Operative Treatment for Ganglion Cyst of Flexor Hallucis Longus Sheath

2020 ◽  
Vol 41 (8) ◽  
pp. 978-983
Author(s):  
Shu Zhang ◽  
Amiethab Aiyer ◽  
Chao Sun ◽  
Zhi Wang ◽  
Dasheng Lin ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Ganglion Cyst ◽  
Case Series ◽  
Tendon Sheath ◽  
Flexor Hallucis Longus ◽  
Level Of Evidence ◽  
Cyst Excision ◽  
Ganglion Cysts ◽  
American Orthopaedic

Background: Intractable hallucal ganglion cysts (HGCs) are often a symptomatic and recurrent condition. Its connection with the ankle joint is not well understood. Our aim was to evaluate the relationship between tenosynovitis of the flexor hallucis longus (FHL) tendon at the level of the ankle with formation of an HGC. In addition, we sought to analyze the outcomes of cyst excision combined with ankle capsulorrhaphy. Methods: Nineteen patients with HGC who underwent surgical intervention were included between June 2016 and June 2019. Eight had known recurrences. Ankle arthrography and cyst excision were performed on all patients. Clinical evaluations included the American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and evaluation of postoperative complications. The mean follow-up period was 16.5 ± 8.6 months. Results: Thirteen of the 19 HGCs (68.4%) had a connection with the FHL tendon sheath. Combined with ankle capsulorrhaphy, there was no recurrence after cyst excision. The VAS score decreased from 2.1 ± 1.5 to 0.4 ± 0.8, and AOFAS score significantly improved from 84.3 ± 8.7 to 97.4 ± 5.2 at final follow-up ( P < .001). Conclusions: Most of these patients had a connection between the HGC and ankle joint. Ankle arthrography appeared to be useful for diagnosis, and cyst excision combined with ankle capsulorrhaphy was an effective treatment without cyst recurrence. Level of Evidence: Level IV, case series.

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.

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.

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 Treatment of chronic lateral ankle instability using the Broström-Gould procedure in athletes: long-term results

Joints ◽  
2016 ◽  
Vol 04 (02) ◽  
pp. 094-097 ◽  
Author(s):  
Adriano Russo ◽  
Paolo Giacchè ◽  
Enrico Marcantoni ◽  
Annalisa Arrighi ◽  
Luigi Molfetta
Keyword(s):  
Ankle Instability ◽  
Case Series ◽  
Long Term Results ◽  
Level Of Evidence ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
American Orthopaedic

Purpose: this study was conducted to evaluate longterm results following treatment of chronic lateral ankle instability using the Broström-Gould technique in athletes. Methods: eighteen athletes involved in competitive sports at different levels, who suffered from chronic lateral ankle instability, underwent Broström-Gould ligamentoplasty between 2000 and 2005. The results of the surgery were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scale. Results: the results at 10-15 years of follow-up were excellent in 94.5% of these cases and good in the remaining 5.5%. An increase of 31.2 points in the AOFAS scale score was recorded at follow-up (with the score rising to 98.8, from 67.6 preoperatively). All the athletes returned to their respective sports at the same level as prior to the surgery. Imaging at longterm follow-up showed no signs of arthritic degeneration. Conclusions: the results of this study show that the Broström-Gould technique is an effective procedure for the treatment of chronic lateral ankle instability in the athlete, giving excellent long-term results. Level of evidence: therapeutic case series, level IV.

Ankle Salvage Following Nonunion of Distal Tibia Fractures

2018 ◽  
Vol 39 (10) ◽  
pp. 1210-1218 ◽  
Author(s):  
Giovanni Lovisetti ◽  
Alexander Kirienko ◽  
Charles Myerson ◽  
Ettore Vulcano
Keyword(s):  
Ankle Joint ◽  
Distal Tibia ◽  
Case Series ◽  
Bone Transport ◽  
Radiographic Evaluation ◽  
Leg Length ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Close Proximity ◽  
American Orthopaedic

Background: Nonunions of the distal tibia in close proximity to the ankle joint can be a challenge to treat. The purpose of this study was to evaluate radiographic and clinical outcomes of patients who underwent ankle-sparing bone transport for periarticular distal tibial nonunions. Methods: Twenty-one patients underwent ankle-sparing bone transport between January 2006 and July 2016. The mean age of the patients was 48.6 years, and 71% (15/21) were male. Patients were followed for an average of 14.6 months (range, 10.6-17.7 months), with an average of 8.6 months in-frame. Thirteen of 21 patients had infected nonunions. Primary endpoints included time to union and American Orthopaedic Foot & Ankle Society (AOFAS) score. Results: All fractures achieved union. Mean time to union was 37.4 weeks. Mean AOFAS score was 86.3 points (range, 37-100). A score of 37 was observed in 1 patient with preexisting Charcot foot. Radiographic evaluation at 6 months revealed a mean lateral distal tibial angle of 89.2 degrees and a mean anterior distal tibial angle of 76 degrees. Leg length discrepancy was less than 1.2 cm in all patients. Superficial pin infection was observed in 7 patients, and operative wound infection at the level of bone resection was observed in 3 patients. Conclusion: The ankle-sparing bone transport technique was an effective alternative to bone graft and arthrodesis for the treatment of periarticular nonunions of the distal tibia and was safe for use in patients with infected nonunions in close proximity to the ankle joint. Level of Evidence: Level IV, case series.

Endoscopic Flexor Hallucis Longus Transfer for Achilles Noninsertional Tendinopathy: Description of Surgical Technique and Functional Outcomes

2020 ◽  
pp. 193864001989591
Author(s):  
Juan Bernardo Gerstner G ◽  
Ian Winson ◽  
Jimmy Campo ◽  
Michael Swords ◽  
Juan Camilo Medina ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Case Series ◽  
Functional Results ◽  
Achilles Tendinopathy ◽  
Flexor Hallucis Longus ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Flexor Hallucis Longus Transfer ◽  
The Mean ◽  
American Orthopaedic

Background. The transfer of the flexor hallucis longus (FHL) tendon is an established treatment for replacing a dysfunctional Achilles tendon. Objectives. (1) Describe a new technique for endoscopic FHL transfer for noninsertional Achilles tendinopathy and (2) describe the functional outcomes and complications after endoscopic and open FHL transfer. Materials and Method. Retrospective study of patients who underwent open or endoscopic FHL transfer between 2014 and 2016. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle/hindfoot scale was used preoperatively and postoperatively to measure the functional results. Results. We included 18 endoscopic FHL transfers and 24 open FHL transfers. The mean age of endoscopic and open procedures was 47.5 years (range 25-77 years) and 61.2 years (range 43-72 years), respectively. An improvement on the average AOFAS of 52.8% (31.9 points) was observed in the endoscopy group during the follow-up from the baseline. The mean improvement in AOFAS score for the open group was 41.4% (24.5 points). Four and 7 cases reported complications in the endoscopy and open FHL transfer groups, respectively. Conclusion. While both procedures were effective in treating noninsertional Achilles tendinopathy, the described arthroscopic treatment led to a greater improvement in the AOFAS score and is slightly less prone to lasting complications. Level of Evidence: Level IV: Case series

Effectiveness of the Dorsal Thermoplastic Locking Orthosis to Prevent Floating Toes in Postoperative Follow-up of Weil Osteotomies

2014 ◽  
Vol 7 (5) ◽  
pp. 356-362 ◽  
Author(s):  
Alexandre Leme Godoy-Santos ◽  
Tulio Diniz Fernandes ◽  
Candida Luzo ◽  
Rafael Trevisan Ortiz ◽  
Marcos Sakaki ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Healing Process ◽  
Case Series ◽  
Metatarsal Osteotomy ◽  
Level Of Evidence ◽  
Surgical Incision ◽  
Superficial Wound ◽  
Distal Metatarsal Osteotomy ◽  
American Orthopaedic

Background: The Weil oblique distal metatarsal osteotomy is regularly used in the treatment of primary metatarsalgia. The most frequent complication is the floating toe, which occurs in up to 36% of postoperative follow-up. The theory of reducing the plantar flexor mechanism tension associated with the retraction of the dorsal structures during the healing process of the surgical procedure may explain this negative evolution. Objective: This study aimed at assessing the effectiveness of the Tucade dorsal thermoplastic locking orthosis in the prevention of floating toe after Weil osteotomy. Methods: In all, 30 patients with metatarsalgia diagnosis submitted to Weil osteotomy were treated in the postoperative period with the Tucade dorsal thermoplastic locking orthosis. Results: The floating toe was not observed in this case series. There was 1 case of superficial wound irritation at the dorsal surgical incision and 1 case that evolved with transfer metatarsalgia. Statistical analyses were performed—American Orthopaedic Foot and Ankle Society Scale for lateral toes and extension of the lateral toes—using the t test, and P < .0001 was obtained for comparison of the preoperative and postoperative periods in the population studied. Conclusion: The Tucade dorsal thermoplastic locking orthosis during the postoperative period of Weil osteotomy proved to be effective in the prevention of floating toes. Level of Evidence: Therapeutic 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.

scholarly journals Medium-term results of the HINTEGRA total ankle arthroplasty

2020 ◽  
Vol 14 (3) ◽  
pp. 231-238
Author(s):  
Mohammadali Khademi ◽  
Paulo Ferrao ◽  
Nikiforos Saragas
Keyword(s):  
Case Series ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Foot And Ankle ◽  
Medium Term ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Secondary Objective ◽  
American Orthopaedic

Objective: The aim of this study was to determine patient satisfaction, survivorship, and revision rate of the HINTEGRA total ankle arthroplasty (TAA). Our secondary objective was to assess hindfoot function. Methods: All patients who underwent a HINTEGRA TAA between 2007 and 2014 were evaluated. We included a total of 69 patients (69 ankles), who were subjected to clinical and radiological examination and completed a visual analogue scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, and the self-reported foot and ankle score (SEFAS). Hindfoot function was assessed using the AOFAS hindfoot score. Mean follow-up was 62 (57–101) months. Results: The mean VAS score was 2 (0–3) and the SEFAS was 37 (26–48) at the most recent follow-up, while the AOFAS ankle score improved from 57 (52–62) to 87 (82–93). The AOFAS hindfoot score improved from 82 to 92 postoperatively. Eight patients had periprosthetic osteolysis and 5 underwent bone grafting of cysts. We detected polyethylene and hydroxyapatite particles in specimens obtained from the cysts. Eight patients had their procedures converted to an ankle arthrodesis. Conclusion: In select patients, TAA improved quality of life. Our medium-term follow-up of the HINTEGRA TAA observed a survivorship of 89% at 5 years with an improvement in the AOFAS score and a mean SEFAS score of 37. We recommend that large periprosthetic cysts, which may be caused by the hydroxyapatite coating and polyethylene particles, be bone grafted prophylactically. We found hindfoot function to be preserved. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals Percutaneous surgical treatment of hallux valgus

2020 ◽  
Vol 14 (3) ◽  
pp. 278-284
Author(s):  
Luiz Lara ◽  
Lúcio Torres Filho ◽  
Gabriel Cervone ◽  
Rafael Viana ◽  
Glaucia Bordignon ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Metatarsal Bone ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Valgus Angle ◽  
Angle Correction ◽  
Age At Surgery ◽  
American Orthopaedic

Objective: To analyze outcomes of hallux valgus surgical correction using the Reverdin-Isham technique by means of clinical and radiographic studies. Methods: We retrospectively assessed 43 feet (38 patients) with moderate to severe hallux valgus treated from June 2009 to July 2014. Mean age at surgery was 59 years; mean postoperative follow-up time was 79 months. Patients were assessed at pre- and postoperative periods both functionally, by the American Orthopaedic Foot and Ankle Society (AOFAS) score, and radiographically, by the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), and shortening of 1st metatarsal bone. Results: AOFAS scores had a mean increase of 55 points. Mean HVA decreased 14.5°, whereas IMA and DMAA exhibited a mean decrease of 3.8° and 9.7°, respectively. Mean shortening of the first metatarsal bone was 3mm. Conclusion: The presented surgical technique showed to be effective to correct mild to moderate hallux valgus, resulting in appropriate angle correction angular and significant increase in AOFAS scores. Level of Evidence IV; Therapeutic Studies; Case Series.

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