Faculty Bibliography

Several methods of obtaining ankle fusion have been described, with numerous studies reporting on patient populations with varied diagnoses and various methods of fixation. This has led to outcome analyses that are difficult to interpret. Our hypothesis is that using a standard method of fusion, without the aid of allograft, a solid ankle fusion can be achieved in patients with end-stage ankle arthritis, and that this outcome can be reflected in standardized outcome tools. Forty-one consecutive ankle fusions in 40 patients were included in our study, with a minimum followup of 3 years. All patients had an ankle arthrodesis using two parallel retrograde 7.3-mm screws and local fibular graft. All but two patients obtained a solid talocrural union (95%), with a mean postoperative improvement in the American Orthopaedic Foot and Ankle Society score of 23 points. Results of our study showed that a simple technique based on sound mechanical and biologic principles can yield excellent outcomes for patients.

UNLABELLED:Interposition arthroplasty reportedly improves outcomes after traditional salvage procedures for advanced hallux rigidus. We hypothesized this procedure can provide pain relief and satisfactory function with few complications. We examined 18 patients with severe articular cartilage loss who received 21 interposition arthroplasties. The patients a mean age was 56 years. They had a mean followup of 38 months. All patients had substantial loss of articular cartilage when examined intraoperatively. Patients were evaluated using the American Orthopaedic Foot and Ankle Society and Short Form-36 scores. All 18 patients had pain relief, and 17 of 18 patients said they would have the procedure again. The mean postoperative increase in range of motion of the first meta-tarsophalangeal joint was 37 degrees . The mean American Orthopaedic Foot and Ankle Society and Short Form-36 scores were 78.4 and 96.3, respectively. The complication rate was 6%. Results of our study indicate that interposition arthroplasty relieves pain and restores motion in patients with advanced hallux rigidus and may offer a reliable option to fusing the joint. LEVEL OF EVIDENCE/METHODS:Therapeutic study, Level IV (case series).

BACKGROUND:Ankle arthrodesis remains the benchmark of treatment for end-stage arthrosis of the ankle joint. Despite that, the incidence of nonunion can be as high as 15%. Various strategies have been used to reduce the incidence of nonunion, including multiple compression screws and larger diameter screws to improve mechanical stability and compression. The space occupied by an increasing amount of hardware across a finite surface area available for fusion has prompted concern that this strategy may be counterproductive and may reduce the biological potential of the construct. The purpose of this study was to look at 40 anatomic sawbone specimens of the ankle to determine the amount of talar surface contact area used by the screw fixation during arthrodesis. METHODS:Four groups were created to examine different techniques for arthrodesis. Simulated ankle arthrodeses were done using two- or three-screw fixation with 6.5-mm and 7.3-mm screws. Hardware was subsequently removed and the surface area used by the passing screws was measured. Total surface areas were calculated for each of the 40 specimens. RESULTS:The maximal surface area of the talus occupied by screws occurred when using three 7.3-mm screws. This configuration used 16% of the possible talar surface area available for arthrodesis. CONCLUSION/CONCLUSIONS:The use of additional screw fixation when performing an ankle arthrodesis does not sacrifice a major amount of the tibiotalar contact area and will most likely not affect the biologic environment needed to obtain fusion.

Adult flat foot deformity, resulting from posterior tibial tendon (PTT) insufficiency has been treated traditionally with a combination of bony and soft tissue procedures with variable outcomes. Many techniques advocate repair of the spring ligament to optimize outcome. In cases of long standing PTT deficiency, however, the spring ligament may be significantly attenuated; compromising potential repair as a useful surgical strategy.The current authors describe a simple technique that uses the distal stump of the PTT to reconstruct and augment the spring ligament fibrocartilage complex. The advantage of this technique is the use of existing autogenous tissue to provide reconstruction of the attenuated spring ligament. The construct provides a broad proximal support; preventing midtarsal pronation and abduction by its Y shaped configuration without donor site morbidity

Repair of the Achilles tendon ruptures is becoming a more accepted means of treatment over casting. However, wound problems are still a problematic complication. Minimally invasive Achilles tendon repair using the Achillon® device is presented and discussed as a treatment method that combines the benefits of surgical repair with less wound complications caused by a smaller surgical approach. Cadaveric studies have shown this repair to be stronger than the traditional modified Krackow suture technique

Calcaneal ostectomy is the benchmark for definitive surgical treatment in patients with Haglund's syndrome, despite conflicting and unpredictable study results. The current study's hypothesis is that when adequate bone is resected and outcomes are evaluated using validated scores, calcaneal ostectomy can give reliable and predictable results. Thirty six consecutive patients (39 feet) underwent calcaneal ostectomy for Haglund's deformity between 1998 and 2002. All patients were evaluated with the AOFAS score and SF-36v2 questionnaire. The mean time to follow-up was 51 months. The mean AOFAS score following surgery was 86/100 points; the mean SF-36v2 score following surgery was 144/152. Six of the 36 patients interviewed, however, would not recommend the procedure to others, citing mainly prolonged recovery time. Calcaneal ostectomy achieves good-to-excellent results in the treatment of Haglund's deformity when appropriate amounts of bone are excised. However, patients must be made aware of the necessary time to recovery, between 6 months and 2 years.

BACKGROUND:The Broström-Gould procedure is a commonly recommended operative treatment for chronic ankle instability. Using standardized physician-based outcome scores, the results of this procedure have been uniformly excellent. Current scoring systems, however, do not adequately evaluate mechanical or functional instability. Therefore, outcome data may suggest greater success than is justified. METHODS:A retrospective review was done of 73 patients who had isolated Broström-Gould repairs of the lateral ankle ligaments. The mean time to followup was 64 months. Both the AOFAS ankle-hindfoot score and the Short Form 36 (SF-36) were used to evaluate outcome. RESULTS:The overall American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 95 of 100 points. Despite that, 17% of patients in the study had functional instability of the ankle that was not reflected in the AOFAS score. The mean physical component score of the SF-36 was 84% and reflected the presence of functional instability. Low correlations were found between the AOFAS ankle-hindfoot score and the SF-36 score. CONCLUSIONS:The current study identified a deficiency in the AOFAS score in evaluating functional ankle stability after the Broström-Gould procedure. A more meaningful analysis of outcomes can be expected using the SF-36 score. The data suggest that greater attention must be paid to functional rehabilitation after ankle stabilization surgery to obtain optimal outcome.

PURPOSE OF REVIEW/OBJECTIVE:To evaluate the increase in overuse injuries in the adolescent athlete, specifically sports-related injuries to the foot and ankle of the adolescent runner. Factors affecting these injuries include anatomic considerations, gender, rate of development, growth, training errors, shoe wear, and running surface. RECENT FINDINGS/RESULTS:Most injuries in adolescent runners are overuse injuries rather than sudden traumatic events. Adolescent athletes are as prone as adults to poor form, poor habits, and poor training patterns. In addition, anatomic variants in the hindfoot, midfoot, and forefoot may predispose an athlete to specific injury. SUMMARY/CONCLUSIONS:Adolescent running injuries are common and becoming more frequent as trainers and athletes place increasing demands on the growing body. There is no evidence that this increased demand produces long-term adverse effects; however, a significant amount of time can be lost to injuries unless training patterns are constructed to allow for repair of the adolescent athlete.

As health care costs increase, evaluating treatment methods in femoral neck fractures to determine the most effective treatment paradigm will become increasingly important. The current study compared two methods of treatment in similar cohorts of displaced femoral neck fractures. One hundred and twenty two patients were randomly assigned to two groups: In Group A, 62 patients were treated with a hemiarthroplasty. In group B, 60 patients were treated with dynamic screw fixation. Patients were evaluated at a minimum 3 year follow-up. Using the Matta functional hip score, 42% of group A and 70% of group B had good to excellent results. This difference was significant (p = 0.004). A significant agreement between physician assessment using the Matta score, and patient perception of outcome using the SF-36 scale was demonstrated (r = 0.64). No statistical difference between groups for revision surgery existed. Both physician based and patient based outcome scores favour retention and internal fixation of the femoral head in this cohort of patients at a short-term follow-up.