Aims. There is a lack of high-quality research investigating outcomes of Ponseti-treated idiopathic clubfeet and correlation with relapse. This study assessed clinical and quality of life (QoL) outcomes using a standardized core outcome set (COS), comparing children with and without relapse. Methods. A total of 11 international centres participated in this institutional review board-approved observational study. Data including demographics, information regarding presentation, treatment, and details of subsequent relapse and management were collected between 1 June 2022 and 30 June 2023 from consecutive clinic patients who had a minimum five-year follow-up. The clubfoot COS incorporating 31 parameters was used. A regression model assessed relationships between baseline variables and outcomes (clinical/QoL). Results. Overall, 293 patients (432 feet) with a median age of 89 months (interquartile range 72 to 113) were included. The relapse rate was 37%, with repeated relapse in 14%. Treatment considered a standard part of the Ponseti journey (recasting, repeat tenotomy, and
The purpose of this study was to assess the success rate and functional outcomes of bone grafting for periprosthetic bone cysts following total ankle arthroplasty (TAA). Additionally, we evaluated the rate of graft incorporation and identified associated predisposing factors using CT scan. We reviewed a total of 37 ankles (34 patients) that had undergone bone grafting for periprosthetic bone cysts. A CT scan was performed one year after bone grafting to check the status of graft incorporation. For accurate analysis of cyst volumes and their postoperative changes, 3D-reconstructed CT scan processed with 3D software was used. For functional outcomes, variables such as the Ankle Osteoarthritis Scale score and the visual analogue scale for pain were measured.Aims
Methods
To compare changes in gait kinematics and walking speed 24 months after conventional (C-MLS) and minimally invasive (MI-MLS) multilevel surgery for children with diplegic cerebral palsy (CP). A retrospective analysis of 19 children following C-MLS, with mean age at surgery of 12 years five months (seven years ten months to 15 years 11 months), and 36 children following MI-MLS, with mean age at surgery of ten years seven months (seven years one month to 14 years ten months), was performed. The Gait Profile Score (GPS) and walking speed were collected preoperatively and six, 12 and 24 months postoperatively. Type and frequency of procedures as part of MLS, surgical adverse events, and subsequent surgery were recorded.Aims
Methods
This study aimed to explore whether intraoperative nerve monitoring can identify risk factors and reduce the incidence of nerve injury in patients with high-riding developmental dysplasia. We conducted a historical controlled study of patients with unilateral Crowe IV developmental dysplasia of the hip (DDH). Between October 2016 and October 2017, intraoperative nerve monitoring of the femoral and sciatic nerves was applied in total hip arthroplasty (THA). A neuromonitoring technician was employed to monitor nerve function and inform the surgeon of ongoing changes in a timely manner. Patients who did not have intraoperative nerve monitoring between September 2015 and October 2016 were selected as the control group. All the surgeries were performed by one surgeon. Demographics and clinical data were analyzed. A total of 35 patients in the monitoring group (ten male, 25 female; mean age 37.1 years (20 to 46)) and 56 patients in the control group (13 male, 43 female; mean age 37.9 years (23 to 52)) were enrolled. The mean follow-up of all patients was 13.1 months (10 to 15).Aims
Patients and Methods
The Ponseti method is the benchmark treatment for the correction of clubfoot. The primary rate of correction is very high, but outcome further down the treatment pathway is less predictable. Several methods of assessing severity at presentation have been reported. Classification later in the course of treatment is more challenging. This systematic review considers the outcome of the Ponseti method in terms of relapse and determines how clubfoot is assessed at presentation, correction, and relapse. A prospectively registered systematic review was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that reported idiopathic clubfoot treated by the Ponseti method between 1 January 2012 and 31 May 2017 were included. The data extracted included demographics, Ponseti methodology, assessment methods, and rates of relapse and surgery.Aims
Patients and Methods
The purpose of this study was to determine the functional outcome and implant survivorship of mobile-bearing total ankle arthroplasty (TAA) performed by a single surgeon. We reviewed 205 consecutive patients (210 ankles) who had undergone mobile-bearing TAA (205 patients) for osteoarthritis of the ankle between January 2005 and December 2015. Their mean follow-up was 6.4 years (2.0 to 13.4). Functional outcome was assessed using the Ankle Osteoarthritis Scale, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, 36-Item Short-Form Health Survey (SF-36) score, visual analogue scale, and range of movement. Implant survivorship and complications were also evaluated.Aims
Patients and Methods
The medial malleolus, once believed to be the primary stabilizer of the ankle, has been the topic of conflicting clinical and biomechanical data for many decades. Despite the relevant surgical anatomy being understood for almost 40 years, the optimal treatment of medial malleolar fractures remains unclear, whether the injury occurs in isolation or as part of an unstable bi- or trimalleolar fracture configuration. Traditional teaching recommends open reduction and fixation of medial malleolar fractures that are part of an unstable injury. However, there is recent evidence to suggest that nonoperative management of well-reduced fractures may result in equivalent outcomes, but without the morbidity associated with surgery. This review gives an update on the relevant anatomy and classification systems for medial malleolar fractures and an overview of the current literature regarding their management, including surgical approaches and the choice of implants. Cite this article: Abstract
Preserving growth following limb-salvage surgery of the upper
limb in children remains a challenge. Vascularized autografts may
provide rapid biological incorporation with the potential for growth
and longevity. In this study, we aimed to describe the outcomes
following proximal humeral reconstruction with a vascularized fibular
epiphyseal transfer in children with a primary sarcoma of bone.
We also aimed to quantify the hypertrophy of the graft and the annual
growth, and to determine the functional outcomes of the neoglenofibular
joint. We retrospectively analyzed 11 patients who underwent this procedure
for a primary bone tumour of the proximal humerus between 2004 and
2015. Six had Ewing’s sarcoma and five had osteosarcoma. Their mean
age at the time of surgery was five years (two to eight). The mean
follow-up was 5.2 years (1 to 12.2).Aims
Patients and Methods
The success of anterior cruciate ligament reconstruction (ACLR)
depends on osseointegration at the graft-tunnel interface and intra-articular
ligamentization. Our aim was to conduct a systematic review of clinical
and preclinical studies that evaluated biological augmentation of
graft healing in ACLR. In all, 1879 studies were identified across three databases.
Following assessment against strict criteria, 112 studies were included
(20 clinical studies; 92 animal studies). Aims
Materials and Methods
Patients with neuromuscular imbalance who require
total hip arthroplasty (THA) present particular technical problems
due to altered anatomy, abnormal bone stock, muscular imbalance
and problems of rehabilitation. In this systematic review, we studied articles dealing with THA
in patients with neuromuscular imbalance, published before April
2017. We recorded the demographics of the patients and the type
of neuromuscular pathology, the indication for surgery, surgical
approach, concomitant soft-tissue releases, the type of implant
and bearing, pain and functional outcome as well as complications
and survival. Recent advances in THA technology allow for successful outcomes
in these patients. Our review suggests excellent benefits for pain
relief and good functional outcome might be expected with a modest
risk of complication. Cite this article:
The purpose of this study was to compare the clinical and radiographic
outcomes of total ankle arthroplasty (TAA) in patients with pre-operatively
moderate and severe arthritic varus ankles to those achieved for
patients with neutral ankles. A total of 105 patients (105 ankles), matched for age, gender,
body mass index, and follow-up duration, were divided into three
groups by pre-operative coronal plane tibiotalar angle; neutral
(<
5°), moderate (5° to 15°) and severe (>
15°) varus deformity.
American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot
score, a visual analogue scale (VAS), and Short Form (SF)-36 score
were used to compare the clinical outcomes after a mean follow-up period
of 51 months (24 to 147).Aims
Patients and Methods
After the initial correction of congenital talipes equinovarus
(CTEV) using the Ponseti method, a subsequent dynamic deformity
is often managed by transfer of the tendon of tibialis anterior
(TATT) to the lateral cuneiform. Many surgeons believe the lateral
cuneiform should be ossified before surgery is undertaken. This
study quantifies the ossification process of the lateral cuneiform
in children with CTEV between one and three years of age. The length, width and height of the lateral cuneiform were measured
in 43 consecutive patients with unilateral CTEV who had been treated
using the Ponseti method. Measurements were taken by two independent
observers on standardised anteroposterior and lateral radiographs
of both feet taken at one, two and three years of age.Aims
Patients and Methods
This retrospective cohort study compared the results of vascularised
and non-vascularised anterior sliding tibial grafts for the treatment
of osteoarthritis (OA)of the ankle secondary to osteonecrosis of
the talus. We reviewed the clinical and radiological outcomes of 27 patients
who underwent arthrodesis with either vascularised or non-vascularised
(conventional) grafts, comparing the outcomes (clinical scores,
proportion with successful union and time to union) between the
two groups. The clinical outcome was assessed using the Mazur and
American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot
scores. The mean follow-up was 35 months (24 to 68).Aims
Patients and Methods
A new method of vascularised tibial grafting
has been developed for the treatment of avascular necrosis (AVN)
of the talus and secondary osteoarthritis (OA) of the ankle. We
used 40 cadavers to identify the vascular anatomy of the distal
tibia in order to establish how to elevate a vascularised tibial
graft safely. Between 2008 and 2012, eight patients (three male,
five female, mean age 50 years; 26 to 68) with isolated AVN of the
talus and 12 patients (four male, eight female, mean age 58 years;
23 to 76) with secondary OA underwent vascularised bone grafting
from the distal tibia either to revascularise the talus or for arthrodesis.
The radiological and clinical outcomes were evaluated at a mean
follow-up of 31 months (24 to 62). The peri-malleolar arterial arch
was confirmed in the cadaveric study. A vascularised bone graft
could be elevated safely using the peri-malleolar pedicle. The clinical
outcomes for the group with AVN of the talus assessed with the mean
Mazur ankle grading scores, improved significantly from 39 points
(21 to 48) pre-operatively to 81 points (73 to 90) at the final
follow-up (p = 0.01). In all eight revascularisations, bone healing
was obtained without progression to talar collapse, and union was
established in 11 of 12 vascularised arthrodeses at a mean follow-up
of 34 months (24 to 58). MRI showed revascularisation of the talus
in all patients. We conclude that a vascularised tibial graft can be used both
for revascularisation of the talus and for the arthrodesis of the
ankle in patients with OA secondary to AVN of the talus. Cite this article:
We report the effect of introducing a dedicated
Ponseti service on the five-year treatment outcomes of children
with idiopathic clubfoot. Between 2002 and 2004, 100 feet (66 children; 50 boys and 16
girls) were treated in a general paediatric orthopaedic clinic.
Of these, 96 feet (96%) responded to initial casting, 85 requiring
a tenotomy of the tendo-Achillis. Recurrent deformity occurred in
38 feet and was successfully treated in 22 by repeat casting and/or
tenotomy and/or transfer of the tendon of
Previous studies have identified clinical and
demographic risk factors for recurrence in the treatment of idiopathic clubfoot
(congenital talipes equinovarus). Evertor muscle activity is not
usually considered amongst them. This study aimed to evaluate whether
recurrence could be predicted by demographic, clinical and gait
parameters. From a series of 103 children with clubfeet, 67 had
completed a follow-up of two years: 41 male and 26 female, 38 with idiopathic
and 29 with non-idiopathic deformities. The mean age was 3.2 years
(2.1 to 6.3). Primary correction was obtained in all 38 children
(100%) with an idiopathic deformity, and in 26 of 29 patients (90%)
with a non-idiopathic deformity. Overall, 60 children (90%) complied
with the abduction brace regime. At a mean follow-up of 31.4 months (24
to 62), recurrence was noted in six children (15.8%) in the idiopathic
and 14 children (48.3%) in the non-idiopathic group. Significant
correlation was found between poor evertor activity and recurrence
in both groups. No statistically significant relationship was found
between the rate of recurrence and the severity of the initial deformity,
the age at the time of treatment, the number of casts required or
the compliance with the brace. After correction of idiopathic and non-idiopathic clubfoot using
the Ponseti method, only poor evertor muscle activity was statistically
associated with recurrence. The identification of risk factors for
recurrent deformity allows clinicians to anticipate problems and
advocate early additional treatment to improve muscle balance around
the ankle. Cite this article:
In this study we evaluated the results of midtarsal
release and open reduction for the treatment of children with convex
congenital foot (CCF) (vertical talus) and compared them with the
published results of peritalar release. Between 1977 and 2009, a
total of 22 children (31 feet) underwent this procedure. In 15 children
(48%) the CCF was isolated and in the remainder it was not (seven
with arthrogryposis, two with spinal dysraphism, one with a polymalformative
syndrome and six with an undefined neurological disorder). Pre-operatively, the mean tibiotalar angle was 150.2° (106° to
175°) and the mean calcaneal pitch angle was -19.3° (-72° to 4°).
The procedure included talonavicular and calcaneocuboid joint capsulotomies,
lengthening of tendons of
There have been a few reports of patients with
a combination of lumbar and thoracic spinal stenosis. We describe six
patients who suffered unexpected acute neurological deterioration
at a mean of 7.8 days (6 to 10) after lumbar decompressive surgery.
Five had progressive weakness and one had recurrent pain in the
lower limbs. There was incomplete recovery following subsequent
thoracic decompressive surgery. The neurological presentation can be confusing. Patients with
compressive myelopathy due to lower thoracic lesions, especially
epiconus lesions (T10 to T12/L1 disc level), present with similar
symptoms to those with lumbar radiculopathy or cauda equina lesions.
Despite the rarity of this condition we advise that patients who
undergo lumbar decompressive surgery for stenosis should have sagittal
whole spine MRI studies pre-operatively to exclude proximal neurological
compression. Cite this article:
We examined the association of graft type with
the risk of early revision of primary anterior cruciate ligament reconstruction
(ACLR) in a community-based sample. A retrospective analysis of
a cohort of 9817 ACLRs recorded in an ACLR Registry was performed.
Patients were included if they underwent primary ACLR with bone–patellar tendon–bone
autograft, hamstring tendon autograft or allograft tissue. Aseptic
failure was the main endpoint of the study. After adjusting for
age, gender, ethnicity, and body mass index, allografts had a
3.02 times (95% confidence interval (CI) 1.93 to 4.72) higher risk
of aseptic revision than bone–patellar tendon–bone autografts (p
<
0.001). Hamstring tendon autografts had a 1.82 times (95% CI
1.10 to 3.00) higher risk of revision compared with bone–patellar
tendon–bone autografts (p = 0.019). For each year increase in age,
the risk of revision decreased by 7% (95% CI 5 to 9). In gender-specific
analyses a 2.26 times (95% CI 1.15 to 4.44) increased risk of hamstring
tendon autograft revision in females was observed compared with
bone–patellar tendon–bone autograft. We conclude that allograft
tissue, hamstring tendon autografts, and younger age may all increase
the risk of early revision surgery after ACLR. Cite this article:
