin Su Kim ◽  
Hyuck Soo Shin
Keyword(s):  
Suture Anchor ◽  
External Rotation ◽  
Activity Level ◽  
Return To Play ◽  
Level Of Evidence ◽  
Chronic Instability ◽  
Sports Activity ◽  
Tibiofibular Ligament ◽  
Anterior Inferior Tibiofibular Ligament

Background: Isolated ankle syndesmosis disruption (without fibula fracture) causes acute pain and may cause chronic instability and pain. The aim of the present study was to evaluate the outcomes after anterior inferior tibiofibular ligament (AITFL) anatomical fixation using anchor sutures for unstable isolated syndesmosis disruption without fibular fractures. Methods: This study assessed 22 athletes who were diagnosed with unstable isolated syndesmosis disruption with a positive external rotation test, had more than 2-mm diastasis on ultrasound, and had complete AITFL rupture on magnetic resonance imaging between 2004 and 2020. Eighteen patients (82%) were elite-level athletes, and the remaining 4 were recreational athletes. Twelve patients (55%) were injured by an external rotation force. The athletes underwent open anatomical suture anchor fixation between the AITFL attachment sites, the fibula and tibia. The mechanism of injury, return-to-play time, and Foot and Ankle Outcome Score (FAOS) were evaluated. Results: All athletes returned to previous play except 1 retired elite athlete. Twenty-two athletes returned to jogging, team training, and official game play at an average of 62, 89, and 102 days, respectively. The final average follow-up FAOS symptom, pain, daily activity, sports activity, and quality of life scores were 98, 97, 100, 99, and 97, respectively. Two athletes were reinjured, and 1 required reoperation in the follow-up period. Conclusion: Athletes with isolated syndesmosis disruption had a high likelihood to return to their previous activity level after suture anchor augmentation. Level of Evidence: Level IV.

scholarly journals Minimum 10-Year Clinical Outcome of Lateral Collagen Meniscal Implants for the Replacement of Partial Lateral Meniscal Defects: Further Results From a Prospective Multicenter Study

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712199491
Author(s):  
Alberto Grassi ◽  
Gian Andrea Lucidi ◽  
Giuseppe Filardo ◽  
Piero Agostinone ◽  
Luca Macchiarola ◽  
...  
Keyword(s):  
Survival Rate ◽  
Case Series ◽  
Final Analysis ◽  
Activity Level ◽  
Long Term Results ◽  
Level Of Evidence ◽  
Unicompartmental Knee Arthroplasties ◽  
Tegner Score

Background: The collagen meniscal implant (CMI) is a biologic scaffold aimed at replacing partial meniscal defects. The long-term results of lateral meniscal replacement have never been investigated. Purpose: To document the clinical outcomes and failures of lateral CMI implantation for partial lateral meniscal defect at a minimum 10-year follow-up. Study Design: Case series; Level of evidence, 4, Methods: This study included 24 consecutive patients who underwent lateral CMI implantation for partial lateral meniscal defects between April 2006 and September 2009 and who were part of a previous study with a 2-year follow-up. Outcome measures at the latest follow-up included the Lysholm score, Knee injury and Osteoarthritis Outcome Score, visual analog scale (VAS) for pain, Tegner activity level, and EuroQol 5-Dimensions score. Data regarding complications and failures were collected, and patients were asked about their satisfaction with the procedure. Results: Included in the final analysis were 19 patients (16 male, 3 female) with a mean age at surgery of 37.1 ± 12.6 years and a mean follow-up of 12.4 ± 1.5 years (range, 10-14 years). Five failures (26%) were reported: 1 CMI removal because of implant breakage and 4 joint replacements (2 unicompartmental knee arthroplasties and 2 total knee arthroplasties). The implant survival rate was 96% at 2 years, 85% at 5 years, 85% at 10 years, 77% at 12 years, and 64% at 14 years. Lysholm scores at the final follow-up were rated as “excellent” in 36% (5 of 14 nonfailures), “good” in 43% (6 of 14), and “fair” in 21% (3 of 14). The VAS score was 3.1 ± 3.1, with only 16% (3 of 19 patients) reporting that they were pain-free; the median Tegner score was 3 (interquartile range, 2-5). All clinical scores decreased from the 2-year follow-up; however, with the exception of the Tegner score, they remained significantly higher compared with the preoperative status. Overall, 79% of patients were willing to undergo the same procedure. Conclusion: Lateral CMI implantation for partial lateral meniscal defects provided good long-term results, with a 10-year survival rate of 85% and a 14-year survival rate of 64%. At the final follow-up, 58% of the patients had “good” or “excellent” Lysholm scores. However, there was a general decrease in outcome scores between the short- and the long-term follow-up.

Lateral Talar Process Fracture and Peroneal Tendon Dislocation: A Previously Unrecognized Injury Complex

2008 ◽  
Vol 29 (10) ◽  
pp. 1020-1024 ◽  
Author(s):  
Sandra E. Klein ◽  
Kevin E. Varner ◽  
John V. Marymont
Keyword(s):  
Retrospective Chart Review ◽  
High Energy ◽  
Activity Level ◽  
Peroneal Tendon ◽  
Type Ii ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Lateral Process ◽  
Subtalar Arthritis ◽  
Final Followup

Background: Lateral talar process fractures and peroneal tendon dislocations are frequently unrecognized at the time of injury. Lateral process fractures were initially classified by Hawkins as three types. Type II injuries are comminuted fractures involving both the talofibular and talocalcaneal articular surfaces. The purpose of this retrospective chart review was to describe an injury complex of Type II lateral talar process fracture with peroneal tendon dislocation. Materials and Methods: Between January of 1995 and December 2006, 13 patients were seen for a lateral talar process fracture. Patients' charts were reviewed for fracture classification, mechanism of injury, radiographic studies, treatment, secondary procedures, length of followup and return to previous activity level. Concurrent peroneal tendon dislocations were identified in a subset of these patients. Results: Thirteen patients were identified with lateral talar process fractures all of which were classified as a Hawkins Type II. Six patients (46%) had a simultaneous peroneal tendon dislocation. All patients underwent operative excision of the comminuted lateral process. Patients with the injury complex were more likely to undergo additional operative procedures, and were more likely to develop subtalar arthritis. At final followup, 71% of patients with isolated lateral process fractures and 33% of injury complex patients had returned to their previous level of activity Conclusion: An injury complex of Hawkins Type II lateral talar process fractures and peroneal tendon dislocation exists. Patients with comminuted lateral talar process fractures, especially those resulting from high-energy injuries, should be carefully evaluated for the possibility of concurrent peroneal tendon dislocation. Level of Evidence: IV, Retrospective Case Study

Evaluating the Outcomes of Rotator Cuff Repairs With Polytetrafluoroethylene Patches for Massive and Irreparable Rotator Cuff Tears With a Minimum 2-Year Follow-up

2018 ◽  
Vol 46 (13) ◽  
pp. 3155-3164 ◽  
Author(s):  
Vasanth Seker ◽  
Lisa Hackett ◽  
Patrick H. Lam ◽  
George A.C. Murrell
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
External Rotation ◽  
Case Series ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Level Of Evidence ◽  
Irreparable Tear ◽  
Pain At Rest

Background: Massive and irreparable rotator cuff tears are difficult to manage surgically. One technique is to use a synthetic polytetrafluoroethylene (PTFE) patch to bridge the tear. However, there is little information regarding the outcomes of this procedure. Purpose: To determine the ≥2-year outcomes of patients for whom synthetic patches were used as tendon substitutes to bridge irreparable rotator cuff defects. Study Design: Case series; Level of evidence, 4. Methods: This retrospective cohort study used prospectively collected data. Patients included those with a synthetic patch inserted as an interposition graft for large and/or irreparable rotator cuff tears with a minimum 2-year follow-up. Standardized assessment of shoulder pain, function, range of motion, and strength was performed preoperatively, at 6 and 12 weeks, and at 6 months and ≥2 years. Radiograph and ultrasound were performed preoperatively, at 6 months, and ≥2 years. Results: At a mean of 36 months, 58 of 68 eligible patients were followed up, and 53 of 58 (90%) patches remained in situ. Three patches failed at the patch-tendon interface, while 1 patient (2 shoulders/patches) went on to have reverse total shoulder replacements. Patient-ranked shoulder stiffness ( P < .001), frequency of pain with activity and sleep ( P < .0001), level of pain at rest and overhead ( P < .0001), and overall shoulder function improved from bad to very good ( P < .0001) by 6 months. Supraspinatus (mean ± SEM: 29 ± 16 N to 42 ± 13 N) and external rotation (39 ± 13 N to 59 ± 15 N) strength were the most notable increases at the ≥2-year follow-up ( P < .0001). Passive range of motion also improved by 49% to 67%; forward flexion, from 131° to 171°; abduction, from 117° to 161°; external rotation, from 38° to 55°; and internal rotation, from L3 to T10 ( P < .0001) preoperatively to ≥2 years. The most improvement in passive range of motion occurred between 12 months and ≥2 years. The mean (SD) Constant-Murley score was 90 (12), while the American Shoulder and Elbow Surgeons score was 95 (8). Conclusion: At 36 months postoperatively, patients who had synthetic patches used as tendon substitutes to bridge irreparable rotator cuff defects reported less pain and greater overall shoulder function as compared with preoperative assessments. They demonstrated improved range of passive motion and improved strength. The data support the hypothesis that the technique of using a synthetic PTFE patch to bridge a large and/or irreparable tear has good construct integrity and improves patient and clinical outcomes.

scholarly journals Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries

2022 ◽  
Vol 11 (2) ◽  
pp. 331
Author(s):  
Markus Regauer ◽  
Gordon Mackay ◽  
Owen Nelson ◽  
Wolfgang Böcker ◽  
Christian Ehrnthaller
Keyword(s):  
Surgical Treatment ◽  
Systematic Reviews ◽  
Treatment Guidelines ◽  
Screw Fixation ◽  
External Rotation ◽  
Treatment Algorithm ◽  
Evidence Based ◽  
Posterior Malleolus ◽  
Anatomic Reduction

Background: Surgical treatment of unstable syndesmotic injuries is not trivial, and there are no generally accepted treatment guidelines. The most common controversies regarding surgical treatment are related to screw fixation versus dynamic fixation, the use of reduction clamps, open versus closed reduction, and the role of the posterior malleolus and of the anterior inferior tibiofibular ligament (AITFL). Our aim was to draw important conclusions from the pertinent literature concerning surgical treatment of unstable syndesmotic injuries, to transform these conclusions into surgical principles supported by the literature, and finally to fuse these principles into an evidence-based surgical treatment algorithm. Methods: PubMed, Embase, Google Scholar, The Cochrane Database of Systematic Reviews, and the reference lists of systematic reviews of relevant studies dealing with the surgical treatment of unstable syndesmotic injuries were searched independently by two reviewers using specific terms and limits. Surgical principles supported by the literature were fused into an evidence-based surgical treatment algorithm. Results: A total of 171 articles were included for further considerations. Among them, 47 articles concerned syndesmotic screw fixation and 41 flexible dynamic fixations of the syndesmosis. Twenty-five studies compared screw fixation with dynamic fixations, and seven out of these comparisons were randomized controlled trials. Nineteen articles addressed the posterior malleolus, 14 the role of the AITFL, and eight the use of reduction clamps. Anatomic reduction is crucial to prevent posttraumatic osteoarthritis. Therefore, flexible dynamic stabilization techniques should be preferred whenever possible. An unstable AITFL should be repaired and augmented, as it represents an important stabilizer of external rotation of the distal fibula. Conclusions: The current literature provides sufficient arguments for the development of an evidence-based surgical treatment algorithm for unstable syndesmotic injuries.

scholarly journals Studies Examining the Efficacy of Ankle Foot Orthoses should Report Activity Level and Mechanical Evidence

2010 ◽  
Vol 34 (3) ◽  
pp. 327-335 ◽  
Author(s):  
Jaap Harlaar ◽  
Merel Brehm ◽  
Jules G. Becher ◽  
Daan J. J. Bregman ◽  
Jaap Buurke ◽  
...  
Keyword(s):  
Treatment Algorithm ◽  
Relevant Information ◽  
Current Treatment ◽  
Activity Level ◽  
Walking Ability ◽  
Foot Orthoses ◽  
Level Of Evidence ◽  
Levels Of Evidence ◽  
Ankle Foot Orthoses

Ankle Foot Orthoses (AFOs) to promote walking ability are a common treatment in patients with neurological or muscular diseases. However, guidelines on the prescription of AFOs are currently based on a low level of evidence regarding their efficacy. Recent studies aiming to demonstrate the efficacy of wearing an AFO in respect to walking ability are not always conclusive. In this paper it is argued to recognize two levels of evidence related to the ICF levels. Activity level evidence expresses the gain in walking ability for the patient, while mechanical evidence expresses the correct functioning of the AFO. Used in combination for the purpose of evaluating the efficacy of orthotic treatment, a conjunct improvement at both levels reinforces the treatment algorithm that is used. Conversely, conflicting outcomes will challenge current treatment algorithms and the supposed working mechanism of the AFO. A treatment algorithm must use relevant information as an input, derived from measurements with a high precision. Its result will be a specific AFO that matches the patient's needs, specified by the mechanical characterization of the AFO footwear combination. It is concluded that research on the efficacy of AFOs should use parameters from two levels of evidence, to prove the efficacy of a treatment algorithm, i.e., how to prescribe a well-matched AFO.

scholarly journals Patient-reported outcomes after surgical and non-surgical treatment of proximal hamstring avulsions in middle-aged patients

2019 ◽  
Vol 5 (1) ◽  
pp. e000511 ◽  
Author(s):  
Elsa Pihl ◽  
Olof Skoldenberg ◽  
Hans Nasell ◽  
Sven Jonhagen ◽  
Paula Kelly Pettersson ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Algorithm ◽  
Hamstring Injury ◽  
Middle Aged ◽  
Mri Findings ◽  
Aged Patients ◽  
Patient Reported ◽  
Proximal Hamstring ◽  
Non Surgical Treatment

ObjectivesIn the literature on proximal hamstring avulsions, only two studies report the outcomes of non-surgically treated patients. Our objective was to compare subjective recovery after surgical and non-surgical treatment of proximal hamstring avulsions in a middle-aged cohort.MethodsWe included 47 patients (33 surgically and 14 non-surgically treated) with a mean (SD) age of 51 (±9) years in a retrospective cohort study. Follow-up time mean (SD) of 3.9 (±1.4) years. The outcome variables were the Lower Extremity Functional Scale (LEFS) and questions from the Proximal Hamstring Injury Questionnaire. Outcome variables were adjusted in regression models for gender, age, American Society of Anestesiologits (ASA) classification and MRI findings at diagnosis.ResultsThe baseline characteristics showed no differences except for the MRI result, in which the surgically treated group had a larger proportion of tendons retracted ≥ 2 cm. The mean LEFS score was 74 (SD±12) in the surgically treated cohort and 72 (SD±16) in the non-surgically treated cohort. This was also true after adjusting for confounders. The only difference in outcome at follow-up was the total hours performing physical activity per week, p=0.02; surgically treated patients reported 2.5 hours or more (5.2 vs 2.7).ConclusionThis study on middle-aged patients with proximal hamstring avulsions was unable to identify any difference in patient-reported outcome measures between surgically and non-surgically treated patients. The vast majority of patients treated surgically had complete proximal hamstring avulsions with ≥ 2 cm of retraction. We conclude that to obtain an evidence-based treatment algorithm for proximal hamstring avulsions studies of higher scientific level are needed.

A Retrospective Study in the Treatment of a 2-Part Greater Tuberosity Fracture Using the F3 Biomet Plate

2016 ◽  
Vol 101 (9-10) ◽  
pp. 465-472
Author(s):  
Jun Ma ◽  
Liangyu Zhao ◽  
Tao Liu ◽  
Qiang Fu ◽  
Aimin Chen
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Constant Score ◽  
Shoulder Function ◽  
Open Reduction Internal Fixation ◽  
Dash Score ◽  
X Rays ◽  
Level Of Evidence ◽  
Greater Tuberosity

The purpose of this study was to evaluate the clinical efficacy of the F3 Biomet plate in the treatment of 2-part displaced humeral greater tuberosity fractures. We compared the clinical outcomes of patients with displaced greater tuberosity fractures who underwent surgical treatment using an F3 plate with those of patients who were treated nonsurgically. Eleven patients with 2-part displaced humeral greater tuberosity fractures were surgically treated with use of an F3 Biomet plate, whereas 12 patients with equal injuries were treated nonsurgically. Each patient underwent follow-up for at least 1 year. We retrospectively collected data and analyzed the clinical outcomes. The Constant score and DASH score were used to assess the shoulder function, and X-rays were taken to evaluate the fracture healing. X-rays of the patients in both groups showed that the fractures achieved union after the 1-year follow-up. Patients treated surgically with an F3 plate and open reduction internal fixation had better Constant score and DASH score results for shoulder function than those treated nonsurgically. In the present study, surgical treatment of displaced humeral greater tuberosity fractures with the use of an F3 plate led to a 100% union rate and good clinical outcomes. The F3 Biomet plate can be considered an effective implant for the treatment of displaced humeral greater tuberosity fractures. The level of evidence is therapeutic III.

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