The Cartiva synthetic cartilage implant (SCI) entered mainstream use in the management of first metatarsophalangeal joint (MTPJ) arthritis following the positive results of large trials in 2016. Limited information is available on the longer-term outcomes of this implant within the literature, particularly when independent from the originator. This single-centre cohort study investigates the efficacy of the Cartiva SCI at up to five years. First MTPJ arthritis was radiologically graded according to the Hattrup and Johnson (HJ) classification. Preoperative and sequential postoperative patient-reported outcome measures (PROMs) were evaluated using the Manchester-Oxford Foot Questionnaire (MOXFQ), and the activities of daily living (ADL) sub-section of the Foot and Ankle Ability Measure (FAAM).Aims
Methods
The optimal management of posterior malleolar ankle fractures, a prevalent type of ankle trauma, is essential for improved prognosis. However, there remains a debate over the most effective surgical approach, particularly between screw and plate fixation methods. This study aims to investigate the differences in outcomes associated with these fixation techniques. We conducted a comprehensive review of clinical trials comparing anteroposterior (A-P) screws, posteroanterior (P-A) screws, and plate fixation. Two investigators validated the data sourced from multiple databases (MEDLINE, EMBASE, and Web of Science). Following PRISMA guidelines, we carried out a network meta-analysis (NMA) using visual analogue scale and American Orthopaedic Foot and Ankle Score (AOFAS) as primary outcomes. Secondary outcomes included range of motion limitations, radiological outcomes, and complication rates.Aims
Methods
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. 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).Aims
Methods
The number of revision total ankle arthroplasties (TAAs) which are undertaken is increasing. Few studies have reported the survival after this procedure. The primary aim of this study was to analyze the survival of revision ankle arthroplasties using large datasets. Secondary aims were to summarize the demographics of the patients, the indications for revision TAA, further operations, and predictors of survival. The study combined data from the National Joint Registry and NHS Digital to report the survival of revision TAA. We have previously reported the failure rates and risk factors for failure after TAA, and the outcome of fusion after a failed TAA, using the same methodology. Survival was assessed using life tables and Kaplan Meier graphs. Cox proportional hazards regression models were fitted to compare failure rates.Aims
Methods
The Vantage Total Ankle System is a fourth-generation low-profile fixed-bearing implant that has been available since 2016. We aimed to describe our early experience with this implant. This is a single-centre retrospective review of patients who underwent primary total ankle arthroplasty (TAA) with a Vantage implant between November 2017 and February 2020, with a minimum of two years’ follow-up. Four surgeons contributed patients. The primary outcome was reoperation and revision rate of the Vantage implant at two years. Secondary outcomes included radiological alignment, peri-implant complications, and pre- and postoperative patient-reported outcomes.Aims
Methods
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. Data on a consecutive group of elite athletes who underwent isolated reconstruction of the anterior inferior tibiofibular ligament using the InternalBrace were collected prospectively. Our patient group consisted of 19 elite male athletes with a mean age of 24.5 years (17 to 52). Isolated injuries were seen in 12 patients while associated injuries were found in seven patients (fibular fracture, medial malleolus fracture, anterior talofibular ligament rupture, and posterior malleolus fracture). All patients had a minimum follow-up period of 17 months (mean 27 months (17 to 35)).Aims
Methods
Arthroplasty has become increasingly popular to treat end-stage ankle arthritis. Iatrogenic posterior neurovascular and tendinous injury have been described from saw cuts. However, it is hypothesized that posterior ankle structures could be damaged by inserting tibial guide pins too deeply and be a potential cause of residual hindfoot pain. The preparation steps for ankle arthroplasty were performed using the Infinity total ankle system in five right-sided cadaveric ankles. All tibial guide pins were intentionally inserted past the posterior tibial cortex for assessment. All posterior ankles were subsequently dissected, with the primary endpoint being the presence of direct contact between the structure and pin.Aims
Methods
Preoperative talar valgus deformity ≥ 15° is considered a contraindication for total ankle arthroplasty (TAA). We compared operative procedures and clinical outcomes of TAA in patients with talar valgus deformity ≥ 15° and < 15°. A matched cohort of patients similar for demographics and components used but differing in preoperative coronal-plane tibiotalar valgus deformity ≥ 15° (valgus, n = 50; 52% male, mean age 65.8 years (SD 10.3), mean body mass index (BMI) 29.4 (SD 5.2)) or < 15° (control, n = 50; 58% male, mean age 65.6 years (SD 9.8), mean BMI 28.7 (SD 4.2)), underwent TAA by one surgeon. Preoperative and postoperative radiographs, Ankle Osteoarthritis Scale (AOS) pain and disability and 36-item Short Form Health Survey (SF-36) version 2 scores were collected prospectively. Ancillary procedures, secondary procedures, and complications were recorded.Aims
Methods
In a randomized controlled trial with two-year follow-up, patients treated with suture button (SB) for acute syndesmotic injury had better outcomes than patients treated with syndesmotic screw (SS). The aim of this study was to compare clinical and radiological outcomes for these treatment groups after five years. A total of 97 patients with acute syndesmotic injury were randomized to SS or SB. The five-year follow-up rate was 81 patients (84%). The primary outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale. Secondary outcome measures included Olerud-Molander Ankle (OMA) score, visual analogue scale (VAS), EuroQol five-dimension questionnaire (EQ-5D), range of movement, complications, reoperations, and radiological results. CT scans of both ankles were obtained after surgery, and after one, two, and five years.Aims
Methods
There is little information about how to manage patients with a recurvatum deformity of the distal tibia and osteoarthritis (OA) of the ankle. The aim of this study was to evaluate the functional and radiological outcome of addressing this deformity using a flexion osteotomy and to assess the progression of OA after this procedure. A total of 39 patients (12 women, 27 men; mean age 47 years (28 to 72)) with a distal tibial recurvatum deformity were treated with a flexion osteotomy, between 2010 and 2015. Nine patients (23%) subsequently required conversion to either a total ankle arthroplasty (seven) or an arthrodesis (two) after a mean of 21 months (9 to 36). A total of 30 patients (77%), with a mean follow-up of 30 months (24 to 76), remained for further evaluation. Functional outcome, sagittal ankle joint OA using a modified Kellgren and Lawrence Score, tibial lateral surface (TLS) angle, and talar offset ratio (TOR) were evaluated on pre- and postoperative weight-bearing radiographs.Aims
Patients and Methods
We hypothesized that there is no difference in the clinical and radiological outcomes using local bone graft We prospectively studied 28 calcaneal malunion patients (the study group) who were managed by subtalar distraction arthrodesis using local calcaneal bone graft. The study group included 16 male and 12 female patients. The median age was 37.5 years (interquartile range (IQR) 29 to 43). The outcome of the study group was compared with a control group of ten patients previously managed by subtalar distraction arthrodesis using iliac bone graft. The control group included six male and four female patients. The median age was 41.5 years (IQR 36 to 44).Aims
Patients and Methods
Total ankle arthroplasty (TAA) surgery is complex and attracts a wide variety of complications. The literature lacks consistency in reporting adverse events and complications. The aim of this article is to provide a comprehensive analysis of each of these complications from a literature review, and to compare them with rates from our Unit, to aid clinicians with the process of informed consent. A total of 278 consecutive total ankle arthroplasties (251 patients), performed by four surgeons over a six-year period in Wrightington Hospital (Wigan, United Kingdom) were prospectively reviewed. There were 143 men and 108 women with a mean age of 64 years (41 to 86). The data were recorded on each follow-up visit. Any complications either during initial hospital stay or subsequently reported on follow-ups were recorded, investigated, monitored, and treated as warranted. Literature search included the studies reporting the outcomes and complications of TAA implants.Aims
Patients and Methods
The pathogenesis of intraneural ganglion cysts is controversial.
Recent reports in the literature described medial plantar intraneural
ganglion cysts (mIGC) with articular branches to subtalar joints.
The aim of the current study was to provide further support for
the principles underlying the articular theory, and to explain the
successes and failures of treatment of mICGs. Between 2006 and 2017, five patients with five mICGs were retrospectively
reviewed. There were five men with a mean age of 50.2 years (33
to 68) and a mean follow-up of 3.8 years (0.8 to 6). Case history,
physical examination, imaging, and intraoperative findings were
reviewed. The outcomes of interest were ultrasound and/or MRI features
of mICG, as well as the clinical outcomes.Aims
Patients and Methods
Morton’s neuroma is common condition of the forefoot, but its
aetiology remains unclear. Our aim was to evaluate the relationship
between the width of the forefoot and the development of a Morton’s
neuroma. Between January 2013 and May 2016, a total of 84 consecutive
patients (17 men, 67 women) with a unilateral Morton’s neuroma were
enrolled into the study. The involved and uninvolved feet of each
patient were compared. A control group of patients with symptoms
from the foot, but without a neuroma who were matched for age, gender, affected
side, and web space location, were enrolled. The first to fifth
intermetatarsal distance, intermetatarsal angle and intermetatarsal
distance of involved web space on standing radiographs were assessed.Aims
Patients and Methods
The last decade has seen a considerable increase
in the use of in total ankle arthroplasty (TAA) to treat patients
with end-stage arthritis of the ankle. However, the longevity of
the implants is still far from that of total knee and hip arthroplasties. The aim of this review is to outline a diagnostic and treatment
algorithm for the painful TAA to be used when considering revision
surgery. Cite this article:
Sporting injuries around the ankle vary from
simple sprains that will resolve spontaneously within a few days
to severe injuries which may never fully recover and may threaten
the career of a professional athlete. Some of these injuries can
be easily overlooked altogether or misdiagnosed with potentially
devastating effects on future performance. In this review article,
we cover some of the common and important sporting injuries involving
the ankle including updates on their management and outcomes. Cite this article:
The purpose of this study was to evaluate the
change in sagittal tibiotalar alignment after total ankle arthroplasty (TAA)
for osteoarthritis and to investigate factors affecting the restoration
of alignment. This retrospective study included 119 patients (120 ankles) who
underwent three component TAA using the Hintegra prosthesis. A total
of 63 ankles had anterior displacement of the talus before surgery
(group A), 49 had alignment in the normal range (group B), and eight
had posterior displacement of the talus (group C). Ankles in group
A were further sub-divided into those in whom normal alignment was
restored following TAA (41 ankles) and those with persistent displacement
(22 ankles). Radiographic and clinical results were assessed. Pre-operatively, the alignment in group A was significantly more
varus than that in group B, and the posterior slope of the tibial
plafond was greater (p <
0.01 in both cases). The posterior slope
of the tibial component was strongly associated with restoration
of alignment: ankles in which the alignment was restored had significantly
less posterior slope (p <
0.001). An anteriorly translated talus was restored to a normal position
after TAA in most patients. We suggest that surgeons performing
TAA using the Hintegra prosthesis should aim to insert the tibial
component at close to 90° relative to the axis of the tibia, hence
reducing posterior soft-tissue tension and allowing restoration
of normal tibiotalar alignment following surgery. Cite this article:
Large osteochondral lesions (OCLs) of the shoulder
of the talus cannot always be treated by traditional osteochondral
autograft techniques because of their size, articular geometry and
loss of an articular buttress. We hypothesised that they could be
treated by transplantation of a vascularised corticoperiosteal graft
from the ipsilateral medial femoral condyle. Between 2004 and 2011, we carried out a prospective study of
a consecutive series of 14 patients (five women, nine men; mean
age 34.8 years, 20 to 54) who were treated for an OCL with a vascularised
bone graft. Clinical outcome was assessed using a visual analogue
scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society
(AOFAS) hindfoot score. Radiological follow-up used plain radiographs
and CT scans to assess graft incorporation and joint deterioration. At a mean follow-up of 4.1 years (2 to 7), the mean VAS for pain
had decreased from 5.8 (5 to 8) to 1.8 (0 to 4) (p = 0.001) and
the mean AOFAS hindfoot score had increased from 65 (41 to 70) to
81 (54 to 92) (p = 0.003). Radiologically, the talar contour had
been successfully reconstructed with stable incorporation of the
vascularised corticoperiosteal graft in all patients. Joint degeneration
was only seen in one ankle. Treatment of a large OCL of the shoulder of the talus with a
vascularised corticoperiosteal graft taken from the medial condyle
of the femur was found to be a safe, reliable method of restoring
the contour of the talus in the early to mid-term. Cite this article:
The incidence of periprosthetic fractures of
the ankle is increasing. However, little is known about the outcome
of treatment and their management remains controversial. The aim
of this study was to assess the impact of periprosthetic fractures
on the functional and radiological outcome of patients with a total
ankle arthroplasty (TAA). A total of 505 TAAs (488 patients) who underwent TAA were retrospectively
evaluated for periprosthetic ankle fracture: these were then classified
according to a recent classification which is orientated towards
treatment. The outcome was evaluated clinically using the American
Orthopedic Foot and Ankle Society (AOFAS) score and a visual analogue
scale for pain, and radiologically. A total of 21 patients with a periprosthetic fracture of the
ankle were identified. There were 13 women and eight men. The mean
age of the patients was 63 years (48 to 74). Thus, the incidence
of fracture was 4.17%. There were 11 intra-operative and ten post-operative fractures,
of which eight were stress fractures and two were traumatic. The
prosthesis was stable in all patients. Five stress fractures were
treated conservatively and the remaining three were treated operatively. A total of 17 patients (81%) were examined clinically and radiologically
at a mean follow-up of 53.5 months (12 to 112). The mean AOFAS score
at follow-up was 79.5 (21 to 100). The mean AOFAS score in those
with an intra-operative fracture was 87.6 (80 to 100) and for those
with a stress fracture, which were mainly because of varus malpositioning,
was 67.3 (21 to 93). Periprosthetic fractures of the ankle do not
necessarily adversely affect the clinical outcome, provided that
a treatment algorithm is implemented with the help of a new classification
system. Cite this article:
We hypothesised that a minimally invasive peroneus
brevis tendon transfer would be effective for the management of
a chronic rupture of the Achilles tendon. In 17 patients (three
women, 14 men) who underwent minimally invasive transfer and tenodesis
of the peroneus brevis to the calcaneum, at a mean follow-up of
4.6 years (2 to 7) the modified Achilles tendon total rupture score
(ATRS) was recorded and the maximum circumference of the calf of
the operated and contralateral limbs was measured. The strength
of isometric plantar flexion of the gastrocsoleus complex and of
eversion of the ankle were measured bilaterally. Functional outcomes
were classified according to the four-point Boyden scale. At the latest review, the mean maximum circumference of the calf
of the operated limb was not significantly different from the pre-operative
mean value, (41.4 cm, 32 to 50 This procedure may be safely performed, is minimally invasive,
and allows most patients to return to pre-injury sport and daily
activities. Cite this article:
