Impact of Early Weight-Bearing Following Ankle Arthroscopy and Microfracture of Talar Osteochondral Defects

Category: Arthroscopy Introduction/Purpose: Ankle impingement and ankle osteochondral defects are common problems seen by foot and ankle specialist that often go on to require surgical managment. After conservative treatment fails, ankle impingement is often managed by arthroscopic debridement, whereas ankle OCDs are often treated with ankle arthroscopy and microfracture as a first line treatment. However, surgeons have various treatment protocols post-operatively after these procedures, with some surgeons allowing immediate weight bearing, were as other surgeons restrict patients weight bearing. There is similar heterogeneity in the manner of immobilization post-operatively. The purpose of this study is to retrospectively review the outcomes of patients undergoing ankle arthroscopy and micro fracture, to determine if immediate weight bearing or removable immobilization had any impact on outcomes. Methods: We retrospectively reviewed 79 patients at our institution who underwent ankle arthroscopy with microfracture for talar osteochondral defects over 3 years. This included surgeries performed by one of 7 fellowship trained foot and ankle surgeons at our institution. Each surgeon had different protocols for post-operative weight bearing and immobilization, allowing for a comparison of various post-operative protocols. Patient outcomes were reviewed pre-operatively and post-operatively including age, sex, comorbidities, etiology of talar pathology, post-operative weight bearing status, time to first weight bearing, as well as method and length of immobilization, VAS scores, range of motion, and complications. Clinical outcomes such as time to return to work and return to sport were also evaluated. Results: The average patient age was 38. 42 patients (53%) had an additional procedure performed at the time of ankle arthroscopy and microfracture. There was no significant difference in the average pre-op and post-op VAS or range of motion between the immediate weight bearing group and the delayed weight bearing group. There was interestingly a trend towards lower VAS scores in the immediate weight bearing group (1.4 vs 2.6). Conclusion: Following ankle arthroscopy and microfracture, we found no difference in VAS, range of motion, or complications when allowing immediate, full weight bearing as well as using removable immobilization as compared to a variety of other protocols at early follow up. In fact, there was a trend towards lower VAS scores in the immediate full weight bearing group. Though this study has early follow up, it does suggest at least the equivalency of allowing immediate weight bearing and removable immobilization following ankle arthroscopy and talar microfracture.

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Clinical and Radiographic Outcomes of 3D Printed Total Talus Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00376 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0037

Author(s):

Daniel Scott ◽

John Steele ◽

Amanda Fletcher ◽

Selene Parekh

Keyword(s):

Avascular Necrosis ◽

Weight Bearing ◽

Treatment Options ◽

Ankle Motion ◽

Motion Data ◽

Radiographic Outcomes ◽

Significant Difference ◽

3D Printed ◽

Vas Scores

Category: Ankle, Ankle Arthritis, Hindfoot, Trauma Introduction/Purpose: Patients with talar avascular necrosis have limited treatment options to manage their symptoms. Historically, surgical options have been limited and can leave patients with little ankle motion and have high failure rates. The use of custom 3D printed total talar replacements (TTR) has arisen as a treatment option for these patients, possibly allowing for better preservation of hind-foot motion. Patients undergoing TTR will demonstrate a statistically significant improvement in FAOS scores at one year after surgery. Methods: We retrospectively reviewed 15 patients who underwent a TTR over 2 years. Patient outcomes were reviewed including age, sex, comorbidities, etiology of talar pathology, number and type of prior surgeries, pre-operative and post-operative weight bearing radiographs, as well as FAOS and VAS scores, and range of motion. Data analysis performed with student T-test and multivariate regression. Results: Results: FAOS scores showed statistically significant improvements post-operatively as compared to pre-operative scores. There was a statistically significant decrease in VAS pain scores from 7.0 pre-operatively to 3.4 post operatively. There was no significant difference in pre-operative and post-operative coronal and sagittal alignment on weight bearing radiographs. All FAOS sub-score shows statistically significant improvements, with the exception of the sports/recreation sub-scale, did show a trend towards improved outcomes (p =0.19). Average follow-up was 12.8 months. Conclusion: Our hypothesis was confirmed that these patients show statistically significant improvements in AOFS and VAS scores at 1 year. Sagittal and coronal alignment was well maintained at an average of 1 year following surgery. TTR represents an exciting treatment options for patients with talar avascular necrosis, though longer-term follow-up is needed.

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Synovial Lipomatosis (Lipoma Arborescens) of the Knee

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00263 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0026

Author(s):

Melih Malkoç ◽

Ozgur Korkmaz ◽

Ali Seker ◽

Mehmet Isyar ◽

Ismail Oltulu ◽

...

Keyword(s):

Range Of Motion ◽

Knee Society Score ◽

Weight Bearing ◽

Full Range ◽

Daily Activities ◽

Full Weight Bearing ◽

Female Group ◽

Arthroscopic Synovectomy ◽

Significant Difference ◽

Synovial Lipomatosis

Objectives: The goals of this retrospective study are to emphasize that the patients who have non surgical treatments for several times due to the massive swelling in their knees should be considered the SL and this pathology is treatable by arthroscopic synovectomy Methods: Seventeen patients (four female and thirteen male), were evaluated retrospectively from May 2009 and April 2013. Mean age for female group was 34,75 (range between 32 to 41) and for male group was 34,23 (range between 26 to 46). Mean follow-up period was 14,76 months (range between 6 months and 38 months). Mean duration of compliance was 26,23 months (range between 9 to 96) months. All patients rated by Knee Society Score preoperatively and postoperatively arthroscopic synovectomy, performed by using radiofrequency ablation and arthroscopic shaver for treatment procedure. Patients were discharged at the end of the one day hospitalization. Postoperatively all patients were allowed to full range of motion and full weight-bearing within one day after surgery. Results: Patients were evaluated preoperatively and postoperatively using the Knee Society Score. The mean Knee Society Score was 67,82 preoperatively and 88,23 was postoperatively. There is significant difference between preoperative and postoperative Knee Society scores.(p <0.05) At the end of the three months, MRI studied and there was no clue of recurrence except two patients. All patients returned to their daily activities with full of range of motion and without swelling of the affected knee joints. At the microscopic histological studies were reported as synovial lipomatosis for all patients Conclusion: Arthroscopic synovectomy is the safe and dramatically effective method of treatment in synovial lipomatosis with less complication, curability and retrieving patients full range of motion with no limitation in their daily activities

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Ankle arthroscopy

Medicinski pregled ◽

10.2298/mpns16s1073k ◽

2016 ◽

Vol 69 (suppl. 1) ◽

pp. 73-76

Author(s):

Vaso Kecojevic ◽

Ivica Lalic ◽

Vladimir Harhaji ◽

Predrag Rasovic ◽

Miodrag Vranjes ◽

...

Keyword(s):

Weight Bearing ◽

Ankle Arthroscopy ◽

Walking Distance ◽

Full Weight Bearing ◽

Complication Rates ◽

Open Approach ◽

Foot And Ankle ◽

Functional Scores ◽

Duration Of Surgery ◽

Tissue Trauma

Introduction. Ankle arthroscopy provides better visualization, less tissue trauma, faster recovery, shorter hospitalization and reduced treatment costs. Complication rates are lower in relation to the classic open approach. This study was aimed at presenting the surgical technique, its advantages and limitations, complications as well as our experience. Material and Methods. We performed 31 ankle arthros?copies in 23 male and 8 female patients in the period from October, 2007 to l September 2016. All surgeries were performed with tourniquet applied on the thigh, using standard arthroscopy portals, with the optic 4.0, 30 degrees. Anterior and posterior bony and soft tissue impingements were found in 23 patients, 4 patients had osteochondral defects of the talar dome, loose bodies were seen in 4 patients. The majority of patients were athletes and recreational sportspeople (29 cases). The average duration of surgery was 25 minutes. The average stay in hospital was one day. Full weight-bearing was achieved 18 days after surgery on average (from 10 to 28 days). There were no infections. Transitory palsy of superficial peroneal nerve was recorded in three cases. Results. The average American Orthopedic Foot and Ankle Score value was 46 before surgery and 92 after surgery. According to Foot and Ankle Outcome Score there were improvements in the postoperative range of motion, alleviation of pain, longer walking distance and improvement in daily living activities. Conclusion. Ankle arthroscopy resulted in a significant postoperative improvement in functional scores in our study sample.

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Arthroscopic and open debridement in primary elbow osteoarthritis: a systematic review and meta-analysis

EFORT Open Reviews ◽

10.1302/2058-5241.5.190095 ◽

2020 ◽

Vol 5 (12) ◽

pp. 874-882

Author(s):

Huub H. de Klerk ◽

Chantal L. Welsink ◽

Anne J. Spaans ◽

Lukas P. E. Verweij ◽

Michel P. J. van den Bekerom

Keyword(s):

Range Of Motion ◽

Meta Analysis ◽

Functional Results ◽

Surgical Debridement ◽

Open Group ◽

Weighted Mean ◽

Significant Difference ◽

Flexion Extension ◽

Vas Scores

Primary osteoarthritis (OA) of the elbow can cause disabling symptoms of pain, locking, stiffness, and a limitation in the range of motion. There is no consensus regarding the role of open and arthroscopic debridement in the treatment of symptomatic primary elbow OA. The aim of this study is to systematically review the outcome of surgical debridement. A preoperative/postoperative comparison will be made between the two surgical procedures. All studies reporting on debridement as treatment for primary elbow OA with a minimum of one-year follow-up were included. Outcome parameters were functional results, complications, and performance scores. Data were extracted from 21 articles. The arthroscopic group consisted of 286 elbows with a weighted mean follow-up of 40 ± 17 months (range, 16–75). The open group consisted of 300 elbows with a weighted mean follow-up of 55 ± 20 months (range, 19–85). Both procedures showed improvement in Mayo Elbow Performance Score (MEPS), range of motion (ROM) flexion-extension, and ROM pronation-supination. Only in ROM flexion was a statistically significant difference in improvement seen between the groups in favour of the open group. The arthroscopic group showed improvement in pain visual analogue scale (VAS) scores. Nothing could be stated about pain VAS scores in the open group due to a lack of data. In the arthroscopic group 18 complications (6%) were described, in the open group 29 complications (12%). Surgical debridement is an effective treatment for the disabling symptoms of primary elbow OA with an acceptable complication rate. Cite this article: EFORT Open Rev 2020;5:874-882. DOI: 10.1302/2058-5241.5.190095

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Tibiotalocalcaneal Arthodesis via a Nitinol Containing Intramedullary Nail

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000227 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Rishin Kadakia ◽

Sameh Labib ◽

Jason Bariteau

Keyword(s):

Bone Resorption ◽

Preoperative Diagnosis ◽

Weight Bearing ◽

Case Series ◽

Full Weight Bearing ◽

Posttraumatic Arthritis ◽

Foot And Ankle ◽

Common Procedure ◽

Proximal Migration

Category: Ankle, Ankle Arthritis, Hindfoot Introduction/Purpose: Tibiotalocalcaneal (TTC) arthrodesis is a common procedure used in the management of foot and ankle pathologies. TTC fusions are frequently performed in patients with limited bone stock and poor vascular status. Adequate compression at the arthrodesis site is vital to successful fusion as even small amounts of bone resorption greatly increase nonunion risk. A recently designed hindfoot nail contains a built in nickel titanium alloy (nitinol) that has psuedoelastic properties which maintains compression across joint surfaces in the setting of bone resorption. The authors present a case series of patients who were managed with this nitinol containing intramedullary hindfoot nail system. Methods: Patients treated by one board certified orthopaedic foot and ankle surgeon who were managed with the nitinol containing hindfoot nailing system were retrospectively reviewed over a two year span. Electronic medical records were reviewed to collect demographic information and details regarding the patient’s procedure. Operative specifics collected included the data of the procedure and the preoperative diagnosis. Records were reviewed postoperatively as well to document the incidence of postoperative complications and functional outcomes. Proximal migration of the distal interlocking screw on lateral radiographs were measured in a standardized fashion at two, six, and twelve weeks to objectively assess additional compression obtained through the nitinol nailing system. Results: Eight patients were included in the case series with an average follow up time of 7 months postoperative (minimum of 4 months for one patient). The most common preoperative diagnosis was posttraumatic arthritis (n = 4). One patient suffered from wound dehiscence postoperatively that required operative intervention within the first three months – this patient’s wound healed by six months with no further complications. All patients were cleared for full weight bearing and activities as tolerated by six months, except only had four months of follow up available. The compression obtained through this nailing system increased at each follow up for all patients. The average compression obtained was 2.9 mm at two weeks, 3.8 mm at six weeks, and 4.4 mm at twelve weeks. Conclusion: Tibiotalocalcaneal arthrodesis can be an excellent procedure that provides significant pain relief and restores function. The patients in this case series all had excellent results with only one postoperative complication that ultimately did not result in any functional deficits. Furthermore, patients all demonstrated increased compression at each follow up radiographs which demonstrates the sustained compression obtained at the arthrodesis site through this hindfoot nail system. Further prospective work with a larger patient cohort is warranted to determine if this nailing system is superior to other TTC hindfoot nails.

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Risk of subsidence and peri-prosthetic fractures using collared hydroxyapatite-coated stem for hip arthroplasty in the elderly

Hip International ◽

10.1177/1120700017754085 ◽

2018 ◽

Vol 28 (6) ◽

pp. 663-667 ◽

Cited By ~ 7

Author(s):

Farhan Syed ◽

Amr Hussein ◽

Krishnaiah Katam ◽

Paul Saunders ◽

Stephen K Young ◽

...

Keyword(s):

Hip Arthroplasty ◽

Periprosthetic Fracture ◽

Weight Bearing ◽

Full Weight Bearing ◽

Elderly Age ◽

Female Ratio ◽

Press Fit ◽

Increased Risk ◽

Significant Difference

Introduction: Subsidence has been noted with both cemented and uncemented stems in hip arthroplasty. On most occasions, it’s minimal (i.e. less than 2 mm) and stabilises at 1 year. However, when its progressive and significant, it causes loss of length and horizontal offset, and when symptomatic warrants a revision. Materials and methods: A retrospective radiological review of the patient database was carried out to identify all patients with age ≥ 70 years who underwent elective hip arthroplasty using uncemented HA coated collared stem and had radiographs at 1 year follow up. A total of 176 patients were identified from January 2009 to June 2010. 2 independent investigators classified the proximal femur based on Dorr type and calculated the subsidence based on Engh and Massin method of calculating the distance between the tip of greater trochanter and shoulder of the prosthesis. Results: 7 patients (4 Bs, 2 As, 1 C) had a subsidence of ≥ 2 mm (2–3.2 mm) at 1 year. None of them was symptomatic. 1 of them was secondary to a missed calcar crack and continued to subside for 9 mm before it stabilised on the lesser trochanter at 4 years follow up. There were Dorr 22 (12.5%) type A, 147(83.5%) type B and 7(4%) type C. The mean age was 77.4 years (70–91 years) and male: female ratio was 7:15. 3 patients had an intraoperative calcar crack requiring cabling. All were mobilised full weight-bearing postoperatively, and none had a subsidence of >2 mm at 1 year follow-up. Discussion: Our subgroup analysis identified that subsidence can happen when the collar is “non-functional” and the initial press fit of the stem wasn’t achieved. It can also occur in an event of calcar crack, which is missed intraoperatively. In cases of calcar crack which went on to have to cable during the primary procedure, it neither changed the post-operative rehabilitation nor did it show an increased risk of subsidence. Conclusion: A fully hydroxyapatite (HA) coated collared stem, when used in elderly age group for elective THR, has only 2% risk of intraoperative periprosthetic fracture. There’s a 4% risk of radiologically significant subsidence (i.e. ≥2 mm), however, it has not proven to be clinically significant in our study. Dorr canal type had no bearing on either risk of periprosthetic fracture or subsidence. Collared stems did not have a statistically significant difference in risk of subsidence and peri-prosthetic fracture in comparison to un-collared stem, although there was a non-significant trend in favour of collar use.

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ARTHROSCOPIC TREATMENT OF POSTERIOR ANKLE IMPINGEMENT IN PEDIATRIC ATHLETES AND ITS OUTCOMES - A PROSPECTIVE STUDY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00030 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0003

Author(s):

Indranil Kushare ◽

Ramesh Ghanta ◽

Sachin Allahabadi ◽

Kristen Kastan ◽

Tracie Stone ◽

...

Keyword(s):

Prospective Study ◽

Conservative Management ◽

Ankle Arthroscopy ◽

Arthroscopic Treatment ◽

Lateral Part ◽

Ankle Impingement ◽

Posterior Ankle Impingement ◽

Posterior Ankle Arthroscopy ◽

Vas Scores

Background: Posterior ankle impingement (PAI) is a known cause of posterior ankle pain in athletes performing repetitive plantarflexion motions, such as in soccer. Even though it is well-described in adults, literature on PAI in pediatric patients is scarce. Purpose: The purpose was to describe prospective outcomes after arthroscopic management of posterior ankle impingement in pediatric and adolescent patients. Methods: An IRB-approved prospective study was performed at a tertiary children’s hospital from 2016-2020. Patients <18 years of age who were diagnosed with posterior ankle impingement and underwent posterior ankle arthroscopy with minimum 3-month post-operative follow-up were included. Data collected included pre-operative demographics and sporting activities, clinical and radiologic findings. Visual Analogue Scale (VAS) scores, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were collected at the initial and follow-up visits. Results: A total of 50 patients (65 ankles; 28 females), were included with mean age 13.3 years. Football and soccer were the most commonly implicated sports. All patients underwent initial conservative management including relative rest, immobilization and/or physical therapy for an average period of 44 weeks. The indication for surgery was failure of conservative management to improve symptoms. All patients underwent posterior ankle arthroscopy with arthroscopic confirmation of impingement pathology followed by debridement. The pathology was predominantly bony (Os trigonum, Stieda process) in 54%, and predominantly soft tissue (low flexor hallucis longus belly, ganglion cyst in the ankle, hypertrophied posterior ankle ligaments) in 46%. All 50 patients (100%) returned to sports at an average 8.5 ± 4.1 weeks. 51 ankles had radiographs done at 1 years post-operatively which did not show recurrence or any new osseous abnormalities. At mean follow up of 26 months, there was a statistically significant improvement in VAS scores (7.0 to 0.53, p<0.05) and AOFAS scores (63.9 to 95.6, p<0.05) from pre- to post-operative final follow-up. Complications included numbness over lateral part of the heel (sural nerve distribution) in 1 patient. Conclusion: The first prospective study on pediatric PAI demonstrates that arthroscopic treatment, after failed conservative management, allowed patients to return to prior level of activity and sports, and resulted in improved pain relief and higher functional parameters. Complications associated with this procedure were minimal.

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Lateral open wedge calcaneus osteotomy with bony allograft augmentation in adult acquired flatfoot deformity. Clinical and radiological results

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-021-02888-3 ◽

2021 ◽

Author(s):

Gabriele Colo’ ◽

Mattia Alessio Mazzola ◽

Giulio Pilone ◽

Giacomo Dagnino ◽

Lamberto Felli

Keyword(s):

Range Of Motion ◽

Case Series ◽

Deformity Correction ◽

Tibialis Posterior ◽

Open Wedge ◽

Foot And Ankle ◽

Retrospective Case ◽

Level Of Evidence ◽

Adult Acquired Flatfoot Deformity

Abstract The aim of this study is to evaluate the results of patients underwent lateral open wedge calcaneus osteotomy with bony allograft augmentation combined with tibialis posterior and tibialis anterior tenodesis. Twenty-two patients underwent adult-acquired flatfoot deformity were retrospectively evaluated with a minimum 2-year follow-up. Radiographic preoperative and final comparison of tibio-calcaneal angle, talo–first metatarsal and calcaneal pitch angles have been performed. The Visual Analog Scale, American Orthopedic Foot and Ankle Score, the Foot and Ankle Disability Index and the Foot and Ankle Ability Measure were used for subjective and functional assessment. The instrumental range of motion has been also assessed at latest follow-up evaluation and compared with preoperative value. There was a significant improvement of final mean values of clinical scores (p < 0.001). Nineteen out of 22 (86.4%) patients resulted very satisfied or satisfied for the clinical result. There was a significant improvement of the radiographic parameters (p < 0.001). There were no differences between preoperative and final values of range of motion. One failure occurred 7 years after surgery. Adult-acquired flatfoot deformity correction demonstrated good mid-term results and low recurrence and complications rate. Level of evidence Level 4, retrospective case series.

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Differences in femoral component subsidence rate after THA using an uncemented collarless femoral stem: full weight-bearing with an enhanced recovery rehabilitation versus partial weight-bearing

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03913-0 ◽

2021 ◽

Author(s):

Franziska Leiss ◽

Julia Sabrina Götz ◽

Matthias Meyer ◽

Günther Maderbacher ◽

Jan Reinhard ◽

...

Keyword(s):

Risk Factors ◽

Enhanced Recovery ◽

Weight Bearing ◽

Femoral Stem ◽

Full Weight Bearing ◽

Partial Weight Bearing ◽

Fill Ratio ◽

Stem Subsidence ◽

Partial Weight

Abstract Background Femoral component subsidence is a known risk factor for early failure of total hip arthroplasty (THA) using cementless stems. The aim of the study was to compare an enhanced recovery concept with early full weight-bearing rehabilitation and partial weight-bearing on stem subsidence. In addition, the influence of patient-related and anatomical risk factors on subsidence shall be assessed. Methods One hundred and fourteen patients underwent primary cementless THA and were retrospectively analyzed. Sixty-three patients had an enhanced recovery rehabilitation with early full weight-bearing and 51 patients had rehabilitation with partial weight-bearing (20 kg) for 6 weeks. Postoperative subsidence was analyzed on standing pelvic anterior–posterior radiographs after 4 weeks and 1 year. Subsidence was measured in mm. Anatomical and prosthetic risk factors (stem size, canal flare index, canal fill ratio as well as BMI and demographic data) were correlated. Results Femoral stem subsidence rate was significantly higher for the group with an enhanced recovery concept compared to the group with partial weight-bearing at the first radiological follow up after 4 weeks [2.54 mm (SD ± 1.86) vs. 1.55 mm (SD ± 1.80)] and the second radiological follow up after 1 year [3.43 mm (SD ± 2.24) vs. 1.94 (SD ± 2.16)] (p < 0.001, respectively). Stem angulation > 3° had a significant influence on subsidence. Canal flare index and canal fill ratio showed no significant correlation with subsidence as well as BMI and age. Conclusion In the present study, cementless stem subsidence was significantly higher in the group with enhanced recovery rehabilitation compared to partial weight-bearing. Small absolute values and differences were demonstrated and therefore possibly below clinical relevance. Anatomical radiological parameters and anthropometric data did not appear to be risk factors for stem subsidence.

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Preliminary Results of Subtalar Arthroereisis with Vulpius Procedure for Symptomatic Flatfoot in Patients with Type I Osteogenesis Imperfecta

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18010067 ◽

2020 ◽

Vol 18 (1) ◽

pp. 67

Author(s):

Cheng-Min Hsu ◽

Sheng-Chieh Lin ◽

Kuan-Wen Wu ◽

Ting-Ming Wang ◽

Jia-Feng Chang ◽

...

Keyword(s):

Osteogenesis Imperfecta ◽

Weight Bearing ◽

Life Quality ◽

Type I ◽

Foot And Ankle ◽

Flexible Flatfoot ◽

Subtalar Arthroereisis ◽

Viable Approach ◽

American Orthopaedic

In this retrospective study, we aim to assess the safety and feasibility of adapting subtalar arthroereisis (SA) for type I osteogenesis imperfecta (OI) patients with symptomatic flatfoot. From December 2013 to January 2018, six type I OI patients (five girls and one boy, 12 feet) with symptomatic flexible flatfoot were treated with SA and the Vulpius procedure. All the patients were ambulatory and skeletally immature with failed conservative treatment and unsatisfactory life quality. The median age at the time of surgery was 10 years (range 5–11), and the median follow-up period was 55 months (range 33–83). All functional and radiographic parameters improved (p < 0.05) after the procedure at the latest follow-up. The median American Orthopaedic Foot and Ankle Society ankle-hindfoot scale improved from 68 (range 38–80) to 95 (range 71–97). All of the patients ambulated well without significant complications. The weight-bearing radiographs showed maintained correction of the tarsal bone alignment with intact bony surfaces adjacent to implants during the post-operative follow-up period. This is the very first study on symptomatic flatfoot in pediatric patients with type I OI. Our data suggest that SA is a potentially viable approach, as functional improvements and maintained radiographic correction without significant complication were observed.

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