Cottom JM, Sisovsky CA. H2 Fixed and H3 Mobile-Bearing Total Ankle Replacement. Roukis TS, Berlet GC, Bibbo C, Hyer CF, and Penner MJ (eds): Primary and Revision Total Ankle Replacement, 2nd Ed. Springer, Cham. https://doi.org/10.1007/978-3-030-69269-8_14 ISBN: 978-3030692681
Achilles tendon pathology is a common ailment affecting a wide variety of the population. Early diagnosis and prompt treatment of an acute injury generally result in a more favorable outcome. That said, as common as these injuries are, 25% of ruptures are missed during initial examination.2 Of these that are missed, most patients present with long-standing pain with the inability to perform normal activities without difficulty. Not all neglected Achilles tendon injuries, however, require surgery. Those who are unable to undergo surgery due to comorbidities or those who have sedentary lifestyles can be treated with custom ankle-foot orthoses...
Lisfranc fracture dislocation is an injury often encountered by the foot and ankle surgeon. This injury, depending on the severity and level of energy, has been shown to lead to posttraumatic osteoarthritis and chronic pain if undiagnosed or improperly managed. The purpose of this study was to retrospectively evaluate the surgical repair with the use of an interosseous suture button for Lisfranc injuries with isolated ligamentous disruption. From 2008 through 2016, 104 patients were consecutively enrolled who underwent open reduction internal fixation (ORIF) of the Lisfranc complex with a suture button and stabilization of the medial and intermediate cuneiform with a 4.0-mm screw. Eighty-four patients were available for a 3-year minimum follow-up. The mean return to full weightbearing was 11 days protected in a controlled ankle motion (CAM) boot. American Orthopedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) scores improved from 30 and 8.4, respectfully, preoperatively to 90 and 1.3 postoperatively. The mean preoperative step-off between the second metatarsal base and intermediate cuneiform was found to be 3.15 mm. The immediate postreduction weightbearing radiograph measured 0.25 mm and 0.43 mm at the final follow-up evaluation, a difference that was found to be significant. There were no revision arthrodeses performed and no removal of the suture button during this time period. ORIF using an interosseous suture button appears to have an adequate medium-term patient satisfaction; however, there is evidence of minimal diastasis in some patients at 3 years postoperatively in ligamentous Lisfranc fracture dislocations.
Cottom JM, Graney CT, Sisovsky CA. Treatment of Lisfranc Injuries Using Interosseous Suture Button: A Retrospective Review of 84 cases. J Foot Ankle Surg. Nov-Dec 2020;59(6):1139-1143. PMID: 32830017
The all-inside arthroscopic Broström surgical procedure for chronic lateral ankle instability is a minimally invasive procedure that is an option surgeons have when treating their patients. There have not been any studies analyzing the integrity of the repair to patients who have an elevated body mass index (BMI) to determine if the strength of the repair is adequate. We retrospectively evaluated a total of 113 consecutive patients who underwent this procedure. Fifty-nine patients had a BMI ≥30 kg/m2; 54 had a BMI <30 kg/m2. Unpaired t tests were performed to determine if a difference in American Orthopedic Foot and Ankle Society, visual analog scale, and Foot Function Index were encountered. Our findings indicate that there is no significant difference between patients with a BMI ≥30 kg/m2 compared to a BMI <30 kg/m2 who undergo an all-inside arthroscopic Broström procedure for chronic lateral ankle instability. This information may help surgeons decide what procedure options are available when treating chronic lateral ankle instability.
Cottom JM, Graney CT, Sisovsky CA. Evaluation of BMI with an All-Inside Arthroscopic Brostrom Procedure for Chronic Lateral Ankle Instability: An Analysis of 113 Patients. JFAS. J Foot Ankle Surg. Sep-Oct 2020;59(5):1008-1012. PMID: 32690232
Traditionally, total ankle replacement has been reserved for elderly patients with low physical demands. With nearly 80% of end-stage ankle arthritis being secondary to prior trauma, patients may require a replacement at a much younger rate than primary hip and knee arthritis. Historical accounts of implant failure and high revision rates in younger patients have been reported in the literature. With increasing technology and surgeon experience, implants are being used in younger patients with significantly fewer complications than early reports. In this retrospective review, we evaluated the patient-reported outcome measures and implant complications in three age subsets in arthroplasty patients; Group 1: <55 years-old, Group 2: 55-70 years-old, and Group 3: >70 years-old. In our study, mean postoperative American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scores were 75.5 for group 1, 79.7 for group 2, and 86.9 for group 3, which improved from preoperative scores of 50, 52.4, and 53.8, respectively. Mean postoperative Foot Function Index (FFI) scores were 10 for group 1, 23.9 for group 2, and 12.3 for group 3, which improved from 59.4, 62.8, and 47.6 preoperatively, respectively. The overall complication rate was found to be 11.2%. The complication rate for group 1 was 18%, the complication rate for group 2 was 11.6%, and the complication rate was 9.4% for group 3. The differences in patient AOFAS hindfoot, FFI scores, and complication rates between the groups were not found to be statistically significant. Our results show that patients younger than age 55 years have similar complication rates and reported satisfaction scores to patients 55 years of age and older.
Cottom JM, Graney CT, Douthett SM, Sisovsky CA, McConnell KK, Plemmons BS . Age-Related Outcomes in Total Ankle Arthroplasty: An Analysis of 112 Patients. JFAS. J Foot Ankle Surg. Jul-Aug 2020;59(4):739-742. PMID: 32113827
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