Lisfranc injuries account for 0.2% of all fractures and have been linked to poorer functional outcomes, in particular resulting in post-traumatic arthritis, midfoot collapse and chronic pain. This study assesses the longitudinal functional outcomes in patients with low and high energy Lisfranc injuries treated both operatively and non-operatively.

Patients above 16 years with Lisfranc injuries from January 2008 and December 2017 were identified through the Victorian Orthopaedic Trauma Outcomes (VOTOR) registry. Follow-up performed at 6, 12 and 24 months through telephone interviews with response rate of 86.1%, 84.2% and 76.2% respectively. Longitudinal functional outcome data using Global Outcome Assessment, EQ-5D-5L, numerical pain scale, Short-Form 12, the WHO Disability Assessment Schedule and return to work status were collected. Univariate analysis was performed and variables showing a significant difference between groups (p < 0.25) were analysed with multivariable mixed effects regression model.

745 patients included in this retrospective cohort study. At 24 months, both the operative and non-operative groups demonstrated similar functional outcomes trending towards an improvement. Mixed effect regression models for the EQ items for mobility (OR 1.80, CI 0.91 – 3.57), self-care (OR 1.95, 95% CI 1.09-3.49), usual activities (OR 1.10, 95% CI 0.99-1.03), pain (OR 1.07, 95% CI 0.61-1.89), anxiety (OR 1.29, 95% CI 0.72-2.34) and pain scale (OR 1.07, 95% CI 0.51 – 2.22) and return to work (OR 1.28, 95% CI 0.56-2.91) between groups were very similar and not statistically significantly different.

We concluded that there was no statistically significant difference between operative and non-operative patients with low and high energy Lisfranc injuries. Current clinical practices in Lisfranc injury management are appropriate and not inadvertently causing any further harm to patients. Future research comparing fracture patterns, fixation types and corresponding functional outcomes can help determine gold standard Lisfranc injury management.

The treatment of osteochondral lesions in the ankle joint remains a challenging problem. While debridement and drilling or microfracture of the lesion reduce symptoms initially, long-term stability of the fibrous repair tissue is questionable. Osteochondral transplantation or mosaicplasty provide hyaline cartilage and repair the bony defect at the same time. However, an open arthrotomy with medial, lateral or anterior osteotomy is necessary to repair lesions of the talus. Lesions of the distal tibia cannot be reached. Matrix Associated Chondrocyte Implantation (MACI) has been shown to produce hyaline like cartilage repair tissue, and the implantation can be performed arthroscopically. Long term follow up studies (up to 10 years) in the knee demonstrate promising results.

The purpose of this study was to assess the efficacy of arthroscopic MACI for the treatment of osteochondral lesions in the ankle joint. We reviewed all patients (n=20) who had arthroscopic MACI treatment (n=22) between February 2006 and November 2008 clinically (Foot Function Index, AAOS Foot and Ankle Questionnaire, AOFAS-Hindfoot Score) and with MRI (3 Tesla Siemens MRI).

The clinical results and MRI findings up to three years after MACI were compared to pre-operative data. Possible correlations with the individual history and the nature, size or location of the lesion will be discussed. The surgical technique will be described. The results of the procedure are promising.

Arthroscopic ankle arthrodesis is an alternative to more traditional open techniques. Potential advantages include more rapid time to union, decreased complication rate, shorter hospital stay and more rapid rehabilitation. Advances in instrumentation and techniques have made the procedure more reproducible and easier to perform. The literature on the subject is reviewed including the indications and contraindications. The surgical technique is also presented along with the potential surgical pitfalls.

Introduction

Although the majority of patients with plantar fasciitis respond to non- surgical management, between 5 and 10% of patients require surgical intervention. The aim of this study is to compare the results of open plantar fascia release with the results following a less invasive endoscopic release.