scholarly journals Mid-term Outcomes & Complications Following the Use of an Arthroereisis Implant to Aid in Stage II Flat-Foot Correction in Adults

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Michael Aynardi ◽  
Kempland Walley ◽  
Jesse Hallam ◽  
Gearin Green ◽  
Paul Juliano
Keyword(s):  
Clinical Results ◽  
Senior Author ◽  
Stage Ii ◽  
Flat Foot ◽  
Initial Surgery ◽  
Metatarsal Angle ◽  
Sf 36 ◽  
Significant Difference ◽  
Foot Reconstruction

Category: Hindfoot Introduction/Purpose: The use of an arthroereisis implant to augment a stage II, flat-foot reconstruction in adults has been described and may improve postoperative alignment. Yet, painful hardware has been reported. Additionally, there are no reports of mid-term follow up on these implants. The purpose of this study is to describe the mid-term clinical and radiographic outcomes as well as complications with the use of an arthroereisis implant as an adjunct procedure for patients undergoing surgical correction of a flexible acquired, stage II, flat-foot deformity as compared to controls Methods: With IRB approval, all patients undergoing stage II, flat-foot reconstruction by the senior author were identified from 2010-2015. A search was conducted to identify patients within this group undergoing implantation of an adjunctive arthroereisis implant during reconstruction. A 2:1 match using age and gender was performed to identify controls undergoing flexor digitorum longus transfer, medial calcaneal osteotomy, spring ligament repair, and Strayer lengthening during the study period. Demographic information, patient records, operative reports, and follow-up radiographs were reviewed. Preoperative and final follow-up, AP and lateral, weightbearing, radiographs measuring talo-1st metatarsal angle, talo-2nd metatarsal angle, and talo-navicular coverage angle were reviewed and recorded. Clinical follow-up was performed to administer satisfaction SF-36 scoring, and to determine survivorship. Patients undergoing additional corrective procedures at the initial surgery or incomplete records were excluded. Results: 48 patients, age 49.7 (range, 16-68), were included, 16 patients received an arthroereisis implant, 4 were metallic and 12 were bioabsorbable. Follow-up was conducted at 3.54 years (range, 1.4-6 years). Radiographic analysis demonstrated significant improvement in alignment from preoperative to mid-term follow-up in both groups. In addition, arthroereisis patients had a statistically significant improvement in correction of talo-navicular coverage angle at final follow-up, 5 degrees ± 3.9, compared to controls, 10.6 degrees ± 6.8. Average SF-36 scores at mid-term follow-up were comparable with no significant difference between cases, 74.6 ± 21.8, and controls, 76.1 ± 15.3 p=0.89. Overall, 84% of patients noted good or excellent satisfaction. Complications included one arthroereisis failure from painful hardware (1/16), one infection in the controls (1/32), and an unrelated mortality. Conclusion: Arthroereisis implants as an adjunct to stage II, flat-foot correction result in improved and maintained radiographic alignment with comparable clinical results to controls at mid-term follow-up. Additionally, the use of the implant demonstrates improved talo-navicular coverage on mid-term radiographs. While painful hardware was noted in a metallic implant, bioabsorbable implants have demonstrated few complications and may be a safe adjunct to stage II, flat-foot correction in adults.

scholarly journals Coccygectomy for coccygodynia: a cohort study with a long-term follow-up of up to 29 years

2020 ◽  
Author(s):  
R. Hochgatterer ◽  
M. Gahleitner ◽  
J. Allerstorfer ◽  
J. Maier ◽  
M. Luger ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Clinical Symptoms ◽  
Clinical Results ◽  
Long Term Results ◽  
Level Of Evidence ◽  
Superficial Infection ◽  
Initial Surgery ◽  
Significant Difference

Abstract Purpose We aim to critically review the effectiveness and safety of coccygectomy with special regard to long-term outcomes. Methods Coccygectomy was performed in our clinic in 38 patients between 1990 and 2019. All these patients (32 females vs. 6 males) have failed to respond to conservative treatment for at least 6 months prior to surgery. All patients were available for follow-up after mean 12,3 years (2 months to 29 years, 11 patients had a minimum FUP of 24 years). We evaluated all patients clinically and radiologically. Results Nineteen patients reported traumatic and 17 patients reported idiopathic onset of their symptoms; one patient had clinical symptoms after childbirth and another patient had coccygodynia after extensive low back surgery. 36 of our 38 patients were free of pain at least 6 months after surgery and had good or excellent clinical results according to the VAS which improved from 6.37 (SD 1.08) preoperatively to 0.68 (SD 0.99) at the recent follow-up. Two patients showed an ODI > 22 at the recent follow-up (24 and 28) and 32 had an ODI equal or under 4. There was no statistical significant difference in terms of clinical outcome between the different radiological types of the coccyx. Postoperative complications were rare: 1 superficial infection and one re-operation 6 months after initial surgery due to an pre-existing exostosis which had not been removed at the index surgery; no neurological complications and no major bleeding occurred. No patient had recurrent onset of coccygodynia. 37 out of 38 patients would have coccygectomy again. Conclusions Coccygectomy is a safe treatment option in patients with coccygodynia and shows excellent long-term results. We recommend to perform coccygectomy if patients fail to respond to conservative treatment for 6 months. Level of evidence IV

Chronic Achilles Tendinopathy

2007 ◽  
Vol 35 (10) ◽  
pp. 1659-1667 ◽  
Author(s):  
Wolf Petersen ◽  
Robert Welp ◽  
Dieter Rosenbaum
Keyword(s):  
Synergistic Effect ◽  
Short Form ◽  
Achilles Tendinopathy ◽  
Eccentric Training ◽  
Treatment Groups ◽  
Alternative Treatment Option ◽  
Sf 36 ◽  
Significant Difference ◽  
Chronic Achilles Tendinopathy

Background Previous studies have shown that eccentric training has a positive effect on chronic Achilles tendinopathy. A new strategy for the treatment of chronic Achilles tendinopathy is the AirHeel brace. Hypothesis AirHeel brace treatment improves the clinical outcome of patients with chronic Achilles tendinopathy. The combination of the AirHeel brace and an eccentric training program has a synergistic effect. Study Design Randomized controlled clinical trial; Level of evidence, 1. Methods One hundred patients were randomly assigned to 1 of 3 treatment groups: (1) eccentric training, (2) AirHeel brace, and (3) combination of eccentric training and AirHeel brace. Patients were evaluated at 6, 12, and 54 weeks after the beginning of the treatment protocol with ultrasonography, visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, and Short Form-36 (SF-36). Results The VAS score for pain, AOFAS score, and SF-36 improved significantly in all 3 groups at all 3 follow-up examinations. At the 3 time points (6 weeks, 12 weeks, and 54 weeks) of follow-up, there was no significant difference between all 3 treatment groups. In all 3 groups, there was no significant difference in tendon thickness after treatment. Conclusions The AirHeel brace is as effective as eccentric training in the treatment of chronic Achilles tendinopathy. There is no synergistic effect when both treatment strategies are combined. Clinical Relevance The AirHeel brace is an alternative treatment option for chronic Achilles tendinopathy.

scholarly journals Surgery of cholesteatoma: Surgical technique and cholesteatoma recurrences

2004 ◽  
Vol 51 (1) ◽  
pp. 103-107
Author(s):  
Nenad Arsovic ◽  
Radomir Radulovic ◽  
Snezana Jesic ◽  
S. Krejovic-Trivic ◽  
P. Stankovic ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Complete Removal ◽  
Initial Surgery ◽  
Group I ◽  
Number Of Patients ◽  
Significant Difference ◽  
Diffuse Form ◽  
Surgical Failure

Past experience with open and closed techniques of tympanoplasty in surgery of cholesteatoma has shown that recurring illness is one of the major causes of surgical failure. The literature has reported varying trend of surgical treatment of cholesteatoma. The objective of the study was to analyze the significance of surgical technique in relation to the incidence and most frequent localization of recurrent cholesteatoma. Our study analyzed 120 patients operated on for cholesteatoma. The patients were divided into two groups, group I (45) with recurring disease and group II (75) without any recurring condition, which were followed up three years. Statistical analysis was carried out by modified t-test. The largest number of patients was re-operated in the first two years from the initial surgery (50%), In the majority of patients (50%), recurrent cholesteatoma was most commonly localized (stage I) in attic (20%) and much rarely in mesotympanum (11,9%). Stage III recurrent cholesteatoma was verified in 35% of patients, most frequently diffuse form (13,4%). The involvement of attic by all three stages of disease accounted for over 60%. The analysis of the used techniques of surgical treatment in both groups revealed significant difference. Open techniques of tympanoplasty were used in 60% of patients with no recurrence. Closed techniques were used more frequently in patients with recurring disease, i.e. in over 90% of cases. Recurrent cholesteatoma develops, in the majority of cases, during the first two years after the surgical intervention. Attic is the most common localization of cholesteatoma. More frequent utilization of open technique of tympanoplasty for surgery of cholesteatoma significantly reduces the incidence of recurring condition. The indications for CWD technique are the initial spread of cholesteatoma, possibility of complete removal of cholesteatoma and postoperative follow-up of patients.

Role of Tendoscopy in Treating Stage II Posterior Tibial Tendon Dysfunction

2018 ◽  
Vol 39 (4) ◽  
pp. 433-442 ◽  
Author(s):  
Alessio Bernasconi ◽  
Francesco Sadile ◽  
Matthew Welck ◽  
Nazim Mehdi ◽  
Julien Laborde ◽  
...  
Keyword(s):  
Invasive Surgery ◽  
Stage Ii ◽  
Preoperative Imaging ◽  
Tibialis Posterior ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial ◽  
Spring Ligament ◽  
Sf 36

Background: Stage II tibialis posterior tendon dysfunction (PTTD) resistant to conservative therapies is usually treated with invasive surgery. Posterior tibial tendoscopy is a novel technique being used in the assessment and treatment of posterior tibial pathology. The aims of this study were (1) to clarify the role of posterior tibial tendon tendoscopy in treating stage II PTTD, (2) to arthroscopically classify spring ligament lesions, and (3) to compare the arthroscopic assessment of spring ligament lesions with magnetic resonance imaging (MRI) and ultrasonographic (US) data. Methods: We reviewed prospectively collected data on 16 patients affected by stage II PTTD and treated by tendoscopy. We report the reoperation rate and functional outcomes evaluated by comparing pre- and postoperative visual analogic scale for pain (VAS-pain) and the Short-Form Health Survey (SF-36; with its physical [PCS] and mental [MCS] components). Postoperative satisfaction was assessed using a VAS-satisfaction scale. One patient was lost to follow-up. Spring ligament lesions were arthroscopically classified in 3 stages. Discrepancies between preoperative imaging and intraoperative findings were evaluated. Results: At a mean of 25.6 months’ follow-up, VAS-pain ( P < .001), SF-36 PCS ( P = .039), and SF-36 MCS ( P < .001) significantly improved. The mean VAS-satisfaction score was 75.3/100. Patients were relieved from symptoms in 80% of cases, while 3 patients required further surgery. MRI and US were in agreement with intraoperative data in 92% and 67%, respectively, for the tendon assessment and in 78% and 42%, respectively, for the spring ligament. Conclusions: Tendoscopy may be considered a valid therapeutic tool in the treatment of stage II PTTD resistant to conservative treatment. It provided objective and subjective encouraging results that could allow continued conservative therapy while avoiding more invasive surgery in most cases. MRI and US were proven more useful in detecting PT lesions than spring ligament tears. Further studies on PT could use this tendoscopic classification to standardize its description. Level of Evidence: Level IV, therapeutic study, case series.

A Modified Extra-articular Lateral Column Lengthening Procedure for Adult Acquired Flatfoot Deformity

2021 ◽  
pp. 107110072110513
Author(s):  
Yin-Chuan Shih ◽  
Chui Jia Farn ◽  
Chen-Chie Wang ◽  
Chung-Li Wang ◽  
Pei-Yu Chen
Keyword(s):  
Subtalar Joint ◽  
Case Series ◽  
Stage Ii ◽  
Posterior Tibial Tendon ◽  
Lateral Column ◽  
Metatarsal Angle ◽  
Lateral Column Lengthening ◽  
Adult Acquired Flatfoot Deformity ◽  
The Mean

Background: Lateral column lengthening (LCL), originally described by Evans, is an established procedure to correct stage II adult acquired flatfoot deformity (AAFD). However, the relative position between the facets is violated, and other problems may include nonunion, malunion, and calcaneocuboid (CC) joint subluxation. Herein, we report a modified extra-articular technique of LCL with hockey-stick osteotomy, which preserves the subtalar joint as a whole, increases bony apposition to enhance healing ability, and preserves the insertion of the calcaneofibular ligament to stabilize the posterior fragment to promote adduction of the forefoot. Methods: We retrospectively recruited 24 patients (26 feet) with stage II AAFD who underwent extra-articular LCL. The mean age was 55.7 ± 15.7 years, and the mean follow-up period was 33.4 ± 12.1 months. Associated procedures of spring ligament repair/reconstruction and posterior tibial tendon plication or flexor digitorum longus transfer were routinely performed and may also include a Cotton osteotomy, heel cord lengthening, or hallux valgus correction. Clinical and radiographic outcomes at the final follow-up were compared with the preoperative assessments. Results: All patients achieved calcaneus union within 3 months of operation. The VAS pain score improved from 5.3 ± 0.75 preoperatively to 1.2 ± 0.79 at the final follow-up ( P < .001), and the AOFAS Ankle-Hindfoot Scale from 63.5 ± 8.5 to 85.8 ± 4.8 points ( P < .001). The radiographic measurements significantly improved in terms of the preoperative vs final angles of 8.9 ± 5.3 vs 15.2 ± 3.6 degrees for calcaneal pitch ( P < .001), 20.5 ± 9.2 vs 4.9 ± 4.8 degrees for Meary angle ( P < .001), 46.5 ± 5.2 vs 41.9 ± 3.2 degrees for lateral talocalcaneal angle ( P < .001), 23.9 ± 8.5 vs 3.9 ± 3.1 degrees for talonavicular coverage angle ( P < .001), and 18.2 ± 9.2 vs 7.3 ± 5.0 degrees for talus-first metatarsal angle ( P = .002). The CC joint subluxation percentage was 7.0% ± 5.4% preoperatively compared with 8.5% ± 2.4% at the final follow-up ( P = .101). No case showed progression of CC joint arthritis or CC joint subluxation (>15% CC joint subluxation percentage). One case showed transient sural nerve territory paresthesia, and 1 had pin tract infection. Three cases had lateral foot pain, which could be relieved by custom insoles. Conclusion: Modified extra-articular LCL as part of AAFD correction is a feasible alternative technique without subtalar joint invasion and may be associated with less CC joint subluxation compared with the Evans osteotomy. Level of Evidence: Level IV, retrospective case series.

scholarly journals 13-year Follow-up of Treatment of Osteochondral Lesions with MACI

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0004 ◽  
Author(s):  
Chris Kreulen ◽  
Trevor Shelton ◽  
Jacqueline Nguyen ◽  
Eric Giza ◽  
Martin Sullivan
Keyword(s):  
Social Functioning ◽  
Physical Functioning ◽  
Bodily Pain ◽  
Long Term Results ◽  
Osteochondral Lesions ◽  
Sf 36 ◽  
Significant Difference ◽  
And Function

Category: Ankle, Arthroscopy, Hindfoot, Sports, Trauma Introduction/Purpose: Surgical management of osteochondral lesions of the talus (OLT) present an ongoing treatment challenge. Previously, matrix-induced autologous chondrocyte implantation (MACI) demonstrated improved pain and function at 7-years postoperative, providing evidence that MACI is a reliable method for treating cartilage. However, it is unknown the long- term results of MACI in OLT. The purpose of this study was to assess 13-year clinical follow-up data and the long-term success of this implant by comparing patient reported outcome measures (PROMs) pre-operatively, at 7-years post-operative, and at 13- years post-operative. Methods: A prospective investigation of MACI was performed on 10 patients with OLTs who had failed previous arthroscopic treatment. Of the 10 patients, 9 were available for 7-year and 13-year follow-up. Short Form Health Survey (SF-36) and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot evaluation were utilized at pre-operative, 7-year, a 13-year postoperative. For each patient, a paired t-test was used to compare 13-year post-operative PROMs to pre-operative PROMs. A single factor analysis of variance (ANOVA) determined whether PROMs were different between pre-operative, 7-year post- operative, and 13-year post-operative time intervals. When a significant difference was detected, a post-hoc Tukey’s determined which time periods were different. Results: SF-36 data at 13-years showed significant improvements in Physical Functioning (p=0.012), Lack of Bodily Pain (p=0.017), and Social Functioning (p=0.007) compared with preoperative data. There were no differences in other components of the SF-36 outcomes (p>0.05). Although the AOFAS was on average 12 points higher at 13-years postoperative, this was not statistically significant (p=0.173). As for comparing PROMs over time, 13-years post-operative PROMs were comparable to 7-years post- operative (Table 1). There were better PROMs for Physical Functioning, Bodily Pain, and Social Functioning at 7- and 13-years post-operative compared to pre-operative while Physical Role Functioning was also better at 7-years post-operative compared to pre-operative. Conclusion: This study shows MACI provides greater pain relief and function at 13-years post-operative with stable long-term follow-up. MACI should be considered for osteochondral lesions that fail initial microfracture.

scholarly journals Comparison Of Medial Arch-Supporting Insoles And Heel Pads In The Treatment Of Plantar Fasciitis

2015 ◽  
Vol 16 (1) ◽  
pp. 39-42 ◽  
Author(s):  
Melih Malkoc ◽  
Ozgur Korkmaz ◽  
Adnan Kara ◽  
Ismail Oltulu ◽  
Ferhat Say
Keyword(s):  
Daily Activity ◽  
Plantar Fasciitis ◽  
Plantar Fascia ◽  
Clinical Results ◽  
Activity Score ◽  
Vas Score ◽  
Sporting Activity ◽  
Significant Difference ◽  
The Mean

ABSTRACTPlantar fasciitis is a disorder caused by inflammation of the insertion point of the plantar fascia over the medial tubercle of the calcaneus. Foot orthotics are used to treat plantar fasciitis. Heel pads medialise the centre of force, whereas medial arch supporting insoles lateralise the force. We assessed the clinical results of the treatment of plantar fasciitis with silicone heel pads and medial arch-supported silicone insoles.We retrospectively reviewed 75 patients with heel pain. A total of 35 patients in the first group were treated with medial arch supporting insoles, and 40 patients in the second group were treated with heel pads. The patients were evaluated with the Visual Analogue Scale (VAS) and the Foot and Ankle Ability Measure (FAAM) at the first and last examinations.The mean VAS score in the first group was 8.6±1,2 (6-10); the FAAM daily activity score was 66.2±16 (41.2-95.0), and the sporting activity score was 45.4±24,4 (0.1-81) before treatment. At the last follow-up in this group, the mean VAS score was 5.3±1,5 (0-9); the FAAM daily activity score was 83,0±15,1 (55,9-100), and the sporting activity score was 73,5±26,2 (25-100). The mean VAS score in the second group was 8,6±0,9 (7-10); the FAAM daily activity score was 66.4±17 (41.4-95.2), and the sporting activity score was 45.8±24,2 (0.8-81, 3) before the treatment. At the last follow-up in this group, the mean VAS score was 5.5±1,2 (0-9); the FAAM daily activity score was 83.4±14,9 (60, 2-100), and the sporting activity score was 73.8±26 (28-100).There was no significant difference in the clinical results of both groups. The force distribution by the use of silicone heel pads and medial arch-supported silicone insoles had no effect on the clinical results of the treatment of plantar fasciitis.

scholarly journals Analysis of the Hindfoot Alignment Measured in 3D After a Medializing Calcaneal Osteotomy Using a Pre- and Postoperative Weightbearing CT

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0003
Author(s):  
Arne Burssens ◽  
Alexej Barg ◽  
Timothy Leenders ◽  
Stefan Clockaerts ◽  
Peter Burssens ◽  
...  
Keyword(s):  
Valgus Deformity ◽  
Stage Ii ◽  
Tibial Rotation ◽  
Flat Foot ◽  
Hindfoot Alignment ◽  
Software Analysis ◽  
Calcaneal Osteotomy ◽  
Significant Difference ◽  
Significant Correction ◽  
The Mean

Category: Hindfoot Introduction/Purpose: An adult acquired flat foot (AAFD) is a complex 3D deformity. A medializing calcaneal osteotomy (MCO) is a surgical procedure frequently performed to correct the valgus alignment of the hindfoot in a stage II AAFD, when conservative measurements fail. However currently little is known on its accurate influence regarding the hindfoot alignment (HA). The aim is therefore to assess the influence of a MCO on the 3D HA using computer aided software analysis of the images retrieved from a weightbearing cone beam CT (WBCT). Methods: Twelve patients with a mean age of 49,4 years (range 18-67yrs) were prospectively included in a pre-post study design. Indications for surgical correction by a MCO with a solitary translation consisted of an AAFD stage II (N=10) and a posttraumatic valgus deformity (N=2). Fixation of the osteotomy was performed by a step-plate or double screw. WBCT was obtained pre- and post-operative. Images were subsequently segmented to allow a HA calculation in 3D(HA3D) by an angle between the anatomical tibia axis and the axis connecting the computed inferior calcaneuspoint and the centroid of the talus in the coronal plane based on a Cartesian coordinatesystem(Fig 1A, C). The tibia in the HA3D was separately assessed by the anatomical tibia axis (TAx 3D) and the axis to determine the tibial rotation(TR 3D) in the axial plane by connecting the computed most outer point of the anterior and posterior tubercle of the incisura fibularis(Fig 2A, D). Results: The mean medial translation of the calcaneal osteotomy during surgery was 5.72 mm (SD = 3.9). The mean HA3D pre-operatively equaled 18.21 degrees of valgus (SD = 6.6) and post-operatively 9.31 degrees of valgus (SD = 6.18). The Paired Student’s t-test showed a significant correction of 8.89 degrees (95%CI [5.99, 11.80], P<0.001). The mean TAX 3D pre-operatively was 6.80 degrees of valgus (SD = 3.38) and post-operatively 4.11 degrees of valgus (SD = 2.77), with a significant difference of 2.69 degrees (95%CI [1.79, 3.59], P <0.001). The mean TR3D pre-operatively was -27.11 degrees (SD = 4.77) and post-operatively - 28.80 degrees (SD = 5.98) and showed a significant difference of 1.69 degrees (95%CI [0.41, 2.97], P = 0,016). Conclusion: This study shows an effective correction of the valgus hindfoot in an AAFD. It appears that the correction is not only situated in the calcaneus but also to a lesser extent in the tibia and this resulted in 15% of the achieved HA correction. The novelty is the 3D weightbearing assessment of a hindfoot correction and the shown influence on the tibia. This information could be of use to take in to account when performing a pre-operative planning of a hindfoot deformity.

Early clinical results of minimally invasive coracoclavicular ligament reconstruction can be maintained at a minimum of five years’ follow-up

2020 ◽  
Vol 102-B (7) ◽  
pp. 918-924
Author(s):  
Steffen B. Rosslenbroich ◽  
Katharina Heimann ◽  
Jan Christoph Katthagen ◽  
Clemens Koesters ◽  
Oliver Riesenbeck ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Constant Score ◽  
Clinical Results ◽  
Long Term Results ◽  
Short Term ◽  
Ac Joint ◽  
Ac Joint Dislocation ◽  
Significant Difference

Aims There is a lack of long-term data for minimally invasive acromioclavicular (AC) joint repair. Furthermore, it is not clear if good early clinical results can be maintained over time. The purpose of this study was to report long-term results of minimally invasive AC joint reconstruction (MINAR) and compare it to corresponding short-term data. Methods We assessed patients with a follow-up of at least five years after minimally invasive flip-button repair for high-grade AC joint dislocation. The clinical outcome was evaluated using the Constant score and a questionnaire. Ultrasound determined the coracoclavicular (CC) distance. Results of the current follow-up were compared to the short-term results of the same cohort. Results A total of 50 patients (three females, 47 males) were successfully followed up for a minimum of five years. The mean follow-up was 7.7 years (63 months to 132 months). The overall Constant score was 94.4 points (54 to 100) versus 97.7 points (83 to 100) for the contralateral side showing a significant difference for the operated shoulder (p = 0.013) The mean difference in the CC distance between the operated and the contralateral shoulder was 3.7 mm (0.2 to 7.8; p = 0.010). In total, 16% (n = 8) of patients showed recurrent instability. All these cases were performed within the first 16 months after introduction of this technique. A total of 84% (n = 42) of the patients were able to return to their previous occupations and sport activities. Comparison of short-term and long-term results revealed no significant difference for the Constant Score (p = 0.348) and the CC distance (p = 0.974). Conclusion The clinical outcome of MINAR is good to excellent after long-term follow-up and no significant differences were found compared to short-term results. We therefore suggest this is a reliable technique for surgical treatment of high-grade AC joint dislocation. Cite this article: Bone Joint J 2020;102-B(7):918–924.

Posterior Tibial Tendon Excision and Postoperative Pain in Adult Flatfoot Reconstruction: A Preliminary Report

2013 ◽  
Vol 3 (1) ◽  
pp. 20-24
Author(s):  
James K DeOrio ◽  
James A Nunley ◽  
Constantine A Demetracopoulos
Keyword(s):  
Surgical Treatment ◽  
Preliminary Report ◽  
Stage Ii ◽  
Posterior Tibial Tendon ◽  
Resection Group ◽  
First Metatarsal ◽  
Posterior Tibial ◽  
Metatarsal Angle

ABSTRACT Background Posterior tibial tendon insufficiency plays a large role in the pathogenesis of adult acquired flatfoot deformity (AAFD) in select patients. Transfer of the flexor digitorum longus is indicated to compensate for the loss of posterior tibial tendon function; however the role of resection of the degenerated posterior tibial tendon remains unclear. The aim of this study was to determine the effect of posterior tibial tendon resection on pain relief following surgical treatment of stage II AAFD. Methods All patients who underwent surgical treatment for stage II AAFD and posterior tibial tendon insufficiency were retrospectively reviewed. Patients were divided into two groups based on whether the degenerated posterior tibial tendon was resected or left in situ. Twenty-seven patients with a mean follow-up of 13.3 months were included in the study. A visual analog scale (VAS) score for pain was recorded for each patient pre-operatively and at final follow-up. Concomitant surgical procedures and the incidence of postoperative medial arch pain were also reported. Preoperative deformity and postoperative deformity correction were assessed by measuring the anteroposterior talar-first metatarsal angle, the talonavicular (TN) coverage angle, the lateral talar-first metatarsal angle, and the calcaneal pitch onstandard weight bearing radiographs. Results Eleven patients underwent FDL transfer and resection of the posterior tibial tendon (PTT resection group), and 16 patients underwent FDL transfer without resection of the posterior tibial tendon (PTT in situ group). A greater percentage of patients in the PTT resection group underwent lateral column lengthening (100 vs 18.8%, p < 0.001), and a greater percentage of patients in the PTT in situ group had a medial displacement calcaneal osteotomy performed (93.8 vs 18.2%, p < 0.001). There was no difference in preoperative VAS pain scores between groups, and all patients demonstrated excellent pain relief postoperatively. No patient in either group reported medial arch pain postoperatively. Radiographic assessment revealed similar deformity preoperatively in both groups, and patients in the PTT resection group demonstrated a greater correction of the TN coverage angle (9.8 ± 4.6 vs 6.0 ± 4.1 degrees, p = 0.041). Conclusion Resection of the PTT did not significantly affect postoperative VAS scores at final follow-up. It did however, correlate with a slightly greater correction of the TN coverage angle. There were no instances of pain along the medial ankle or medial arch of the foot in either group postoperatively. Future prospective studies are needed to determine whether resection of the PTT is necessary at the time of surgery for stage II AAFD. Demetracopoulos CA, DeOrio JK, Nunley JA II. Posterior Tibial Tendon Excision and Postoperative Pain in Adult Flatfoot Reconstruction: A Preliminary Report. The Duke Orthop J 2013;3(1):20-24.

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