Aims

The ideal management of acute syndesmotic injuries in elite athletes is controversial. Among several treatment methods used to stabilize the syndesmosis and facilitate healing of the ligaments, the use of suture tape (InternalBrace) has previously been described. The purpose of this study was to analyze the functional outcome, including American Orthopaedic Foot & Ankle Society (AOFAS) scores, knee-to-wall measurements, and the time to return to play in days, of unstable syndesmotic injuries treated with the use of the InternalBrace in elite athletes.

Aims

The aim of this study was to present a series of patients with aseptic failure of a total ankle arthroplasty (TAA) who were treated with fusion of the hindfoot using a nail.

Introduction: We present the results of 35 patients following Ankle Evolution System (AES) total ankle replacements (TAR) with a minimum follow up of four years.

Methods: We retrospectively reviewed 39 consecutive total ankle replacements. Two patients died, and two emigrated. Thirty-five patients were available for clinical and radiological assessment. All patients underwent standardised radiographs. Complications and failures were recorded. Patient satisfaction and functional outcome of all patients was determined using the American orthopaedic foot and ankle society (AOFAS) score.

Results: All ankles were examined at a mean of 4.7 years postoperatively. The mean age at operation was 64 years. In 18 ankles the indication for the operation was primary osteoarthritis (OA), in 13 ankles post-traumatic OA, in three ankles rheumatoid arthritis and in one ankle psoriatic arthropathy. One patient had revision of the tibial component because of loosening. Sixteen patients recorded their satisfaction as excellent postoperatively, 15 patients as much better, three as better and only one patient recorded that he was worse off. The mean AOFAS score was 88.9 (confidence interval 85.7–92.1). The mean walking distance for our cohort is two miles. Thirteen ankles had radiological osteolysis; in two ankles this was more that 2cms.

Conclusion: The medium term results after implantation of the AES ankle prosthesis are encouraging. With the correct indication, a high rate of pain reduction and patient satisfaction can be achieved. The long-term benefit of this procedure has yet to be determined. The rate of osteolysis is of some concern.

We present the outcomes in 38 consecutive patients who had total ankle replacement using the Ankle Evolution System with a minimum follow-up of four years. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and regular standardised anteroposterior and lateral weight-bearing radiographs were obtained. Patient satisfaction and complications were recorded and the survival of the implants was demonstrated by the Kaplan-Meier method.

The mean follow-up was for 57.8 months (48 to 80). The cumulative survival rate at six years was 94.7% (95% confidence interval 80.3 to 98.7). The mean total AOFAS score was 88.1 (53 to 100). The mean score for pain was 35.8 (20 to 40). Ten patients presented with edge-loading of whom nine had corrective surgery. Two ankles were revised, one to an arthrodesis and the other to replace the tibial component. Nine patients showed radiological evidence of osteolysis. They had minimal non-progressive symptoms and further surgery was not undertaken. Nevertheless, the concerns about osteolysis led to the implant being withdrawn by the manufacturer.

The medium-term results of the ankle evolution system ankle replacement are satisfactory with high patient satisfaction, but the rate of osteolysis is of some concern. The long-term benefit of this procedure has yet to be determined.

Introduction: We report the clinical and radiological results of 137 AES Total Ankle Replacements (TAR)(Biomet, Europe) over a 4-year period.

Methods: 134 patients underwent 137 Total Ankle Replacements. There were 47 females and 87 males. Three patients underwent bilateral procedures. The mean age of the patients was 64 years (48–78). The main indication for surgery was post-traumatic arthritis other indications included primary arthritis, inflammatory arthritis, haemophilia, haemochromatosis, polio, cavo-varus deformity and revision of a loose STAR. The pre-op coronal deformity ranged from 20 degrees varus to 40 degrees valgus. The same surgeon performed all operations. All patients had a clinical and radiological follow-up at 3, 6 and 12 months then annually, thereafter.

Results: At a mean time to follow up of 18 months the mean AOFAS Hindfoot Score was 79. Excluding those patients with other joint disorders the stratified AOFAS score increases to 81. Four patients experienced postoperative talar subsidence and 8 patients had gaps or lysis around the tibial bone implant interface. Three patients developed soft tissue complications, two of which had to have a split skin graft and one of these developed a deep infection. The third patient required a fascio cutaneous local flap. Thirteen patients required a further procedure for postoperative edge loading. No implant has been revised to date. Two patients feel no better off since surgery and one patient feels worse off. The remainder rate their surgery as good or excellent.

Discussion: The early results of the AES TAR are encouraging. Careful management of the soft tissues and correct soft tissue balancing are important. In our series we have modified the surgical technique so less talar bone is resected.

Conclusion: We feel the AES TAR provides encouraging early results.