Clinical and functional outcomes of Lambrinudi arthrodesis for correcting fixed equinus deformity

Objective: To evaluate the clinical and functional outcomes of correction of fixed equinus deformity by Lambrinudi arthrodesis. Methods: Eight patients with fixed equinus deformity were retrospectively assessed. Of these patients, three cases developed secondary to Charcot-Marie-Tooth disease, and five cases developed secondary to fibular nerve injury following trauma. All patients underwent Lambrinudi arthrodesis using the open technique, and functional improvement was analysed postoperatively. The mean age of the patients was 27 years and six months, and six patients were men. Results: The results were evaluated using the ankle and hindfoot score of the American Orthopedic Foot and Ankle Society (AOFAS) scale. The mean score in the postoperative period was 61.71 points, ranging from 41 to 74 points. The difference in the tibia-ground angle in the pre- and postoperative period was measured, and there was a significant correction of this angle. Conclusion: The outcomes of Lambrinudi arthrodesis in patients with fixed equinus deformity were satisfactory concerning the improvement of pain, gait, a high degree of correction of the deformity according to the difference in the tibia-ground angle between the pre- and postoperative period, and preservation of the ankle joint. Level of Evidence IV; Therapeutic Studies; Case Series.

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Minimally Invasive Double-Button Fixation of Displaced Lateral Clavicular Fractures in Athletes

The American Journal of Sports Medicine ◽

10.1177/0363546516666816 ◽

2016 ◽

Vol 45 (2) ◽

pp. 462-467 ◽

Cited By ~ 6

Author(s):

Maximiliano Ranalletta ◽

Luciano A. Rossi ◽

Hugo Barros ◽

Francisco Nally ◽

Ignacio Tanoira ◽

...

Keyword(s):

Minimally Invasive ◽

Closed Reduction ◽

Functional Outcomes ◽

Constant Score ◽

Case Series ◽

Return To Sport ◽

Return To Play ◽

Short Version ◽

Level Of Evidence ◽

The Mean

Background: Early union and a rapid return to prior function are the priorities for young athletes with lateral clavicular fractures. Furthermore, it is essential to avoid nonunion in this subgroup of patients, as this is frequently associated with persistent pain, restriction of movement, and loss of strength and endurance of the shoulder. Purpose: To analyze the time to return to sport, functional outcomes, and complications in a group of athletes with displaced lateral clavicular fractures treated using closed reduction and minimally invasive double-button fixation. Study Design: Case series; Level of evidence, 4. Methods: A total of 21 athletes with displaced lateral clavicular fractures were treated with closed reduction and minimally invasive double-button fixation between March 2008 and October 2013. Patients completed a questionnaire focused on the time to return to sport and treatment course. Functional outcomes were assessed with the Constant score and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Pain was evaluated with the visual analog scale (VAS). Radiographs were reviewed to identify radiographic union, malunion, and nonunion. Results: Of the 21 study patients, 20 returned to sport after treatment; 100% returned to the same level. The mean time to return to play was 78 days (range, 41-120 days). Four patients (20%) returned to sport less than 6 weeks after surgery, 14 (70%) returned between 6 and 12 weeks after surgery, and 2 (10%) returned after 12 weeks. The mean Constant score was 89.1 ± 4.2 (range, 79-100), the mean QuickDASH score was 0.4 ± 2.6 (range, 0-7.1), and the mean VAS pain score was 0.4 ± 1.0 (range, 0-3) at final follow-up (mean, 41 months). The only complication was asymptomatic nonunion. Hardware removal was not necessary in any patient. Conclusion: Closed reduction and minimally invasive double-button fixation of displaced lateral clavicular fractures in athletes was successful in terms of returning to the previous level of athletic activity regardless of the type of sport, with excellent clinical results and a low rate of complications.

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Efficacy of triple surgery for cavovarus foot in Charcot-Marie-Tooth disease

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2021.v15.1222 ◽

2021 ◽

Vol 15 (1) ◽

pp. 19-25

Author(s):

Luciene Moré ◽

Noé De Marchi Neto ◽

Ricardo Ferreira

Keyword(s):

Case Series ◽

Final Analysis ◽

Pain Scale ◽

Functional Improvement ◽

Radiographic Evaluation ◽

Level Of Evidence ◽

Charcot Marie Tooth ◽

Charcot Marie Tooth Disease ◽

Numerical Scale ◽

Tooth Disease

Objective: To evaluate the efficacy of surgical treatment to correct the main deformities associated with flexible cavovarus foot due to Charcot-Marie-Tooth disease. Methods: Fifteen patients (18 feet) with flexible cavovarus feet due to Charcot-Marie-Tooth disease were evaluated and underwent surgery between 2000 and 2015. We used a “triple surgery” protocol: a combination of plantar fasciotomy, valgus-inducing osteotomy of the calcaneus, and lengthening osteotomy of the first metatarsal. After a mean follow-up time of 105 (48 to 198) months, we developed a numerical scale to assess the main aspects of patient complaints: pain (3 points), function (3 points) and deformity (4 points). The scale considered the results of the visual analog pain scale, the American Orthopedic Foot and Ankle Society Scale, and the Coleman block test, as well as clinical and radiographic evaluation of gait and cavovarus deformities. Results: According to the numerical scale, the results were considered satisfactory in 15 of the 18 feet (84%) and unsatisfactory in 3 (16%). Conclusion: In the medium term, the “triple surgery” protocol proved efficient for correcting cavovarus deformities, providing functional improvement while preserving mobility without pain complaints. In the final analysis, through the “triple surgery” protocol, early indication for arthrodesis can be avoided, postponing sacrifice of the hindfoot joints. Level of Evidence IV; Therapeutic Studies; Case Series.

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Correlation Between Gastrocnemius Tightness and Heel Pain Severity in Plantar Fasciitis

Foot & Ankle International ◽

10.1177/1071100720955144 ◽

2020 ◽

pp. 107110072095514

Author(s):

Christopher J. Pearce ◽

Dexter Seow ◽

Bernard P. Lau

Keyword(s):

Plantar Fasciitis ◽

Case Series ◽

Heel Pain ◽

Level Of Evidence ◽

Data Points ◽

The Mean ◽

The Difference ◽

Night Splint ◽

Gastrocnemius Tightness

Background: It is known that there is an association between gastrocnemius tightness and plantar fasciitis, but this has never been quantified. The purpose of the study was to determine the correlation between gastrocnemius tightness and the severity of heel pain in plantar fasciitis. Methods: Thirty-three patients were prescribed physiotherapist-directed gastrocnemius stretching exercises, a Strassburg Sock or night splint, and silicone heel insoles as required. Outcome measures included (1) gastrocnemius tightness, (2) 100-mm visual analog scale (VAS) for pain on the first steps in the morning, and (3) 100-mm VAS for the worst pain felt during the previous week. Gastrocnemius tightness was measured by the difference in maximal ankle dorsiflexion between knee bent and straight with a goniometer. Results: The mean gastrocnemius tightness was 22 degrees at baseline compared with 9 degrees at the final follow-up ( P < .01). A reduction in VAS for pain on the first steps in the morning and VAS for the worst pain felt during the previous week from baseline to final follow-up was observed ( P < .01). Correlation analysis of 105 data points between gastrocnemius tightness and VAS for pain on the first steps in the morning was R = 0.757 ( P < .001), and between gastrocnemius tightness and VAS for the worst pain felt during the previous week was R = 0.781 ( P < .001). Conclusion: The study observed a strong, statistically significant correlation between gastrocnemius tightness and the severity of heel pain in plantar fasciitis. Level of Evidence: Level IV, case series.

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Medial Ulnar Collateral Ligament Repair With Internal Brace Augmentation: Results in 40 Consecutive Patients

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211014230 ◽

2021 ◽

Vol 9 (7) ◽

pp. 232596712110142

Author(s):

Robert O’Connell ◽

Marcus Hoof ◽

John Heffernan ◽

Michael O’Brien ◽

Felix Savoie

Keyword(s):

Functional Outcomes ◽

Case Series ◽

Ulnar Collateral Ligament ◽

Return To Play ◽

Collateral Ligament ◽

Level Of Evidence ◽

Orthopaedic Clinic ◽

Overhead Athletes ◽

Internal Brace ◽

The Mean

Background: Medial ulnar collateral ligament (MUCL) repair has been proven to be effective in nonprofessional overhead-throwing athletes, with faster and higher rates of return to play (RTP) than the more traditional Tommy John reconstruction. Biomechanical studies and clinical data suggest that MUCL repair augmented with a collagen-coated internal brace may be an effective treatment option in this patient population. Purpose: To evaluate the functional outcomes of young nonprofessional athletes who underwent MUCL repair with internal brace augmentation for medial elbow instability. The hypothesis was that these patients will have high rates of RTP and improved functional outcomes. Study Design: Case series; Level of evidence, 4. Methods: Nonprofessional overhead athletes treated with MUCL repair with internal brace augmentation between 2015 and 2017 were prospectively evaluated for a minimum of 1 year. Preoperatively, all patients had evidence of medial elbow pain caused by MUCL insufficiency, as confirmed by signal changes on magnetic resonance imaging and valgus instability on arthroscopic examination. These findings did not allow them to participate in their chosen sport or profession, and each patient had failed nonoperative treatment. Postoperative outcomes were evaluated using the Overhead Athlete Shoulder and Elbow Score of the Kerlan-Jobe Orthopaedic Clinic. Complications were recorded and detailed. Results: A total of 40 nonprofessional overhead athletes were included in this study (35 men and 5 women; mean age, 17.8 years [range, 14-28 years]). The mean follow-up time was 23.8 months (range, 12-44 months). The mean postoperative Kerlan-Jobe Orthopaedic Clinic score was 92.6 (range, 64-100). Overall, 37 athletes (92.5%) returned to play or profession at the same level or higher at a mean time of 6.9 months (range, 2-12 months). Three patients did not RTP: 1 was limited by a concomitant medical diagnosis, and the other 2 chose not to resume athletics after the procedure but remained symptom free. Conclusion: In the nonprofessional athlete, primary MUCL repair with internal brace augmentation is a viable alternative to traditional repair techniques or reconstruction, allowing for a rapid RTP and promising functional outcomes.

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

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2021.v15.1239 ◽

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.

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

Foot & Ankle Specialist ◽

10.1177/1938640019895919 ◽

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

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Superior Labral Injuries in Elite Gymnasts: Symptoms, Pathology, and Outcomes After Surgical Repair

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120935001 ◽

2020 ◽

Vol 8 (7) ◽

pp. 232596712093500

Author(s):

Yasutaka Takeuchi ◽

Hiroyuki Sugaya ◽

Norimasa Takahashi ◽

Keisuke Matsuki ◽

Morihito Tokai ◽

...

Keyword(s):

Arthroscopic Surgery ◽

Case Series ◽

Return To Sport ◽

Labral Repair ◽

Level Of Evidence ◽

Baseball Players ◽

Slap Lesions ◽

Type Iv ◽

The Mean ◽

The Difference

Background: Superior labral anterior-posterior (SLAP) lesions are common among elite gymnasts and throwing athletes. Although SLAP lesions in throwers are well-described in the literature, no study has described the characteristics of SLAP lesions in gymnasts. We aimed to reveal the characteristics of SLAP lesions in gymnasts by comparing the location and extension of these lesions between gymnasts and throwers. Hypothesis: The location and arc of SLAP lesions in gymnasts will be different from those in throwing athletes. Study Design: Case series; Level of evidence, 4. Methods: This study included 27 shoulders in 20 males and 3 females with a mean ± SD age of 20 ± 2.5 years (range, 16-25 years). We performed debridement alone for shoulders with a stable lesion. Anterior and/or posterior labral repair was added for unstable SLAP lesions depending on the extension and stability of the lesions. We investigated symptoms, onset, return to sport (based on patient records), and subjective shoulder values. SLAP lesions were evaluated through use of the Snyder classification. The location and arc of SLAP lesions were determined from surgical records and videos and described by use of the right shoulder clockface method. During the same period, 65 baseball players (65 shoulders; all males; mean age, 23 ± 7.0 years; range, 16-44 years) underwent arthroscopic SLAP surgery. We compared the location and arc of SLAP lesions between gymnasts and baseball players. Results: Symptoms during gymnastics included pain (100%), apprehension (48%), or catching (11%). We found that 20 shoulders had symptom onset during gymnastics, most commonly during rings events. Type II SLAP lesions were found in 17 shoulders, type III in 2 shoulders, and type IV in 8 shoulders. The mean center of SLAP lesions was at the 11:40 clockface position in 27 gymnasts and 10:40 clockface position in 65 baseball players, and the difference was statistically significant ( P < .001). The mean arc of SLAP lesions was 125° in gymnasts and 140° in baseball players, and the difference was not significant. We performed debridement in 2 shoulders (7%) and labral repair in 25 shoulders (93%). After surgery, all patients returned to gymnastics. The mean subjective shoulder value was 35 (range, 10-90) preoperatively and 76 (range, 40-100) postoperatively. Conclusion: SLAP lesions in gymnasts were significantly located anteriorly compared with those in baseball players. All patients returned to gymnastics after arthroscopic surgery. Secure repair of SLAP lesions may be important for good surgical outcomes, because 50% of patients experienced preoperative shoulder apprehension.

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Polyurethane Meniscal Scaffold: Does Preoperative Remnant Meniscal Extrusion Have an Influence on Postoperative Extrusion and Knee Function?

The Journal of Knee Surgery ◽

10.1055/s-0040-1710377 ◽

2020 ◽

Author(s):

Pablo E. Gelber ◽

Raúl Torres-Claramunt ◽

Francesco Poggioli ◽

Daniel Pérez-Prieto ◽

Joan C. Monllau

Keyword(s):

Functional Outcomes ◽

Case Series ◽

Meniscal Extrusion ◽

Level Of Evidence ◽

Meniscal Scaffold ◽

Functional Scores ◽

The Mean ◽

Group 2 ◽

Group 1

AbstractMeniscal extrusion (ME) has been identified as a risk factor in the development of knee osteoarthritis. The relevance of this finding when a meniscal scaffold is used has not been extensively studied. The objective of this study was to determine whether preoperative meniscal remnant extrusion (MRE) was correlated with postoperative scaffold extrusion (SE) or with functional outcomes at the 2-year follow-up. Retrospective study included all polyurethane scaffolds implanted with a minimum 2-year follow-up. A magnetic resonance imaging (MRI) was performed preoperatively and postoperatively at 2 years. Extrusion was measured in millimeters in a coronal view. Patients were assigned to either group 1 or 2 depending on the preoperative MRE being either <3 mm (minor extrusion) or 3 mm (major extrusion). Functional outcomes were analyzed by means of the Western Ontario Meniscal Evaluation Tool (WOMET), International Knee Documentation Committee, Kujala and Tegner scores, as well as visual analog scale. Satisfaction was also documented. Sixty-two out of 98 patients were available to undergo an MRI at final follow-up. The mean age was 41.3 years (range, 17–58) and the mean follow-up was 45 months (range, 25–69). The mean preoperative MRE was 2.8 mm (standard deviation [SD] 1.2) and the mean postoperative SE was 3.8 mm (SD 1.8) (p < 0.01). All functional scores improved during the study period. When the correlation (Spearman's rho) between the difference in extrusion between the pre 26 and postoperative periods and their correlation with the different scores was assessed, correlation was only observed in the WOMET (rho 0.61, p = 0.02). The preoperative MRE in Group 1 was 1.85 mm (SD 0.83) and 3.7 mm (SD 2.2) in Group 2 (p < 0.01). At final follow-up, SE was 3.86 mm (SD 0.7) in Group 1, whereas it was 3.98 mm (SD 1) in Group 2 (p = 0.81). No differences were observed in the scores used for these two groups. The SE observed at the 2-year follow-up after the implantation of a polyurethane scaffold did not depend on preoperative MRE (major or minor extrusion). The WOMET score, which was the only meniscal-specific functional scored used, showed some inferior results in the most extruded meniscal scaffolds. This is a retrospective case series. Level of evidence is 4.

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Functional evaluation of patients undergoing endoscopic calcaneoplasty for Haglund deformity

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2021.v15.1564 ◽

2021 ◽

Vol 15 (2) ◽

pp. 155-160

Author(s):

Hallan Douglas Bertelli ◽

Bruno Arvatti Michelin ◽

Isabela Ferreira Perucci ◽

Mário Sérgio Paulillo de Cillo ◽

Carlos Daniel Candido Castro Filho ◽

...

Keyword(s):

Postoperative Complications ◽

Functional Outcomes ◽

Case Series ◽

Functional Evaluation ◽

Foot And Ankle ◽

Level Of Evidence ◽

The Mean ◽

Haglund Deformity ◽

American Orthopaedic ◽

Preoperative Score

Objective: To analyze the functional outcomes of patients undergoing endoscopic calcaneoplasty for the treatment of Haglund deformity. Methods: This study consists of a case series of patients undergoing endoscopic calcaneoplasty. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, was used to evaluate patients before and 12 months after the procedure, providing preoperative and postoperative scores. Results: Nineteen patients were evaluated for a total of 24 endoscopic calcaneoplasties. The American Orthopaedic Foot and Ankle Society scale provided a mean preoperative score of 31.4 and a mean postoperative score of 93.3, which shows a significantly increased score after surgery. The mean patient age was 52 years, and the youngest patient was 25 years old and the oldest patient was 73 years old. However, no significant relationship was found between age and change in the American Orthopaedic Foot and Ankle Society score. No complications were observed in the immediate or late postoperative periods. Conclusion: Arthroscopic resection is efficient in the treatment of Haglund deformity given the significant improvement in the American Orthopaedic Foot and Ankle Society score observed after the procedure. Also, no postoperative complications were seen in patients who underwent endoscopic calcaneoplasty. Level of Evidence: IV; Therapeutic Studies; Case series.

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Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.6.peds18716 ◽

2019 ◽

Vol 24 (5) ◽

pp. 549-557

Author(s):

Malia McAvoy ◽

Heather J. McCrea ◽

Vamsidhar Chavakula ◽

Hoon Choi ◽

Wenya Linda Bi ◽

...

Keyword(s):

Conservative Management ◽

Functional Outcomes ◽

Pediatric Patients ◽

Clinical Presentation ◽

Case Series ◽

Csf Leak ◽

Single Institution ◽

The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

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