The foot and ankle outcome score (FAOS) has been evaluated for many conditions of the foot and ankle. We evaluated its construct validity in 136 patients with osteoarthritis of the ankle, its content validity in 37 patients and its responsiveness in 39. Data were collected prospectively from the registry of patients at our institution. All FAOS subscales were rated relevant by patients. The Pain, Activities of Daily Living, and Quality of Life subscales showed good correlation with the Physical Component score of the Short-Form-12v2. All subscales except Symptoms were responsive to change after surgery. We concluded that the FAOS is a weak instrument for evaluating osteoarthritis of the ankle. However, some of the FAOS subscales have relative strengths that allow for its limited use while we continue to seek other satisfactory outcome instruments. Cite this article: Bone Joint J 2015; 97-B:662–7

Introduction. The purpose of this study was to examine trends in patient characteristics and clinical outcomes that occur with age as a statistical variable when performing autologous osteochondral transplantation (AOT) for the treatment of osteochondral lesions of the talus (OLT). Methods. A retrospective cohort study for AOT procedures on 78 patients from 2006 to 2019. was conducted Clinical outcomes were evaluated via FAOS scores. A multivariable linear regression was used to assess the independent factors predictive of the first post-operative FAOS after AOT. The independent variables included pre-operative FAOS, age, defect size, shoulder lesion, cystic lesion, prior traumatic injury, and history of microfracture surgery. A p-value <.05 was considered significant and 95% confidence limits (95% CL) for regression coefficient estimates (est.) were calculated. Results. 78 patients were included with a mean age of 35.5 ± 13.6years at a mean follow-up was 54.4 ± 18.9 months. The mean pre-operative FAOS was 54.3 ± 19.4 and the mean post-operative FAOS was 83.4 ± 13.6. The mean defect size was 109.3±62.4 mm2. The multivariable linear regression showed that the pre-operative FAOS was associated with a higher post-operative FAOS (est., 95% CL: 0.16, 0.012 – 0.307; p=0.034). Defect size (est., 95% CL: −0.05, −0.097 – −0.003; p=0.0358), having a shoulder lesion (est., 95% CL: −9.068, −15.448 – −2.688; p=0.006), or having a prior microfracture surgery (est., 95% CL: −7.07, −13.118 – −1.021; p=0.0226) were associated with a lower post-operative FAOS. Conclusion. Patient age was not an independent risk factor for inferior clinical outcomes after AOT for OLT. Additionally, cystic lesions, or lesions with a traumatic aetiology were not significantly associated with post-operative FAOS. Having a shoulder lesion had the largest marginal effect on post-operative FAOS. These findings provide important information for providers when counseling and selecting patients for AOT procedure for treatment of OLT

Autologous osteochondral transplantation (AOT) is an effective treatment for large Osteochondral Lesions of the Talus (OLT), however little is reported on an athletic population, who are likely to place higher demands on the reconstruction. The aim is to report the outcomes of large OLT (>150mm. 2. ) within an athletic population. The study population was limited to professional or amateur athletes (Tegner score >6) with an OLT of size 150mm. 2. or greater. The surgical intervention was AOT with a donor site from the lateral femoral condyle. Clinical outcomes at a minimum of 24 months included Return to Sport, VAS and FAOS Scores. In addition, graft incorporation was evaluated by MRI using MOCART scores at 12 months post-surgery. 38 athletes including 11 professional athletes were assessed. Mean follow-up was 46 months. Mean lesion size was 249mm. 2. 33 patients returned to sport at their previous level and one did not return to sport (mean return to play 8.2 months). Visual analogue scores improved from 4.53 pre-operatively to 0.63 post-operatively (p=0.002). FAOS Scores improved significantly in all domains (p< 0.001). Two patients developed knee donor site pain, and both had three osteochondral plugs harvested. Univariant analysis demonstrated no association between pre-operative patient or lesion characteristics and ability to return to sport. However, there was a strong correlation between MOCART scores and ability to return to sport (AUC=0.89). Our study suggests that AOT is a viable option in the management of large osteochondral talar defects in an athletic population, with favourable return to sport levels, patient satisfaction, and FAOS/VAS scores. The ability to return to sport is predicated upon good graft incorporation and further research is required to optimise this technique. Our data also suggests that patients should be aware of the increased risk of developing knee donor site pain when three osteochondral plugs are harvested

Aims. The primary aim of this study was to present the mid-term follow-up of a multicentre randomized controlled trial (RCT) which compared the functional outcome following routine removal (RR) to the outcome following on-demand removal (ODR) of the syndesmotic screw (SS). Methods. All patients included in the ‘ROutine vs on DEmand removal Of the syndesmotic screw’ (RODEO) trial received the Olerud-Molander Ankle Score (OMAS), American Orthopaedic Foot and Ankle Hindfoot Score (AOFAS), Foot and Ankle Outcome Score (FAOS), and EuroQol five-dimension questionnaire (EQ-5D). Out of the 152 patients, 109 (71.7%) completed the mid-term follow-up questionnaire and were included in this study (53 treated with RR and 56 with ODR). Median follow-up was 50 months (interquartile range 43.0 to 56.0) since the initial surgical treatment of the acute syndesmotic injury. The primary outcome of this study consisted of the OMAS scores of the two groups. Results. The median OMAS score was 85.0 for patients treated with RR, and 90.0 for patients treated with ODR (p = 0.384), indicating no significant difference between ODR and RR. The secondary outcome measures included the AOFAS (88.0 in the RR group and 90.0 for ODR; p = 0.722), FAOS (87.5 in the RR group and 92.9 for ODR; p = 0.399), and EQ-5D (0.87 in the RR group and 0.96 for ODR; p = 0.092). Conclusion. This study demonstrated no functional difference comparing ODR to RR in syndesmotic injuries at a four year follow-up period, which supports the results of the primary RODEO trial. ODR should be the standard practice after syndesmotic screw fixation. Cite this article: Bone Jt Open 2023;4(12):957–963

Aims. Osteochondral lesions of the talus (OLT) are a common cause of disability and chronic ankle pain. Many operative treatment strategies have been introduced; however, they have their own disadvantages. Recently lesion repair using autologous cartilage chip has emerged therefore we investigated the efficacy of particulated autologous cartilage transplantation (PACT) in OLT. Methods. We retrospectively analyzed 32 consecutive symptomatic patients with OLT who underwent PACT with minimum one-year follow-up. Standard preoperative radiography and MRI were performed for all patients. Follow-up second-look arthroscopy or MRI was performed with patient consent approximately one-year postoperatively. Magnetic resonance Observation of Cartilage Repair Tissue (MOCART) score and International Cartilage Repair Society (ICRS) grades were used to evaluate the quality of the regenerated cartilage. Clinical outcomes were assessed using the pain visual analogue scale (VAS), Foot Function Index (FFI), and Foot Ankle Outcome Scale (FAOS). Results. All patients had ICRS grade IV cartilage lesions, except for one (ICRS grade III). The paired MOCART scores significantly improved from 42.5 (SD 1.53) to 63.5 (SD 22.60) (p = 0.025) in ten patients. Seven patients agreed to undergo second-look arthroscopy; 5 patients had grade I (normal) ICRS scores and two patients had grade II (nearly normal) ICRS scores. VAS, FFI, and all subscales of FAOS were significantly improved postoperatively (p ≤ 0.003). Conclusion. PACT significantly improved the clinical, radiological, and morphological outcomes of OLT. We consider this to be a safe and effective surgical method based on the short-term clinical results of this study. Cite this article: Bone Jt Open 2023;4(12):942–947

Introduction. Total ankle replacement as a valid treatment for end stage ankle arthritis, is gaining popularity and every year there is an increasing number of procedures. With revision rates as high as 21% at 5 years and 43% at 10 years there is a need for understanding and reporting the outcome of revision ankle replacement. Our aim was to study the patient reported outcomes following revision TAR with a minimum of 2 year follow up. Methods. All patients that underwent a revision total ankle replacement between 2012 and 2016 were included in the study. All patients received a post-operative questionnaire comprising of MOX-FQ score, EQ-5D (UK) and Foot and Ankle outcomes scores (FAOS) and patients satisfaction questionnaire with a minimum of 2 years follow up. Results. 33 patients had a revision total ankle replacement between 2012 and 2016. 2 patients were deceased therefore 31 patients were included in the study. 4 patients declined participation for completing questionnaires. We received 15/27 (55.5%) completed questionnaires. The mean MOX-FQ average domain score for pain was (50.6 ± 26.9), walking/standing (62.4 ± 36.5) and social function was (43.7± 31.0). The mean FAOS scores were (52.5 ± 30.6; pain), (54.5 ± 29.2; symptoms), (62.1 ± 30.5; ADL) and (35.5 ± 28.2; for quality of life). The mean overall health score today for EQ-5D was 73.9/100. 50% of patients were satisfied with the pain relief and return to sports and recreation obtained following the operation, 57% were satisfied with the improved in daily activities. 78.5% were overall satisfied with the results from surgery. Conclusion. Revision total ankle replacement gives overall satisfactory results demonstrated from patients reported outcomes at a minimum of 2 years following surgery

The effect of BMI on patient-reported outcomes following total ankle replacement (TAR) is uncertain and the change in BMI experienced by these patients in the 5 years following surgery has not been studied. We report a series of 106 patients with complete 5-year data on BMI and patient-reported outcome scores. Patients undergoing TAR between 2006 and 2009, took part in the hospital joint registry, which provides routine clinical audit of patient progress following total joint arthroplasty; therefore, ethics committee approval was not required for this study. Data on BMI, Foot and Ankle Score (FAOS) and SF-36 score were collected preoperatively and annually postoperatively. Patients who were obese (BMI >30) had lower FAOS scores pre-operatively and at 5 years, however this did not reach significance. Both obese (p = 0.0004) and non-obese (p < 0.0001) patients demonstrated a significant improvement in FAOS score from baseline to 5 years. This improvement was more marked for the non-obese patients. No significant differences were seen for SF36 scores between obese and non-obese patients either at baseline or 5 years. There was a trend for improved score in both groups. Mean pre-operative BMI was 28.49. Mean post-operative BMI was 28.33. The mean difference between pre- and post-operative BMI was −0.15, which was not statistically significant (p=0.55). There were no significant differences in revisions in the obese (2) and non-obese (1 and one awaited) groups at 5 years. This data supports use of TAR in the obese population, as significant increases in mean FAOS score were seen in this group at 5 years. Obesity did not have a significant influence on patients' overall health perceptions, measured by the SF36 and a trend for improvement was seen in both obese and non-obese patients. TAR cannot be relied upon to result in significant post-operative weight-loss without further interventions

Aims. The aim of this prospective study was to evaluate the intermediate-term outcomes after revision anatomical ankle ligament reconstruction augmented with suture tape for a failed modified Broström procedure. Patients and Methods. A total of 30 patients with persistent instability of the ankle after a Broström procedure underwent revision augmented with suture tape. Of these, 24 patients who were followed up for more than two years were included in the study. There were 13 men and 11 women. Their mean age was 31.8 years (23 to 44). The mean follow-up was 38.5 months (24 to 56) The clinical outcome was assessed using the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM) score. The stability of the ankle was assessed using stress radiographs. Results. The mean FAOS and FAAM scores improved significantly to 87.5 (73 to 94) and 85.1 (70 to 95) points at final follow-up, respectively (p < 0.001). The mean angle of talar tilt and anterior talar translation improved significantly to 2.8° (0° to 6°) and 4.1 mm (2 to 7) at final follow-up, respectively (p < 0.001). Side to side comparison in stress radiographs at final follow-up showed no significant difference. The revision failed in one patient who underwent a further revision using allograft tendon. Conclusion. The revision modified Broström procedure augmented with suture tape is an effective form of treatment for recurrent instability of the ankle following a failed Broström procedure. This technique provides reliable stability and satisfactory clinical outcomes at intermediate-term follow-up. Cite this article: Bone Joint J 2017;99-B:1183–9

Introduction:. The role of total ankle replacements remains unproven within orthopaedic literature. We present a prospective series of patients who underwent a SALTO TAR (Tornier) between October 2006 and January 2014. Methods:. A cohort of 53 TAR (50 patients) were prospectively followed up and assessed clinically, radiologically and asked to complete FAOS, VAS and Modified AOFAS scores. Four patients had bilateral procedures. The mean age was 71 years old (range 42–92). The mean follow up was 55 months (range 6–92). Nineteen TARs (19 patients) have a follow up of more than 60 months. Results:. Our survival rate is 98% as one patient proceeded to have an ankle fusion at 12 months due to loosening. Three patients had ankle arthroscopies at 1 year post TAR; one for removal of a fibula cyst, one for synovitis in the lateral gutter and another for fibula impingement. One patient had an early postoperative infection. Mean overall FAOS scores were 73.4 for the entire cohort and 74.2 for the cohort with over 5 years follow-up. Mean modified AOFAS scores for the entire cohort and the cohort with over 5 years follow up was 71.5 and 78.9 respectively. Mean VAS scores for the entire cohort and the cohort with over 5 years follow-up was 18.8 and 25.8 respectively. Discussion:. Ankle joint arthrodesis has been shown to be a reliable in relieving pain and result in good patient satisfaction. However, total ankle replacement provides an alternative surgical option for the management of ankle arthritis. The improving survivorship of ankle replacements is making this an increasingly popular option. Our follow-up of almost five years as an entire cohort, but also those with over five years, show that these latest generations of TAR have excellent mid term survivorship, accompanied by high levels of patient satisfaction and function

Introduction:. Total Ankle Replacement is proving to be a viable option for younger patients with Post Traumatic Osteoarthritis of the Ankle. The aim of our study was to study the clinical and patient reported outcomes between patients of < 60 and > 60 years who underwent TAR. Method:. Patients who underwent a TAR between March 2006 and May 2009 were invited to take part in the hospital patient registry. They were divided into two groups based on Age (Group A-Age > 60 and Group B-Age < 60). Patient demographics, co-morbidities, Clinical (AOFAS) outcomes, patient reported outcomes (FAOS, SF-36, patient satisfaction) and complications were collected from patients pre-operatively and at 1, 2 and 3 years follow up. Comparisons were made between groups for all outcome measures. Results:. There were 56 patients in Group A and 32 patients in Group B. There was no difference in Gender, side of operation and diagnosis reported between the 2 groups (P>0.05). Group A reported higher number of co-morbidities than Group B (1.54 vs. 1.00); p=0.032. There was no difference in AOFAS scores and FAOS scores for pain and function at all follow up times (p>0.05). Although Group B reported worse scores for FAOS stiffness pre-operatively (p=0.002) and at 1 year (p=0.029); there was no difference between scores at 2 and 3 years follow up. There was no difference in SF-36 scores and patient satisfaction and complications between groups. We expect to have the 4 year results processed by October this year. Conclusion:. We have found satisfactory outcomes following TAR, both clinical and patient reported, irrespective of age of patient. Although long-term survivorship results for TAR are unavailable, we feel that younger age may not be a contra-indication to TAR as it provides good quality of life and potentially allows continuation of work

Background:. Achilles pathology is a serious and frequently occurring problem, especially in elite athletes. Recent research has suggested a role for the plantaris tendon in non-insertional achilles tendinopathy. We report on the outcomes after excision of the plantaris tendon in elite athletes. Aim:. To assess whether or not excising the plantaris tendon improves the symptoms of Achilles tendinopathy in elite athletes. Methods:. A group of 32 elite athletes who underwent plantaris tendon excision to treat medially located pain associated with non-insertional Achilles tendinopathy were investigated. Outcomes were assessed with pre and post-operative Visual Analogue Scores (VAS) for pain and the Foot and Ankle Outcome Score (FAOS) as well as time to return to sport and satisfaction scores. Results:. At a mean follow-up of 22.4 months (12–48), 29/32 (90%) of athletes were satisfied with the results. 30/32 athletes (94%) returned to sport at a mean of 10.3 weeks (5–27). The mean VAS score improved from 5.8 to 0.8 (p<0.01) and the mean FAOS improved in all domains (p<0.01). Conclusions:. The plantaris tendon may be responsible for symptoms in some patients with non-insertional Achilles tendinopathy. Excision using a mini-incision technique carries a low risk of complications and may provide significant improvement in symptoms enabling an early return to elite level sports

Introduction. Postoperative pain following the 3 component ankle arthroplasty (AA) (Mobility™) is a recognised problem without any apparent cause. This study aimed to determine pattern of postoperative pain following Total Ankle Arthroplasty (TAA) and its management options. Materials and methods. In prospective observational study 167 patients who had (AA) and minimum follow-up of 24 months were included. FAOS ankle score, patients' satisfaction, SF36 and diagrammatic mapping of postoperative pain among other parameters were collected preoperatively and postoperatively at 3 months, 6 months and the annually. 20 Patients (12%) had moderate to severe postoperative ankle pain following the ankle arthroplasty. Results. Most of patients with mild pain and low AOFAS score during first year improved by the 2 year review. The pain was localised to the medial aspect of the ankle in 10 patients, lateral side in 8 patients, and both medial and lateral side in 1 patient and global in 1 patient with complex regional pain syndrome. 8 patients with medial or lateral pain needed a re-operation. 5 patients with medial pain were treated by complete release of deltoid ligament along with bony decompression of the medial compartment. None of the above implants were loose intra-operatively. 2 AA with lateral pain needed subtalar arthrodesis. 1 patient needed removal of metalwork from the calcaneum for relief of symptoms. A significant improvement of pain and AOFAS scores was observed in 3 out of the 5 patients who underwent medial compartment decompression and both patients who underwent subtalar arthrodesis. Conclusion. There are 10–13% of low AOFAS scores following Ankle Arthroplasty due to pain. In our series, the pain did not co-relate to implant loosening. Our treatment protocol of mapping of pain and re-do surgery could improve the long term outcome in a significant proportion of the patients

Aim. We aimed to study the effect of BMI on clinical and patient-reported outcomes in patients with TAR with a minimum follow-up of three years. Method. Patients who underwent a TAR between March 2006 and May 2009 were invited to take part in the hospital patient registry. Patients were divided into two groups based on BMI (Group A – BMI <30 and Group B – BMI >30). Patient demographics, co-morbidities, clinical (AOFAS), patient reported outcomes (FAOS, SF-36, patient satisfaction) and complications were collected pre-operatively and at 1, 2 and 3 years and comparison made between groups. Results. There were 50 patients in group A and 31 in group B. There was no significant difference between age (Mean 64.5 (A) and Mean 61.3 (B), gender and side of operation between the groups (p>0.05). Group A had higher percentage of patients with OA and RA compared to Group B (p=0.027). Group B (1.16) reported higher co-morbidites than Group A (1.81); p=0.012. There was no difference in AOFAS scores, FAOS scores (for pain, function and stiffness) and SF-36 scores reported between groups at 1, 2 and 3 years post-operatively (p>0.05). At 3 years, Group B reported less patient satisfaction with return to ADL 84.6 %(A) vs. 50.1%(B) and recreational activities 73.1 %(A) vs. 43.8 %(B); p<0.05. There was no significant difference in overall satisfaction and pain relief and also in the number of reported complications between Groups A and B (p>0.05). Conclusion. Patients with BMI > 30 reported higher co-morbidities pre-operatively and less patient satisfaction (return to ADL and recreation) at 3 years when compared to patients with BMI <30. There was no difference in clinical, complications and patient reported outcomes between these groups

Background. Lisfranc/midfoot injuries are complex injuries with a reported incidence of 1 in 55000 in literature and frequently overlooked. But, recently they are becoming more commonly diagnosed with advent of CT scan and examination under anaesthesias (EUA) for suspicion fractures. Here we present a case series results of a single surgeons experience over the last 6 years. Methods. Retrospective review of 68 patients treated by a single surgeon over the last 6 years. Injuries were diagnosed on plain Xrays, clinic examination. Any suspicious injury were further assessed by a CT scan, all injuries were confirmed by EUA and treated with open reduction and internal fixation within 4 weeks of injury. Post-operative immobilisation in full cast for 6 weeks then a removal boot with non-weight bearing for a total of 3months. They were followed up regularly initially at 3, 6 and 12months. At final review the following data was collected: clinical examination, plain x-ray looking for: late deformity, signs of OA in Lisfranc joint, Auto fusion rate, rate of metal work failure. The x-rays findings were correlated with: (1) type of fixation. (2) The following scores: FAOS, AOFAS-M, specially designed new foot and ankle score. Results. 43 males: 25 females. 37 right: 31 left sided injuries. 90% were fully weight bearing with minimal discomfort after 6months. In 12 months all of them returned to their normal daily life activities. Wound complications: 2 of them had initial wound complications which were treated successfully with 2 weeks of oral antibiotics, 2 had lateral scar tenderness. One had loosened metal work, revised to fusion. Conclusion. Early operative intervention with good anatomical reduction can minimise the potential chronic disability associated with these injuries. This is a largest series of Lis-franc injuries of a single surgeon with good clinical outcome following surgical fixation

There is no optimal treatment for osteochondral defects of the talus after failed primary surgical treatment. To treat these patients, a 15-mm diameter metal implant was developed for the medial talar dome. The present study was undertaken to evaluate the clinical effectiveness of the metal implantation technique for osteochondral lesions of the medial talar dome. This is a prospective case series. The inclusion criteria were the combination of a large OCD (ϕ >12 mm) of the medial talar dome, persistent complaints >1 year after treatment, and clinically relevant pain levels. The exclusion criteria were: age <18 years, OCD size >20 mm, ankle osteoarthritis grade 2 or 3, concomitant ankle pathology, and diabetes. The primary outcome measure was the Numeric Rating Scale pain (NRS) rest, walking, running, and stair climbing. Secondary outcome measures were: Foot Ankle Outcome Score (FAOS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, and clinical and radiographic complications. The Wilcoxon signed ranks test was used to calculate p-values. Between October 2007 and March 2009 10 patients were included. The median follow-up was 2 years (range, 2–3 years). On preoperative CT scanning, the median lesion size was 15 (range, 12–20) × 11 (range, 8–14) mm. The NRS rest improved from a median of 3 (0–7) preoperatively to 0.5 (0–2) at final follow-up (p = 0.017), NRS walking from 6.5 (4–8) to 1 (0–4) (p = 0.005), NRS running from 9 (6–10) to 3 (0–10) (p = 0.024), and NRS stair climbing from 6 (4–8) to 1 (0–7) (p = 0.012). The FAOS improved significantly on four of five subscales. The AOFAS improved from a median of 70 (47–75) before surgery to 89 (69–100) at final follow-up (p = 0.008). There were three temporary complications: hyposensibility about the scar in two and a superficial wound infection in one. There were no radiographic complications

Introduction. There is less literature reporting outcomes following total ankle replacement (TAR) in patients presenting with a coronal plane deformity preoperatively. This study compares clinical and patient reported outcomes at 1 year between TAR patients with and without coronal plane deformity. Methods. Patients from single centre prospective cohort (132) who underwent TAR between 2006 and 2010 were included. They were divided into 2 groups based on preoperative coronal plane deformity. Groups 1 and 2 had a coronal plane deformity of <10 and >10 respectively. Assessments included American Orthopaedic Foot and Ankle Score (AOFAS), Foot and Ankle Outcome Score (FAOS), SF-36 (Generic Health Measure) and complications recorded preoperatively and 3, 6 and 12 months postoperatively. Results. There were 102 ankles (77.2%) in group 1 and 30 ankles (22.7%) in group 2. There was no difference in age and BMI between groups (p > 0.05). AOFAS, FAOS and SF-36 scores showed improvement for both groups from pre-op to 1 year (p < 0.01) with no difference between groups (p > 0.05) at all assessment times; except for mental health scores (SF-36 component) which showed no significant improvement (p > 0.05) and no difference between groups (p > 0.05). There was no difference in patient satisfaction for overall outcomes, pain relief, improvement in ADL and recreational activities between groups at 1 year (p > 0.05). There was no incidence of DVT/PE in both groups. The incidence of peri-prosthetic fractures was 8 (7.8%) for group 1 and 2 (6.6%) in group 2. Discussion and Conclusion. These early results of total ankle replacement demonstrate that patients with >10 degrees coronal plane deformity had equivalent outcomes to patients with <10 degrees of coronal plane deformity. Our surgical techniques for correction of deformity are reliable to reduce the requirement of ankle fusion

Aims

Hindfoot arthrodesis with retrograde intramedullary nailing has been described as a surgical strategy to reconstruct deformities of the ankle and hindfoot in patients with Charcot arthropathy. This study presents case series of Charcot arthropathy patients treated with two different retrograde intramedullary straight compression nails in order to reconstruct the hindfoot and assess the results over a mid-term follow-up.

Talonavicular and subtalar joint fusion through a medial incision (modified triple arthrodesis) has become an increasingly popular technique for treating symptomatic flatfoot deformity caused by posterior tibial tendon dysfunction.

The purpose of this study was to look at its clinical and radiological mid- to long-term outcomes, including the rates of recurrent flatfoot deformity, nonunion and avascular necrosis of the dome of the talus.

A total of 84 patients (96 feet) with a symptomatic rigid flatfoot deformity caused by posterior tibial tendon dysfunction were treated using a modified triple arthrodesis. The mean age of the patients was 66 years (35 to 85) and the mean follow-up was 4.7 years (1 to 8.3). Both clinical and radiological outcomes were analysed retrospectively.

In 86 of the 95 feet (90.5%) for which radiographs were available, there was no loss of correction at final follow-up. In all, 14 feet (14.7%) needed secondary surgery, six for nonunion, two for avascular necrosis, five for progression of the flatfoot deformity and tibiotalar arthritis and one because of symptomatic overcorrection. The mean American Orthopaedic Foot and Ankle Society Hindfoot score (AOFAS score) at final follow-up was 67 (between 16 and 100) and the mean visual analogue score for pain 2.4 points (between 0 and 10).

In conclusion, modified triple arthrodesis provides reliable correction of deformity and a good clinical outcome at mid- to long-term follow-up, with nonunion as the most frequent complication. Avascular necrosis of the talus is a rare but serious complication of this technique.

Cite this article: Bone Joint J 2015; 97-B:668–74.

We have evaluated the clinical effectiveness of a metal resurfacing inlay implant for osteochondral defects of the medial talar dome after failed previous surgical treatment. We prospectively studied 20 consecutive patients with a mean age of 38 years (20 to 60), for a mean of three years (2 to 5) post-surgery. There was statistically significant reduction of pain in each of four situations (i.e., rest, walking, stair climbing and running; p ≤ 0.01). The median American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved from 62 (interquartile range (IQR) 46 to 72) pre-operatively to 87 (IQR 75 to 95) at final follow-up (p < 0.001). The Foot and Ankle Outcome Score improved on all subscales (p ≤ 0.03). The mean Short-Form 36 physical component scale improved from 36 (23 to 50) pre-operatively to 45 (29 to 55) at final follow-up (p = 0.001); the mental component scale did not change significantly. On radiographs, progressive degenerative changes of the opposing tibial plafond were observed in two patients. One patient required additional surgery for the osteochondral defect. This study shows that a metal implant is a promising treatment for osteochondral defects of the medial talar dome after failed previous surgery.

Cite this article: Bone Joint J 2013;95-B:1650–5.