Endoscopic Resection of Different Types of Talocalcaneal Coalition

2018 ◽  
Vol 39 (9) ◽  
pp. 1082-1088 ◽  
Author(s):  
Wael Aldahshan ◽  
Adel Hamed ◽  
Faisal Elsherief ◽  
Ashraf Mohamed Abdelaziz
Keyword(s):  
Endoscopic Resection ◽  
Nonoperative Treatment ◽  
Level Of Evidence ◽  
Vas Score ◽  
Talocalcaneal Coalition ◽  
Short Term Study ◽  
Different Types ◽  
The Mean ◽  
American Orthopaedic

Background: The purpose of this study was to describe the technique of endoscopic resection of talocalcaneal coalition (TCC) by using 2 posterior portals and to report the outcomes of endoscopic resection of different types and sites of TCC. Methods: An interventional prospective study was conducted on 20 feet in 18 consecutive patients who were diagnosed by computed tomography to have TCC for which nonoperative treatment had failed and endoscopic resection was performed. The patients were divided into groups according to the site of the coalition (middle facet or posterior facet) and according to type (fibrous, cartilage, or bony). The mean follow-up period was 26 months (range, 6-36). Results: The average preoperative American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was 57.7 (range, 40-65), and the average preoperative visual analog scale (VAS) score was 7.8 (range, 6-8). The average postoperative AOFAS hindfoot score was 92.4 (range, 85-98; P < .01). The average postoperative VAS score was 2.4 (range, 1-4). All patients showed no recurrence on postoperative lateral and Harris-Beath X-ray until the end of the study. Conclusions: Endoscopic resection of TCC was an effective and useful method for the treatment of talocalcaneal coalition. It provided excellent outcomes with no recurrence in this short-term study. Resection of the fibrous type had a better outcome than resection of cartilage and bony types. Endoscopic resection of the posterior coalition had a better outcome than resection of the middle coalition. Level of Evidence: Level III, comparative study.

Arthroscopic-Assisted Versus All-Arthroscopic Ankle Stabilization Technique

2020 ◽  
Vol 41 (11) ◽  
pp. 1360-1367 ◽  
Author(s):  
Matteo Guelfi ◽  
Gustavo Araujo Nunes ◽  
Francesc Malagelada ◽  
Guillaume Cordier ◽  
Miki Dalmau-Pastor ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Clinical Results ◽  
Pain Scale ◽  
Chronic Ankle Instability ◽  
Percutaneous Technique ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Vas Score ◽  
The Mean

Background: Both the percutaneous technique with arthroscopic assistance, also known as arthroscopic Broström (AB), and the arthroscopic all-inside ligament repair (AI) are widely used to treat chronic lateral ankle instability. The aim of this study was to compare the clinical outcomes of these 2 arthroscopic stabilizing techniques. Methods: Thirty-nine consecutive patients were arthroscopically treated for chronic ankle instability by 2 different surgeons. The AB group comprised 20 patients with a mean age of 30.2 (range, 18-42) years and a mean follow-up of 19.6 (range, 12-28) months. The AI group comprised 19 patients with a mean age of 30.9 (range, 18-46) years and mean follow-up of 20.7 (range, 13-32) months. Functional outcomes using the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog pain scale (VAS) were assessed pre- and postoperatively. Range of motion (ROM) and complications were recorded. Results: In both groups the AOFAS and VAS scores significantly improved compared with preoperative values ( P < .001) with no difference ( P > .1) between groups. In the AB group the mean AOFAS score improved from 67 (range, 44-87) to 92 (range, 76-100) and the mean VAS score from 6.4 (range, 3-10) to 1.2 (range, 0-3). In the AI group the mean AOFAS score changed from 60 (range, 32-87) to 93 (range, 76-100) and the mean VAS score from 6.1 (range, 4-10) to 0.8 (range, 0-3). At the final follow-up 8 complications (40%) were recorded in the AB group. In the AI group 1 complication (5.3%) was observed ( P < .05). Conclusion: Both the AB and AI techniques are suitable surgical options to treat chronic ankle instability providing excellent clinical results. However, the AB had a higher overall complication rate than the AI group, particularly involving a painful restriction of ankle plantarflexion and neuritis of the superficial peroneal nerve. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Incidence of and Functional Significance of Floating Toe After Weil Osteotomy

2019 ◽  
Vol 4 (4) ◽  
pp. 247301141989195
Author(s):  
Emilio Wagner ◽  
Luis A. O’Connell ◽  
Ruben Radkievich ◽  
Nathaly Caicedo ◽  
Pablo Mococain ◽  
...  
Keyword(s):  
Clear Correlation ◽  
Functional Scale ◽  
Level Of Evidence ◽  
Patient’S Satisfaction ◽  
Significant Difference ◽  
The Mean ◽  
American Orthopaedic ◽  
Toe Deformity

Background: The most frequent complication after Weil osteotomies is a floating toe deformity, but there are no reports about its effect on the patient. In this study, we analyzed the consequences of floating toe deformities after the performance of a modified Weil osteotomy (MWO) or a modified Weil osteotomy with interphalangeal fixation (MWOIF). Methods: We performed a retrospective review with a prospective follow-up of 50 patients (98% women, 120 rays) who underwent MWO (65 rays) or MWOIF (55 rays), with a mean age of 54 ± 12 years and a minimum follow-up of 4 years (mean of 6 years). We analyzed the presence of floating toe deformity in MWO and MWOIF and the outcomes measured by the subjective satisfaction, Lower Extremity Functional Scale (LEFS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and quality of prehension force between patients with or without floating toe deformity. Results: The mean floating toe incidence was of 57%, with no significant difference between operative techniques (48% MWO, 67% MWOIF; P = .053). Our analysis did not show differences in satisfaction, LEFS and AOFAS scores, or grip strength between the group of patients with or without floating toes. Conclusion: The presence of a floating toe deformity was more frequent than generally believed but did not have a meaningful impact on the patient’s satisfaction or functional outcomes measured by the AOFAS and LEFS scales. There was no clear correlation between operative technique, floating toe, and quality of prehension force. Level of Evidence: Level III, retrospective comparative series.

The Value of Power Doppler Ultrasonography in Achilles Tendinopathy

2007 ◽  
Vol 35 (10) ◽  
pp. 1696-1701 ◽  
Author(s):  
Robert-Jan de Vos ◽  
Adam Weir ◽  
Lodewijk P. J. Cobben ◽  
Johannes L. Tol
Keyword(s):  
Conservative Treatment ◽  
Doppler Ultrasonography ◽  
Power Doppler ◽  
Achilles Tendinopathy ◽  
Clinical Severity ◽  
Power Doppler Ultrasonography ◽  
Level Of Evidence ◽  
Vas Score ◽  
The Mean

Background Neovascularization, detected with power Doppler ultrasonography (PDU), is thought by some to play a central role in pathogenesis of Achilles tendinopathy. Hypothesis Power Doppler ultrasonography neovascularization score is correlated with clinical severity at baseline and after conservative treatment. Study Design Cohort study (prognosis); Level of evidence, 2. Methods Seventy tendons from 58 patients with chronic midportion Achilles tendinopathy were included, and 63 symptomatic tendons were analyzed. All patients were prescribed a 12-week heavy-load eccentric training program and evaluated with PDU at baseline and 12 weeks. Patient satisfaction, Victorian Institute of Sports Assessment—Achilles (VISA-A) score, and mean visual analog scale (VAS) score were correlated with degree of neovascularization (5-grade scale). Results Of the 63 symptomatic tendons, baseline neovascularization scores were 23 grade 0 (37% no neovessels), 18 grade 1, 8 grade 2, 8 grade 3, and 6 grade 4 (63% neovascularization grades 1-4). At baseline, neovascularization was not significantly correlated with the mean VAS score (r = .19, P = .131) and VISA-A score (r = —.23, P = .074). At 12-week follow-up, the neovascularization score significantly correlated with the mean VAS score (r = .43, P < .001) and VISA-A score (r = —.46, P < .001). No significant differences were found in improvement of VISA-A score after treatment between patients with neovessels (grades 1-4) or without neovessels (grade 0) at baseline. Conclusion Sixty-three percent of the symptomatic tendons were found to have neovessels at baseline. There was no significant correlation between neovascularization score and clinical severity at baseline, but at follow-up, there was a significant correlation. Neovascularization at baseline did not predict clinical outcome after conservative treatment.

Open surgery versus nonoperative treatments for paediatric trigger thumb: a systematic review

2014 ◽  
Vol 39 (7) ◽  
pp. 719-726 ◽  
Author(s):  
S. Farr ◽  
F. Grill ◽  
R. Ganger ◽  
W. Girsch
Keyword(s):  
Systematic Review ◽  
Open Surgery ◽  
Nonoperative Treatment ◽  
Joint Motion ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Trigger Thumb ◽  
The Mean ◽  
Results Of Surgery

The purpose of this systematic review was to determine the outcome of interphalangeal (IP) joint motion in children undergoing open surgical release, splinting, and passive exercising therapy for the treatment of paediatric trigger thumb. We conducted an online literature search of seven major databases. Only studies with a mean follow-up of at least 12 months were considered for inclusion. Seventeen retrospective studies and one prospective study met all the inclusion criteria. They reported on the results of surgery (634 children, 759 thumbs), splinting (115 children, 138 thumbs), and passive exercising (89 children, 108 thumbs). The mean follow-up periods were 59 (surgery), 23 (splinting), and 76 months (exercising), respectively. Full IP joint motion without residual triggering was achieved in 95% of all children undergoing surgery, in 67% of children treated with continuous splinting, and 55% after passive exercising. Based on the low level of evidence available, it seems that open surgery resulted in more reliable and rapid outcomes compared with nonoperative treatment.

scholarly journals Surgical treatment of hallux valgus using a modified Reverdin-Isham technique

2021 ◽  
Vol 15 (1) ◽  
pp. 49-53
Author(s):  
Luiz Lara ◽  
Lúcio Torres Filho ◽  
Gabriel Cervone ◽  
Juan Grajales ◽  
Glaucia Bordignon ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hallux Valgus ◽  
Case Series ◽  
Metatarsal Head ◽  
Level Of Evidence ◽  
Valgus Angle ◽  
Significant Correction ◽  
The Mean ◽  
American Orthopaedic

Objective: To evaluate the postoperative results of patients who underwent surgical treatment of hallux valgus with a modified Reverdin-Isham (RI) technique and to compare the achieved correction with that reported by studies using the original technique. Methods: This is a retrospective study with patients with mild to moderate hallux valgus who underwent surgery from June 2010 to July 2019. All patients were operated using the modified RI technique. Data were collected through the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire, in addition to pre and postoperative radiographic studies of the intermetatarsal angle (IMA), the hallux valgus angle (HVA), and the distal metatarsal articular angle (DMAA). Results: The mean postoperative follow-up was 30.1 months, and the mean age of patients was 56.4 years. The median AOFAS score in the postoperative period was increased by 56 points. The mean HVA was reduced in 16.5°, the mean IMA was reduced in 4.3°, and the mean DMAA was reduced in 10°. There were no cases of displacement or deviation of the first metatarsal head during the postoperative follow-up. Conclusion: The modified RI technique provided considerable stability to the osteotomy, in addition to a significant correction of the measured angles and an improvement in AOFAS scores, demonstrating itself as an effective technique for correcting mild to moderate hallux valgus. Level of Evidence IV, Therapeutic Studies, Case Series.

scholarly journals Mid-term follow-up after surgical treatment of fifth metatarsal base fractures in professional soccer players

2019 ◽  
Vol 13 (2) ◽  
pp. 154-159
Author(s):  
Luis Paulo Vilela Lemos ◽  
Tiago Soares Baumfeld ◽  
Benjamim Dutra Macedo ◽  
Caio Augusto De Souza Nery ◽  
Jorge P. Batista ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Case Series ◽  
Return To Sport ◽  
Soccer Players ◽  
Level Of Evidence ◽  
Time To Surgery ◽  
Vas Score ◽  
Professional Soccer ◽  
The Mean

Objective: Fifth metatarsal fractures occur mainly in young athletes, with an estimated incidence of 1.8 per 1,000 people a year. The objective of this study was to evaluate the functional outcome of professional soccer players subjected to surgical treatment of fifth metatarsal base fractures. Methods: A total of 34 soccer players who underwent surgery from July 2001 to June 2016 were evaluated. All participants were evaluated by the American Orthopedic Foot and Ankle Score (AOFAS) and visual analogue scale (VAS) score before and after surgery, with a mean follow-up of 23 months. The need for grafting relative to time to surgery, time to fracture consolidation and Torg classification and graft use relative to return to sport were valuated. Results: There were 10 forwards, 7 offensive midfielders, 6 fullbacks, 5 center midfielders, 3 defenders, 2 goalkeepers and 1 defensive midfielder, with a mean age of 19 years. The mean pre- and postoperative AOFAS was 42 and 99 points whereas the mean VAS score was 6 and 0, respectively. The longer the time to surgery, the greater was the need for grafting (p=0.011). The time to return to sport was not influenced by the time to surgery, time to consolidation, Torg classification or graft use. Conclusion: The surgical treatment of fifth metatarsal base fractures in professional soccer players showed good clinical results. The return to activities after surgery is not influenced by the time to surgery, time to consolidation, Torg classification or grafting. Level of Evidence IV; Therapeutic Studies; Case Series.

Efficacy of Calcaneus Osteotomy for Treatment of Symptomatic Müller-Weiss Disease

2016 ◽  
Vol 38 (3) ◽  
pp. 261-269 ◽  
Author(s):  
Shu-Yuan Li ◽  
Mark S. Myerson ◽  
Manuel Monteagudo ◽  
Ernesto Maceira
Keyword(s):  
Case Series ◽  
Stage Iv ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Vas Score ◽  
Calcaneal Osteotomy ◽  
Alternative Treatment Option ◽  
American Orthopaedic ◽  
Hindfoot Arthrodesis

Background: Various methods of midfoot and hindfoot arthrodesis for treating symptomatic Müller-Weiss disease (MWD) have been reported in the literature. In this study, we present the results of a previously unreported method of treatment using a calcaneal osteotomy incorporating a wedge and lateral translation. Methods: Thirteen patients (14 feet) with MWD were treated with a calcaneal osteotomy and retrospectively reviewed. These included 7 females and 6 males, with an average age of 56 years (33-79 years), and an average symptoms duration of 10.6 years (1-16 years). The disease was staged according to Maceira, which included 5 feet in stage II, 4 feet in stage III, 4 feet in stage IV, and 1 foot in stage V. Pre- and postoperative visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS), radiologic examination, and patients’ satisfaction rate of the surgery were evaluated at an average of 3.7 years (range, 1-8.5 years) following surgery. Results: The final follow-up visit showed satisfactory outcomes, with VAS score reducing from the preoperative 8 (7-9) to postoperative 2 (0-4), whereas the AOFAS score improved from the preoperative 29 (20-44) to the postoperative 79 (70-88). The patient’s subjective ratings showed excellent results in 4 feet, good results in 8 feet, and fair outcomes in 2 feet. The hindfoot range of motion remained unchanged, as did the extent of the navicular complex arthritis, and no patient required an arthrodesis since surgery. Conclusion: A calcaneal osteotomy can be used as an alternative treatment option for selected MWD patients regardless of the radiologic stage of the disease. Level of Evidence: Level IV, retrospective case series.

scholarly journals Outcomes of Ultrasound-Guided Gastrocnemius Injection With Botulinum Toxin for Chronic Plantar Fasciitis

2019 ◽  
Vol 41 (1) ◽  
pp. 63-68 ◽  
Author(s):  
Mohammadreza Abbasian ◽  
Salar Baghbani ◽  
Samira Barangi ◽  
Paul Gilbert Fairhurst ◽  
Adel Ebrahimpour ◽  
...  
Keyword(s):  
Placebo Group ◽  
Botulinum Toxin ◽  
Plantar Fasciitis ◽  
Botulinum Toxin A ◽  
Controlled Trial ◽  
Level Of Evidence ◽  
The Mean ◽  
Level I ◽  
American Orthopaedic

Background: The objective of this study was to determine whether the injection of botulinum toxin A (BTA) in the medial head of the gastrocnemius muscle could yield improvements in function and disability in patients with chronic plantar fasciitis with follow-up 12 months after treatment. Methods: Thirty-two patients with chronic plantar fasciitis were included in the study and randomly allocated to the BTA and placebo groups. The visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) scores were used to evaluate pain levels pre- and postinjection as well as function of the foot, respectively. Patients were also asked to rate their treatment satisfaction 1 year after injection. The range of dorsiflexion was measured before and 12 months after the injection. Results: At the 12-month follow-up, the mean VAS decreased from 7.8 to 4 in the placebo group and from 8 to 0.33 in the BTA group. Furthermore, the mean AOFAS scores increased from 48.4 to 65.3 in the placebo group and from 45.5 to 90.6 in the BTA group. The postinjection scores in the BTA group were significantly higher than those in the placebo group ( P < .001). Patient satisfaction in the BTA group was higher than that in the placebo group at the 12-month follow-up. Conclusion: In patients with chronic plantar fasciitis, the use of BTA had a positive effect on improvement in pain and foot function 1 year after treatment. Level of Evidence: Level I, prospective randomized controlled trial.

Resection of Medial Talocalcaneal Coalition With Interposition of a Pediculated Flap of Tibialis Posterior Tendon Sheath

2018 ◽  
Vol 39 (8) ◽  
pp. 935-941 ◽  
Author(s):  
Jan Hubert ◽  
Thelonius Hawellek ◽  
Frank Timo Beil ◽  
Dominik Saul ◽  
Jens Henning Kling ◽  
...  
Keyword(s):  
Case Series ◽  
Tendon Sheath ◽  
Activity Level ◽  
Tibialis Posterior ◽  
Level Of Evidence ◽  
Tibialis Posterior Tendon ◽  
Talocalcaneal Coalition ◽  
American Orthopaedic ◽  
Pediculated Flap

Background: The purpose of the study was to present a novel operative technique in the management of medial talocalcaneal coalition (TC) and to report our clinical and radiologic results after interposition of a pediculated flap (PF) of the tibialis posterior tendon sheath. Methods: Twelve feet of 10 patients with a medial TC were treated with the interposition of PF of the tibialis posterior tendon sheath following resection. Pre- and postoperative clinical examinations were performed to evaluate the range of motion and the function of the tibialis posterior muscle of the affected foot. Pain was registered by visual analog scale (VAS) and the function of the foot by the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. The mean follow-up duration was 57.2 months (SD ±37.2 range 12-128) after surgery. Magnetic resonance imaging (MRI) was carried out to assess the outcome. Results: All patients reported a significant reduction of pain ( P = .002) at the final follow-up. The activity level had improved since the operation, and the subtalar joint motion was increased, but no weakness of the tibialis posterior muscle could be observed. The AOFAS hindfoot score was significantly improved ( P = .002). MRI did not reveal any migration of the tibialis posterior tendon sheath, and the interposed PF was confirmed at the resection zone. Furthermore, no TC relapse or ruptures of the functional anatomical structures could be observed. Conclusion: The resection combined with the interposition of a PF of the tendon sheath seems to avoid relapse of TC and improves symptoms and the function of the foot. Level of Evidence: Level IV, case series.

Tendoscopic Treatment of Peroneal Intrasheath Subluxation: A New Subgroup With Superior Peroneal Retinaculum Injury

2018 ◽  
Vol 39 (5) ◽  
pp. 542-550 ◽  
Author(s):  
Matteo Guelfi ◽  
Jordi Vega ◽  
Francesc Malagelada ◽  
Albert Baduell ◽  
Miki Dalmau-Pastor
Keyword(s):  
Clinical Signs ◽  
Case Series ◽  
Peroneal Tendon ◽  
Level Of Evidence ◽  
Lateral Ankle ◽  
Peroneal Tendons ◽  
The Mean ◽  
American Orthopaedic ◽  
Space Occupying Lesion

Background: Snapping peroneal tendons is a rare cause of lateral ankle pain. Two subgroups have been described: chronic subluxation with superior peroneal retinaculum (SPR) injury and intrasheath subluxation with SPR intact. The aim of the study was to report the tendoscopic findings and results in patients affected by snapping peroneal tendons without evident dislocation. Methods: Between 2010 and 2015, a total of 18 patients with a retromalleolar “click” sensation and no clinical signs of peroneal tendon dislocation underwent tendoscopy. Mean age was 29 years (range, 18-47). Mean follow-up was 45 months (range, 18-72). Results: Tendoscopic examination revealed an intact SPR in 12 patients. Of these 12, a space-occupying lesion was present in 7, a superficial tear of peroneus brevis in 4, and a shallow fibular groove in 7. An SPR injury without peroneal tendon dislocation was observed in the remaining 6 patients. All these 6 patients presented a shallow fibular groove. Although the SPR was injured, they had been diagnosed as intrasheath subluxation. Patients with intrasheath subluxation and intact SPR underwent debridement of a space-occupying lesion in 11 cases and fibular groove deepening in 5 cases. Patients with intrasheath subluxation and SPR injury underwent fibular groove deepening without addressing the SPR. At follow-up, the mean American Orthopaedic Foot & Ankle Society score increased from 76 (range, 69-85) preoperatively to 97 (range, 84-100). No recurrence or major complications were reported. Conclusion Intrasheath subluxation of peroneal tendons was successfully treated tendoscopically. A new subgroup of intrasheath subluxation with SPR injury but no clinically evident peroneal tendon dislocation is reported. Level of Evidence: Level IV, case series.

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