Ankle arthroplasty with custom-made talar component is used to avoid talar subsidence, one of the most common causes of ankle prosthesis failure. We have used Agility ankle system with custom-made talar component to treat young patients with postraumatic arthritis, revision arthroplasty and takedown ankle arthrodesis. Ankle substitution was indicated in young patients who refused arthrodesis and understood that revision or additional surgery would be inevitable in the future. Twelve cases were revised with a minimum of nine months of follow-up, females, 2; males, 10; average age, 42 years. Primary replacements were performed in 9 patients, takedown fusion in 2 and revision arthroplasty in 1. Other additional procedures as subtalar fusion (8 cases), calcaneal osteotomies (6), medial column reconstruction (2), anterior compartment tendon lengthening (2 cases) and TAL or gastrocnemius lengthening (12 cases) and reoperation were also revised. Early complications included a fracture of the malleoli in 1 ankle and a dehiscence of the principal wound in 1 case. The mean postoperative ankle ROM was 32° (range 10°–40°) in comparison with preoperatively (0° –15°). The postoperative functional results were evaluated with the SMFA (Short Musculoskeletal Function Assessment) score system and a visual analog pain scale (VAS Questionnaire). The average preoperative SMFA and VAS scores for all patients was, 40,6 and 8,1 respectively. Postoperatively, these scores averaged 18,9 and 2,0 respectively. Those patients with conversion to ankle arthroplasty presented more stiffness after surgery and had required more rehabilitation time. Despite short-term follow-up, talar stems may provide an excellent alternative for the difficult problem of talar subsidence in young patients in total ankle arthroplasty, with good results and restoration of ankle function.

Introduction and purpose: To assess the results of the reconstruction of osteochondral lesions and transchondral fractures of the talus by means of mosaicoplasty.

Materials and methods: 20 patients (mean age: 30) were operated on in 3.5 years, with a minimal follow-up of 6 months. There were 17 medial and 3 lateral lesions. Ferkel’s and Sgaglioni’s classifications were used for the CT images. Medial lesions were approached by means of an osteotomy of the tibial malleolus. Lateral lesions were treated either directly or through an osteotomy of the fibular malleolus. Chondral lesions were debrided; the cylindrical osteochondral grafts were harvested from either the upper part of the femoral condyle or the anterior part of the talus. They were subsequently inserted into the talar dome. An average of three grafts were used (range: 1–7 tesseras). Patients non-weight bearing for 2–4 weeks. Movement was allowed after 7 days postop.

Results: Results were assessed by means of the Hannover and the Bandi scores. With the former, 94% of cases had excellent or good results; with the latter 94.7 % results were good with no knee morbility or talar complications. Complications: one case had a superficial infection.

Conclusions: In a mosaicoplasty there is either a replacement of the damaged bone or a filling of defect in the cartilage. The rehabilitation time is short and no painful sequela remain in the donor joint.

Introduction and purpose: Posttraumatic compartmental syndromes of the deep posterior compartment of the leg are usually given an incorrect diagnosis. There can be an involvement of the three muscles of the posterior compartment (albeit to different degrees) and muscle necrosis can cause a retraction that flexes the hallux and other toes as well as varus hindfoot and various degrees of equinus and cavus, hindering gait. We revised patients operated on who had had previous tibia and fibular fractures which had led to subsequent foot deformities.

Materials and methods: Seven patients were operated on in 5 years. The whole of the fibrous scar tissue was removed from the involved muscle and tendon and a medial capsule release was performed. A subtalar arthrodesis was carried out, laterally displacing the calcaneus under the talus, to correct the varus hindfoot. In addition a transplant of the FHL was made to the base of first phalanx as well as a transplant of the EHL to the base of the first metatarsal/tibialis anterior and a tenodesis of the distal end to EHB. The small toes were treated by means of a replacement of the extensor longus by the extensor brevis and an intrinsicoplasty of every toe.

Results: Using the AOFAS ankle and hindfoot scales, the mean postop score was e 90.8 points (range: 62–100), for hallux and small toes it was 90.2 points (range: 67–100). 5 patients (71.4 %) were considered to have obtained excellent results, 1 good and 1 poor. As regards complications, there was one instance of varus recurrence and one case of late consolidation.

Conclusions: Repair after a compartmental syndrome can be successfully carried out to achieve a plantigrade foot that allows ambulation.