The Peroneal Groove Deepening Procedure: A Biomechanical Study of Pressure Reduction

2005 ◽  
Vol 26 (6) ◽  
pp. 442-448 ◽  
Author(s):  
Craig I. Title ◽  
Hung-Geun Jung ◽  
Brent G. Parks ◽  
Lew C. Schon

Background: The goal of this study was to identify pressure changes throughout the peroneal groove after a groove deepening procedure. We hypothesized that pressures would decrease. Methods: Twelve fresh-frozen foot and ankle specimens were used. A thin pressure strip containing four sensor pads was secured within the peroneal groove with pads 1 through 4 positioned at the calcaneofibular ligament (CFL) and at the distal, middle, and proximal groove, respectively. The midstance phase of gait was simulated with loads applied to the plantar foot and posterior tibial tendon and to the peroneus longus and brevis tendons. Pressures were recorded with the ankle in neutral, plantarflexion, dorsiflexion, inversion, and eversion. Groove deepening was done by osteotomizing the posterior fibular wall. Pressure readings were then recorded. Average pressures for each of the four sensor pads after the procedure were compared to those obtained before the procedure. Results: The mean pressure overlying the CFL increased at all five ankle positions; however, these changes were not significant. Significant decreases in pressure were noted within the distal and middle groove at all ankle positions after the peroneal groove deepening procedure. Pressure within the proximal groove increased at all but one position, with a significant difference noted in neutral and plantarflexion. Conclusion: Pressures within the middle and distal peroneal groove significantly decreased after a groove deepening procedure. Combining this technique with peroneal tendon debridement may be advantageous for treatment of partial peroneal tendon tears or recalcitrant peroneal tendinitis.

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712198928
Author(s):  
Heath P. Gould ◽  
Nicholas R. Delaney ◽  
Brent G. Parks ◽  
Roshan T. Melvani ◽  
Richard Y. Hinton

Background: Femoral-sided graft fixation in medial patellofemoral ligament (MPFL) reconstruction is commonly performed using an interference screw (IS). However, the IS method is associated with several clinical disadvantages that may be ameliorated by the use of suture anchors (SAs) for femoral fixation. Purpose: To compare the load to failure and stiffness of SAs versus an IS for the femoral fixation of a semitendinosus autograft in MPFL reconstruction. Study Design: Controlled laboratory study. Methods: Based on a priori power analysis, a total of 6 matched pairs of cadaveric knees were included. Specimens in each pair were randomly assigned to receive either SA or IS fixation. After an appropriate reconstruction procedure, the looped end of the MPFL graft was pulled laterally at a rate of 6 mm/s until construct failure. The best-fit slope of the load-displacement curve was then used to calculate the stiffness (N/mm) in a post hoc fashion. A paired t test was used to compare the mean load to failure and the mean stiffness between groups. Results: No significant difference in load to failure was observed between the IS and the SA fixation groups (294.0 ± 61.1 vs 250.0 ± 55.9; P = .352), although the mean stiffness was significantly higher in IS specimens (34.5 ± 9.6 vs 14.7 ± 1.2; P = .004). All IS reconstructions failed by graft pullout from the femoral tunnel, whereas 5 of the 6 SA reconstructions failed by anchor pullout. Conclusion: In this biomechanical study using a cadaveric model of MPFL reconstruction, SA femoral fixation was not significantly different from IS fixation in terms of load to failure. The mean load-to-failure values for both reconstruction techniques were greater than the literature-reported values for the native MPFL. Clinical Relevance: These results suggest that SAs are a biomechanically viable alternative for femoral-sided graft fixation in MPFL reconstruction.


Foot & Ankle ◽  
1993 ◽  
Vol 14 (5) ◽  
pp. 278-283 ◽  
Author(s):  
William C. Biehl ◽  
James M. Morgan ◽  
F. William Wagner ◽  
Rodney A. Gabriel

The use of an Esmarch bandage as a tourniquet in surgery has been criticized. Many authors claim that the pressures under the Esmarch are inconsistent and may be extremely high. We have seen few, if any, problems from the use of an Esmarch in surgery of the foot and ankle. The purpose of this study was to evaluate the pressures generated under the Esmarch tourniquet in a situation that mimics its clinical application, and to determine whether pressures of appropriate magnitude and consistency are obtained in order to recommend its continued use in surgery. Ten volunteers performed numerous applications of the Esmarch. The number of wraps and the width of the Esmarch bandage used were varied. The Esmarch was applied as it would be for a surgical case. Pressures directly beneath the Esmarch were recorded 8 cm proximal to the distal tip of the medial malleolus. Considering all volunteers and all pressures generated, a 3-in Esmarch applied with three wraps gave a mean pressure (±SD) of 225 ± 46 mm Hg. A 3-in Esmarch applied with four wraps gave a mean pressure of 291 ± 53 mm Hg. A 4-in Esmarch applied with three wraps gave a mean pressure of 233 ± 35 mm Hg, and a 4-in Esmarch with four wraps gave a mean pressure of 284 ± 42 mm Hg. The maximum pressures generated by any individual were as follows: 3-in three wraps, 321 mm Hg; 3-in four wraps, 413 mm Hg; 4-in three wraps, 328 mm Hg; and 4-in four wraps, 380 mm Hg. There was no significant difference in the magnitude or consistency of pressures generated between the experienced and inexperienced wrappers. There did not appear to be a learning curve for the application of the Esmarch bandage. We conclude that an Esmarch bandage, used as a tourniquet, can generate safe and reliable pressures. Either a 3-in or 4-in Esmarch bandage applied above the ankle with three circumferential overlapping wraps consistently results in pressures that are in a safe range.


2021 ◽  
Vol 111 (5) ◽  
Author(s):  
Mehmet Kuyumcu ◽  
Emre Bilgin ◽  
Hasan Bombacı

Background This study was performed to determine the factors that influence the clinical outcomes of surgically treated ankle fractures associated with the posterior malleolus (PM). Methods We evaluated 42 fractures of 42 patients. Posterior malleolus fracture size was calculated using computed tomography. Posterior malleolar fractures with a size less than 10% were left nonfixated. The decision for larger fragments was performed using fluoroscopy following the fixation of other components. If the joint was found to be congruent, the PM was left nonfixated. Otherwise, the PM was reduced and fixated. Clinical outcomes were evaluated based on Weber, Freiburg, and American Orthopaedic Foot and Ankle Society scores. Ankle osteoarthritis was determined according to the Canadian Orthopaedic Foot and Ankle Society classification. The effect of PM fixation, age, PM fragment size, waiting period before surgery, presence of ankle dislocation, and number of injured malleoli on clinical outcomes were assessed. Statistical significance was set at a value of P < .05. Results The mean patients age was 48.5 ± 14.9 years (range, 20–84 years) and the mean follow-up was 23.7 ± 8.6 months (range, 12–56 months). Fixation of the PM was performed solely in 12 patients. Postoperative displacement of the PM and articular step were less than 2 mm in all fractures. Statistically significant worse outcomes were demonstrated based on functional scores in the patients with a PM size greater than or equal to 25% (P = .042, P = .038, and P = .048, respectively) and in patients aged 60 years or older (P = .005, P = .007, and P = .018, respectively). However, there was no significant difference between functional scores and the other factors. Ankle osteoarthritis was observed at a higher rate in patients with PM size greater than or equal to 25% and in patients aged 60 years or older. Conclusions Clinical outcomes of the patients are mainly influenced by the patient's age and PM fragment size. However, if the tibiotalar joint is congruent, comparable results can be obtained in PM fixated or nonfixated patients.


2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0052
Author(s):  
Guang-rong Yu

Category: Ankle Introduction/Purpose: To explore the effectiveness and operative methods to treat various mal-united Pilon fractures with joint-sparing osteotomy. Methods: Between January 2011 and October 2016, 21 patients with mal-united Pilon fractures were treated with joint-sparing osteotomy. There were 13 males and 8 females with an average age of 38.4 years (range, 22-48 years). 14 were left feet and 7, right. The time from injury to reconstructive operation was 4 months to 10 years. 17 received operative treatment previously, and 4 were treated by plaster fixation. According to Rüedi-Allgöwer classification, 16 were rated as type II (including 6 medial Pilon fractures, 5 anterior, 5 posterior) and 5, type III. All patients received standardized postoperative managements. Results: All patients were followed up for more than 1 year. All the fractures were reunited in an average time of 13.8 weeks (range 9 to 18 weeks). The mean visual analogue scale (VAS) score was 2.42 (range 0 to 5) and the mean ankle and hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS) score was 78.81(range 65 to 92) 6 months after operation. The VAS score was 5.27 (range 2 to 7) and the AOFAS score was 57.26 (range 20 to 81) before. Comparing to preoperative data, statistically significant difference was found postoperatively (P<0.05). Conclusion: Results by joint-sparing osteotomy to realign and reconstruct articular surfaces of ankles are acceptable. Functions and symptoms are improved significantly after operation. Joint-sparing osteotomy can be a considerable option for treating mal-united Pilon fractures.


Foot & Ankle ◽  
1993 ◽  
Vol 14 (6) ◽  
pp. 330-334 ◽  
Author(s):  
Mark J. Geppert ◽  
Mark Sobel ◽  
Walther H.O. Bohne

The role of the competent superior peroneal retinaculum (SPR) as a primary restraint to peroneal tendon subluxation and mechanical attritional wear is clear. Injury to the SPR has classically been described as a dorsiflexion aversion movement of the ankle coupled with a forceful peroneal tendon reflex contraction. This mechanism, however, does not cause injury to the lateral collateral ligaments of the ankle and does not explain the coexistent findings of lateral ankle instability, laxity of the SPR, and concurrent peroneal tendon pathology. Anatomic studies reveal a parallel alignment of the calcaneal band of the SPR and the calcaneofibular ligament. A cadaveric model of ankle instability created by serial sectioning of the lateral collateral ligaments revealed increasing visual strain on the SPR with increasing degrees of ankle instability. These findings suggest the SPR serves as a secondary restraint to ankle inversion stress and that the force or forces that result in chronic ankle instability can also injure and attenuate the superior peroneal retinaculum.


2019 ◽  
Vol 2 (1) ◽  
pp. 174-181
Author(s):  
Mahendra Khatri ◽  
Sambardhan Dabadi ◽  
Sandeep Kumar Shrestha ◽  
Saugat Acharya ◽  
Sudip Tamang ◽  
...  

Foot plantar pressure is the pressure field that acts between the plantar region of the foot and supporting ground. The pressure exerted on the variable region of the foot can be determined using discrete pressure sensors. Information obtained from these sensors is useful in the measurement of gait and posture for diagnosing various problems associated with a lower limb, footwear design, and sports biomechanics. This project is aimed to design a portable in-shoe plantar pressure and gyroscope-based gait angle measurement system. Six Force Sensitive Resistor (FSR) placed in the sole (hallux, 1st, 5th metatarsal, midfoot lateral, midfoot medial and heel respectively) detects the plantar pressure and gyroscope placed at the ankle, knee and hip help measure the orientation and angle of joint movement during various phases of gait. The study among 16 male and 16 female subjects illustrated the significant pressure variation (p<0.0001, t=5.17 with α=95%). Similarly, there was a significant difference in pressure between normal and fast walking speed (p<0.0001, t=5.88) with mean values of 353Kpa and 426Kpa respectively. The mean pressure value for slow walking speed was 423Kpa while there was no significant variation between slow and normal walking speeds (p=0.62, t=1.98). Plantar pressure increased linearly with an increase in the body weight of a person as well. The mean pressure for the 45-50 age group was 313.25Kpa and that for 70-75 was 449Kpa. The study among 10 diabetics and 10 non-diabetic subjects illustrated significantly higher pressure on 1st and 5th metatarsal on diabetic subjects (p=0.0207 and t=2.536). The movement of ankle, knee and hip joint is visualized using the 3D model of a lower limb through processing software. The study illustrated the range of ankle joint movement between -60(dorsiflexion) to 200(plantarflexion), for knee joint was 00 to 300 (flexion) and that for hip joint was -50(extension) to 400(flexion). There was a significant difference in angular values for all three joints while climbing up and down the staircase as compared to walk in a level surface.


2019 ◽  
Vol 40 (5) ◽  
pp. 553-561 ◽  
Author(s):  
Sajeeban Krishnapillai ◽  
Boudijn Joling ◽  
Inger N. Sierevelt ◽  
Gino M.M.J. Kerkhoffs ◽  
Daniël Haverkamp ◽  
...  

Background: Total ankle replacement (TAR) is gaining popularity as a treatment option for ankle osteoarthritis. Long-term implant survival is a critical outcome to determine the success of the TAR implant. The Buechel-Pappas (BP) implant is a second-generation mobile bearing implant. The aim of this study was to analyze the BP implant survivorship at 10-year follow-up, make a subanalysis between patient groups, and evaluate long-term functional outcomes. Methods: Data of 86 patients who received 101 BP implants between 1993 and 2010 were obtained from a prospectively documented database. Subanalyses were done for patients diagnosed with inflammatory joint disease and noninflammatory joint disease, and patients with preoperative tibiotalar neutral and nonneutral alignment. A Kaplan-Meier curve was used for survival analysis. Long-term functional outcomes were assessed with the following patient-reported outcome measures: Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM), Short Form-36 (SF-36) Stand Version 2.0 Health Survey and 3 anchor questions. Results: The survival rate of the BP implant at 10 years was 86% (95% confidence interval, 78%-93%). A total of 31 patients (36%) required 55 reoperations, and in 13 patients (15%) a revision procedure was performed. In this series, no significant difference in 10-year survival rate was found between neither the inflammatory joint disease and noninflammatory joint disease group ( P = .47), nor the tibiotalar neutral and nonneutral alignment group ( P = .16). At a mean follow-up of 16.8 years for 21 patients, the mean FAOS activities of daily living (ADL) and FAAM ADL subscale scores were 75/100 and 56/100 points. The mean physical component summary (PCS) and mental component summary (MCS) of the SF-36 were 34/100 and 51/100 points, respectively. Conclusion: A survival rate of 86% was found at 10-year follow-up for the Buechel-Pappas implant. Our series demonstrated no significant difference in 10-year survival rates between the 2 patient subgroups. Long-term results of the various functional outcomes varied between poor and moderate. Level of Evidence: Level II, prospective cohort study.


2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0007
Author(s):  
Jeremy T. Smith ◽  
Abdurrahman Abdurrob ◽  
Adam Sangeorzan ◽  
Seth O’Donnell ◽  
Eric M. Bluman

Category: Arthroscopy Introduction/Purpose: Peroneal tendoscopy may be used to treat patients with peroneal tendinopathy. It is typically used for diagnostic purposes and to address tendinopathy in the absence of large tendon tears. Its value includes preservation of the superior peroneal retinaculum, small incision size, and faster postoperative recovery compared to open treatment. The goal of this study is to explore the functional outcomes of patients who have undergone isolated peroneal tendoscopy. Methods: Consecutive adult patients who underwent isolated peroneal tendoscopy between January 2010 and January 2018 at a single Foot and Ankle center were identified. The electronic medical record and operative notes were reviewed to identify patients with a minimum 12-month follow-up. Those undergoing open tendon repair, tendon transfer, peroneal groove deepening, and any other concurrent foot or ankle procedure were excluded from the study. Eligible patients were administered the PROMIS Physical Function-Short Form 10A (PF SF10A), Foot and Ankle Ability Measure (FAAM), and the Visual Analog Scale (VAS). Demographic information was also collected. Data was pooled, and descriptive analyses and unpaired T-tests were conducted. Results: Thirty patients met inclusion criteria and 22/30 patients (73%) were able to be reached. Our patient cohort was predominantly female (90.9%), had a mean age of 46.4 years, and an average BMI of 27.6. The mean pre-operative FAAM and PROMIS PF SF10A for patients were 58.3 and 39.7, while the mean post-operative FAAM and PROMIS PF SF10A were 83.3 and 50.5, respectively. There was a statistically significant improvement between the mean pre-operative and post-operative FAAM and PROMIS PF SF10A scores for patients (p =0.0050 and 0.0025, respectively) with a mean improvement of 25.0 in FAAM and 10.8 for PROMIS PF SF10A scoring. At an average of 33.4 month follow-up, the mean VAS for pain was 20.9 out of 100. Conclusion: Isolated peroneal tendoscopy is an effective treatment for patients who have peroneal pain in the absence of frank tears or tendon instability. The improvement in FAAM and PF SF10A scores was statistically significant and exceeds published MCIDs for both FAAM and PROMIS PF SF10A. Additional research is required to further evaluate the effectiveness of peroneal tendoscopy as compared to other methods of treating peroneal tendinopathy, such as open peroneal tenosynovectomy.


2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0038
Author(s):  
Charles C. Pitts ◽  
Bradley Alexander ◽  
Elise M. Greco ◽  
Benjamin B. Cage ◽  
Spaulding F. Solar ◽  
...  

Category: Other; Ankle; Ankle Arthritis; Bunion; Hindfoot; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: The Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) has become increasingly utilized in orthopaedic foot and ankle surgery to assess outcomes and better understand patient function, pain, and disability. Similarly, the Foot Function Index (FFI) is used to assess pain, disability, and activity limitation. PROMIS scores have been shown to predict, preoperatively, which patients will benefit most from foot and ankle surgery from a general perspective. It is currently unknown, with regard to chronic foot pathology, which region of the foot has the greatest effect on PROMIS and FFI scores and which region is affected the most by surgical intervention. Methods: PROMIS physical function, pain index, and depression scores along with FFI scoring subsets of pain, disability, and activity limitation were retrospectively reviewed for patients at a tertiary referral center with chronic pathology in either the hindfoot, midfoot, or forefoot that underwent surgery. Scores were obtained preoperatively and at 6 weeks postoperatively, and a preoperative to postoperative difference was calculated. Once the mean of each subcategory was obtained, an analysis of variance (ANOVA) was conducted in order to compare the means and identify statistically significant differences. Significance was set at p < 0.05 and p < 0.10. Results: There was no statistically significant difference between the mean preoperative PROMIS or FFI scores in the forefoot, midfoot, or hindfoot regions. There was also no statistically significant difference between means of PROMIS or FFI categories at 6 weeks postoperatively. However, the mean pre- to postoperative differences between PROMIS physical function scores of the forefoot, midfoot, and hindfoot were statistically significantly different at 9.12, 8.16, and 2.88, respectively (p=0.037). There was no statistically significant difference between the remaining scoring categories. Conclusion: Physical function, pain, depression, disability, and activity limitation are not affected disparately by the location of chronic pathology within the foot. Surgical intervention for problems in the forefoot, midfoot, and hindfoot does not provide differences in outcomes with regard to pain, disability, depression, or activity limitation based on region. Patients who have undergone surgical intervention for forefoot or midfoot pathology may experience greater improvements in physical function postoperatively when compared to patients who have undergone hindfoot surgery. [Table: see text]


2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Hong-Yun Li ◽  
Sheng-Kun Li ◽  
Ri Zhou ◽  
Shi-Yi Chen ◽  
Ying-Hui Hua

Background. Both percutaneous and arthroscopic techniques have been introduced in anatomic ankle lateral ligaments reconstruction. The purpose of this study was to compare these two techniques in identifying the calcaneal insertion of the calcaneofibular ligament (CFL). Methods. Fifteen fresh-frozen human ankle cadaver specimens were used in this study. Each specimen was tested in three stages. For stage 1, each specimen was evaluated under arthroscopy. After debridement was performed, the insertion of the CFL on the calcaneus was identified, and a 1.5mm Kirschner wire was drilled at the center of the insertion. For stage 2, a percutaneous technique was used to identify the center of the insertion of the CFL. A second 1.5 mm Kirschner wire was drilled through the skin marker. For stage 3, the ankle was dissected, the footprint of the CFL was identified under direct vision, and the distances between the center of the CFL insertion on the calcaneus and the two Kirschner wires were measured, respectively. Results. In the arthroscopic technique group, the mean distance from the Kirschner wire to the center of the CFL insertion in the calcaneus was 3.4 ± 1.3 mm. In the percutaneous technique group, the mean distance from the Kirschner wire to the center of the CFL insertion was 3.2 ± 1.4 mm. No significant difference was found between the two groups. Conclusion. No difference in identifying the calcaneal insertion of the CFL was found between the percutaneous and the arthroscopic ankle lateral ligaments reconstruction technique. Both techniques can be used during anatomic ligaments reconstruction in treatment of chronic ankle instability.


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