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Foot & Ankle International Mar 2021Joint-preserving procedures of the ankle may postpone the need for ankle arthrodesis (AA) or total ankle replacement (TAR). The challenge for the surgeon is to determine...
BACKGROUND
Joint-preserving procedures of the ankle may postpone the need for ankle arthrodesis (AA) or total ankle replacement (TAR). The challenge for the surgeon is to determine which patients may benefit from these joint-preserving procedures. We hypothesized that patents with less than 2 mm of ankle joint space on preoperative radiographs would report inferior outcomes following joint-preserving surgery compared with those with 2 mm or greater joint space.
METHODS
Patients 18 years of age or older treated with joint-preserving ankle surgery with a minimum of 2 years of follow-up were considered for study inclusion. The ankle joint space was measured on standardized weightbearing preoperative radiographs. At follow-up, patients completed questionnaires including the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales, the Short Form-12 (SF-12) Physical Component Summary and Mental Component Summary, the Tegner Activity Scale, and satisfaction with outcome.
RESULTS
A total of 251 patients were included in the study. Forty-three patients had an ankle joint space of less than 2 mm. Compared with the 208 patients with an ankle joint space of 2 mm or greater, they had inferior FAAM ADL, FAAM Sports, and SF-12 Physical Component Summary scores ( = .001, = .001, and = .006, respectively). Additionally, a statistically significant positive correlation between joint space distance and the FAAM ADL ( = .012, = 0.158), FAAM Sports ( < .001, = 0.301), and SF-12 Physical Component Summary ( < .010, = 0.163) scores was found.
CONCLUSION
Patients with a preoperatively narrowed ankle joint space of less than 2 mm had significantly lower outcome scores following joint-preserving ankle surgery compared with patients with preserved ankle joint space. These results may assist clinicians in selecting patients who may benefit from ankle joint-preserving procedures, as well as counseling patients with a narrowed ankle joint space regarding expected outcome after joint-preserving ankle surgery.
LEVEL OF EVIDENCE
Level II, prognostic comparative study.
Topics: Activities of Daily Living; Adolescent; Adult; Ankle Joint; Arthroplasty, Replacement, Ankle; Humans; Sports; Surveys and Questionnaires; Tibia
PubMed: 33030037
DOI: 10.1177/1071100720962490 -
The Bone & Joint Journal Aug 2023The aim of this study was to capture 12-month outcomes from a representative multicentre cohort of patients undergoing total ankle arthroplasty (TAA), describe the...
AIMS
The aim of this study was to capture 12-month outcomes from a representative multicentre cohort of patients undergoing total ankle arthroplasty (TAA), describe the pattern of patient-reported outcome measures (PROMs) at 12 months, and identify predictors of these outcome measures.
METHODS
Patients listed for a primary TAA at 19 NHS hospitals between February 2016 and October 2017 were eligible. PROMs data were collected preoperatively and at six and 12 months including: Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ (foot and ankle)) and the EuroQol five-dimension five-level questionnaire (EQ-5D-5L). Radiological pre- and postoperative data included Kellgren-Lawrence score and implant position measurement. This was supplemented by data from the National Joint Registry through record linkage to determine: American Society of Anesthesiologists (ASA) grade at index procedure; indication for surgery, index ankle previous fracture; tibial hind foot alignment; additional surgery at the time of TAA; and implant type. Multivariate regression models assessed outcomes, and the relationship between MOXFQ and EQ-5D-5L outcomes, with patient characteristics.
RESULTS
Data from 238 patients were analyzed. There were significant improvements in MOXFQ and EQ-5D-5L among people who underwent TAA at six- and 12-month assessments compared with preoperative scores (p < 0.001). Most improvement occurred between preoperative and six months, with little further improvement at 12 months. A greater improvement in MOXFQ outcome postoperatively was associated with older age and more advanced radiological signs of ankle osteoarthritis at baseline.
CONCLUSION
TAA significantly benefits patients with end-stage ankle disease. The lack of substantial further overall change between six and 12 months suggests that capturing PROMs at six months is sufficient to assess the success of the procedure. Older patients and those with advanced radiological disease had the greater gains. These outcome predictors can be used to counsel younger patients and those with earlier ankle disease on the expectations of TAA.
Topics: Humans; Ankle; Treatment Outcome; Arthroplasty, Replacement, Ankle; Ankle Joint; Outcome Assessment, Health Care
PubMed: 37524340
DOI: 10.1302/0301-620X.105B8.BJJ-2022-1242.R1 -
Clinics in Podiatric Medicine and... Jan 2024Successful outcomes in the surgical treatment of the fractured ankle require methods that respect the soft tissue envelope and establish a stable mortise for functional... (Review)
Review
Successful outcomes in the surgical treatment of the fractured ankle require methods that respect the soft tissue envelope and establish a stable mortise for functional rehabilitation. Ankle fractures in patients with osteopenia and in diabetic patients with deranged bone remodeling constitute high-risk injuries that may result in catastrophic complications. These patients present unique care challenges and should not be approached in the same manner as their healthy counterparts. We present the principles of treatment in high-risk ankle fractures, operative treatment philosophy illustrating techniques frequently used at our institution, and a review of current literature.
Topics: Humans; Ankle Fractures; Fracture Fixation, Internal; Ankle Injuries; Ankle; Ankle Joint; Treatment Outcome; Retrospective Studies
PubMed: 37951680
DOI: 10.1016/j.cpm.2023.06.003 -
Foot and Ankle Clinics Sep 2023
Topics: Humans; Ankle; Ankle Joint; Foot Diseases; Postoperative Care
PubMed: 37536827
DOI: 10.1016/j.fcl.2023.05.013 -
Clinics in Podiatric Medicine and... Jan 2022Children with cerebral palsy (CP) are at a high risk of developing foot and ankle deformities that can impact function, brace/shoe fit, and seating. The 3 commonly... (Review)
Review
Children with cerebral palsy (CP) are at a high risk of developing foot and ankle deformities that can impact function, brace/shoe fit, and seating. The 3 commonly observed foot and ankle segmental malalignment patterns include equinus, planovalgus, and equinovarus. Assessment of foot deformities is multifaceted, requiring the collection and integration of data from a combination of sources that include the clinical history, standardized physical examination, observational and quantitative gait analysis, GMFCS classification, and radiographic findings. Surgical procedures are determined by identifying all segmental malalignments and assessing the contribution of dynamic or flexible soft-tissue imbalance, fixed soft-tissue imbalance, and skeletal deformities.
Topics: Ankle; Ankle Joint; Cerebral Palsy; Child; Clubfoot; Gait; Humans; Physical Examination
PubMed: 34809794
DOI: 10.1016/j.cpm.2021.09.001 -
Foot and Ankle Clinics Jun 2023Ankle microinstability results from the superior fascicle of anterior talofibular ligament (ATFL) injury and is a potential cause of chronic pain and disability after an... (Review)
Review
Ankle microinstability results from the superior fascicle of anterior talofibular ligament (ATFL) injury and is a potential cause of chronic pain and disability after an ankle sprain. Ankle microinstability is usually asymptomatic. When symptoms appear, patients describe a subjective ankle instability feeling, recurrent symptomatic ankle sprains, anterolateral pain, or a combination of them. A subtle anterior drawer test can usually be observed, with no talar tilt. Ankle microinstability should be initially treated conservatively. If this fails, and because superior fascicle of ATFL is an intra-articular ligament, an arthroscopic procedure is recommended to address.
Topics: Humans; Ankle; Ankle Joint; Joint Instability; Lateral Ligament, Ankle; Ligaments, Articular; Sprains and Strains
PubMed: 37137627
DOI: 10.1016/j.fcl.2023.01.008 -
Clinics in Podiatric Medicine and... Oct 2022Surgical reconstruction of Charcot arthropathy in the foot and ankle is extremely difficult. The fundamentals of reconstruction are necessary to provide adequate... (Review)
Review
Surgical reconstruction of Charcot arthropathy in the foot and ankle is extremely difficult. The fundamentals of reconstruction are necessary to provide adequate outcome. Removing and resecting the diseased bone is needed along with good anatomic alignment and rigid fixation. This reconstructive surgery is not only difficult from medical management point of view but also involves patient compliance and good technical components of the surgery from the surgeon. The surgeon must have skills with internal and external fixation, a good understanding of lower extremity vascular disease, and a good understanding of infectious disease and plastic surgical techniques of the lower extremity.
Topics: Ankle; Ankle Joint; Arthropathy, Neurogenic; Diabetic Foot; Humans; Lower Extremity; Plastics
PubMed: 36180196
DOI: 10.1016/j.cpm.2022.06.001 -
Seminars in Musculoskeletal Radiology Dec 2022This article reviews situations in which surgical treatment is required in the context of different types of pathology in the foot and ankle of children, focusing on the... (Review)
Review
This article reviews situations in which surgical treatment is required in the context of different types of pathology in the foot and ankle of children, focusing on the role of imaging in surgical planning and postsurgical assessment. The types of pathology analyzed from this perspective are congenital pathology, neuromuscular disorders, osteochondral lesions, fractures and infection, ligament injuries, and tumors.We address the most common pitfalls of postsurgical imaging of the ankle and foot in children. With some exceptions, postsurgical follow-up focuses on clinical assessment, with imaging follow-up only needed in patients where complications are suspected or symptoms recur. Postoperative assessment of the foot and ankle in children and adolescents requires knowing the indications for surgery and the most common types of interventions, along with their imaging characteristics. The radiologist needs to be aware of the normal sequence of development of structures and how to select adequate imaging techniques to assess anatomy at various stages or in different postsurgical scenarios.
Topics: Adolescent; Humans; Child; Ankle; Magnetic Resonance Imaging; Ankle Joint; Joint Diseases; Fractures, Bone; Foot Injuries
PubMed: 36791743
DOI: 10.1055/s-0042-1760244 -
Clinics in Podiatric Medicine and... Oct 2023Ankle arthrodesis has been a time-tested procedure for osteoarthritis, avascular necrosis of the talus, deformity correction, and significant trauma of the ankle.... (Review)
Review
Ankle arthrodesis has been a time-tested procedure for osteoarthritis, avascular necrosis of the talus, deformity correction, and significant trauma of the ankle. Technique guides have created dissection pearls, ease of fixation, and arthroscopic techniques to mitigate complications of the procedure. Major complications, such as nonunion, malunion, or implant infection are the most worrisome and cumbersome complications to handle. The aim of this article is to provide the practicing surgeon evidence to provide innovative management techniques for nonunion, malunion, and infection following primary ankle arthrodesis.
Topics: Humans; Ankle Joint; Ankle; Arthrodesis; Osteoarthritis; Osteonecrosis
PubMed: 37716746
DOI: 10.1016/j.cpm.2023.05.011 -
Clinics in Podiatric Medicine and... Jul 2021The varus ankle and cavus foot pose challenges in surgical correction with regard to total ankle replacement surgery. Etiology of cavus foot type and varus ankle must be... (Review)
Review
The varus ankle and cavus foot pose challenges in surgical correction with regard to total ankle replacement surgery. Etiology of cavus foot type and varus ankle must be evaluated and confirmed. Pes cavus is increased height of the arch with metatarsus adductus and increased calcaneal inclination angle. There often is intrinsic musculature irregularity leading to imbalance of the foot. Although not all cavus foot types and varus ankle deformities are sequelae of neuromuscular disorder, neurologic etiology must be considered. Attaining neutral alignment of ankle joint articular surface is paramount to longevity and functionality of ankle joint replacement implant.
Topics: Ankle Joint; Arthroplasty, Replacement, Ankle; Humans; Lateral Ligament, Ankle; Osteotomy; Talipes Cavus
PubMed: 34053657
DOI: 10.1016/j.cpm.2021.03.003