Percutaneus repair of Achilles tendon rupture under direct ultrasound surveillance

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E-Poster / Foot and Ankle Surgery 22S (2016) 80–104

208 FI2016_E-Poster_31 First metatarsophalangeal arthrodesis with an endomedullary screw technique J. Calvi 1,*, A. Migues 2, P. Sotelano 2, M. Carrasco 2, G. Slullitel 1, L. Conti 2 1

Instituto Dr. Jaime Slullitel Rosario, Argentina Argentina, Hospital Italiano De Buenos Aires, Argentina *Corresponding author. 2

60.1 (SD 13.7) to 28.1 (SD 21.0). The overall FFI improved from 57.9 (SD 13.7) to 26.5 SD (17.4). The AOFAS score increased from 50.8 (SD 17.9) to 81.7 (SD 12.8). Bone marrow edema (BME) was a common finding. Up to 12 months BME in the MRI was not correlated to poor clinical outcome. Detachment of the membrane, delamination of cartilage at the edge, as well as synovitis in the MRI showed a strong correlation with pain in the clinical scores. A normal bone and cartilage signal was not found, even if clinical scores were excellent. http://dx.doi.org/10.1016/j.fas.2016.05.231

Problem Description: The purpose of this study was to evaluate the clinical and radiological results in a group of patients who underwent first metatarsophalangeal joint arthrodesis with an endomedullary screw fixation technique (MPA-E). Design: Case-series. Control Group: None Material: Between 2003 and 2009, 101 metatarsophalangeal arthrodesis were performed in 76 patients. There were 64 women and 12 men with an average age of 68 years. Methods: Patients were evaluated radiologically and with the American Orthopaedic Foot & Ankle Society scoring system (AOFAS) at an average follow-up of 32 months (range, 24–92 months). Results: The success rate was 93%, with an increase of the average preoperative AOFAS from 38.5 points to 85.5 points postoperatively (P < .0001). The consolidation rate after radiological evaluation was 90.1%; there were 5 cases (5.0%) with asymptomatic nonunion and 5 cases (5.0%) with poor results because of symptomatic nonunion. Screw removal was needed in 4 feet (4.0%), and 2 feet (2.0%) had acute postoperative superficial infection. No implant cutout was observed. Conclusion: The MPA-E technique provided consistent and high functional outcomes. This valid and effective alternative should be considered as an option for hallux metatarsophalangeal arthrodesis. http://dx.doi.org/10.1016/j.fas.2016.05.230

209 FI2016_E-Poster_32 MRI imaging after cartilage reconstruction with autologous membrane induced chondrogenesis (AMIC) M. Walther 1,*, U. Szeimies 2, O. Gottschalk 1 1

Scho¨n Klinik Mu¨nchen Harlaching, Germany Radiologie in Mu¨nchen Harlaching, Germany *Corresponding author. 2

Purpose: Correlation of MRI and clinical outcome after cartilage reconstruction with a cellfree collagen membrane at the talus. Methods: 25 consecutive patients (17 male, 8 female, average age 32, range 21–58) were included in a prospective cohort study. All patients were treated with an autologous, matrix induced chondrogenesis (AMIC) due to a cartilage defect of the talus larger than 1.5 cm2. The patients were reevaluated at 12 months and between 18 and 48 months postoperative with 3.0 Tesla and 1.5 Tesla (Pdw fat sat, 2 mm slice, high resolution ankle coil, 15 channel). If clinical symptoms were present, Gadolinium was used as contrast agent. The assessment included AOFAS score and FFI prior surgery and during the follow up. Results and Conclusions: The Foot Function Index (FFI–0 best, 100 poor result) improved in the category pain from 55.0 (SD 19.6) to 24.5 (SD 14.5). In the category function the FFI improved from

210 FI2016_E-Poster_33 Minimal invasive Hallux valgus surgery: Learning curve and early results M. Walther *, S. Kriegelstein, S. Altenberger, A. Ro¨ser Scho¨n Klinik Mu¨nchen Harlaching, Germany *Corresponding author. Introduction: The authors report the early results and learning curve establishing minimal invasive hallux valgus (HV) surgery. Material and Methods: 50 consecutive patients (female 42, male 8, average age 56, range 19–72) were included in the prospective cohort study. All patients were treated with minimal invasive Chevron and Akin osteotomy, performed by 4 foot and ankle consultants after a surgical training in cadaver labs before starting minimal invasive forefoot surgery. All patients had a 3-6 month follow up (FU) with x-ray and clinical examination and a 12 month FU using the Foot Function Index (FFI). Results: There have been 3 technical complications requiring revision surgery (2 loss of correction with dislocation of screws, 1 inadequate shortening) and 8 material conflicts. There was no neuro-vascular or tendon injury and non-union, although the radiological healing took up to 6 months. The complications were equally distributed among the surgeons. 45 patients reported good/excellent results especially due to low amount of swelling and nearly painless range of motion. The mean HVA improved from 38.18 (range, 28–528) to 12.88 (range, 5–208). The mean IMA improved from 17.08 (range, 13–248) to 6.88 (range, 3–108). The FFI score improved 50% compared to the preoperative value. All surgeons reported a moderate learning curve and benefit of surgical cadaver lab training. Conclusion: The minimal invasive Chevron and Akin osteotomy is a save and reproducible technique for correction of HV after cadaver lab training with a moderate learning curve, providing at least similar results to open HV surgery. http://dx.doi.org/10.1016/j.fas.2016.05.232

211 FI2016_E-Poster_34 Percutaneus repair of Achilles tendon rupture under direct ultrasound surveillance M. Wro´bel *, A. Mioduszewski, R. Swierczynski, J. Sroczynski, G. Klos Ortopedika, Warsaw, Poland *Corresponding author. Background: Open repair of Achilles tears is a standard procedure, however complications may occure due to extensive

E-Poster / Foot and Ankle Surgery 22S (2016) 80–104

approach. In minimally invasive procedures were the risk of damaging sural nerve was pointed out. Aims: We developed percutaneus repair of Achilles tendon ruptures under direct ultrasound surveillance. Methods: Between 05.2011 and 09.2015 we performed 14 procedures. The tendons were repaired with suture loop passed through the tendon below and above rupture through the skin with elastic needle under direct ultrasound visualization. Most of patients were burdened with general conditions with relative contraindications for open procedure. Only acute ruptures were qualified for treatment. Results: We assessed function of repaired tendon in clinical examination and ultrasound exam 6 weeks and three months after surgery. Also AOFAS score was used. 13 of 14 patients healed tendon and returned to their activities. In one case conversion to open surgery was necessary as patient experienced another trauma in postoperative period. Another patient reported persisting pain due to suture conflict with soft tissues. Release of the suture was necessary six months after surgery. There was no sural nerve entrapement nor skin healing problems. AOFAS score rised from 57.8 to 92.8 three months after surgery. Conclusions: Percutaneus repair of Achilles tendon rupture under ultrasound surveillance is minimally invasive and effective method of treatment of acute ruptures. It is safe and allows to avoid both sural nerve entrapement and skin healing problems. Hovewer it requires some experience with ultrasound diagnostics. http://dx.doi.org/10.1016/j.fas.2016.05.233

212 FI2016_E-Poster_35 Is forefoot day case surgery acceptable to patients T. El Gamal *, D. Makki, S. Abdullah, G. Jackson, S. Platt Wirral University Teaching Hospital, UK *Corresponding author. Background: The number of day case forefoot procedures performed in the United Kingdom has grown rapidly in recent years. There remains a good deal of controversy concerning day case forefoot surgery. Aim: Assess safety and patient satisfaction with forefoot day surgery. Methods: 40 consecutive patient attending Wirral university hospitals for forefoot day surgery e were surveyed. Basic demographic data was captured along with patient’s satisfaction with process and overall care. Results: The mean patient age was 53.8. 34 were females and 6 were males. The mean BMI was 26.4. 26 patients had American Society of Anaesthesiologists Score (ASA) of 1 while 14 were ASA 2. 15 patients underwent Minimally invasive Chevron and Akins osteotomy, 10 had SCARF osteotomy, 4 had minimally invasive Cheilectomy, 5 had lesser toes corrective surgery, 3 had first metatarsophalangeal joint fusion, and 3 had Mortons neuroma excision. All the patients filled in a 2 pages A4 pro forma to assess satisfaction after forefoot day surgery. 36 patients had received a clinic letter outlining their procedure prior to surgery. 39 patients knew that they were having a day surgery procedure. All the 40 patients attended a preoperative consent clinic. The mean satisfaction rate with the preoperative process was 89.1%. The mean satisfaction rate with the postoperative Physiotherapy was 81%. The mean postoperative pain score was

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50.58%. None of the patients suffered a postoperative complication. The mean satisfaction rate of the day surgery experience was 92.7%. Conclusions: Forefoot day surgery is acceptable, safe and associated with high patient satisfaction rate. http://dx.doi.org/10.1016/j.fas.2016.05.234

213 FI2016_E-Poster_36 First metatarsophalangeal joint arthroscopy in posttraumatic osteochondritis dissecans case R. Chiavegatti *, F. Estallo, J.M. Cidraque, R. Marin, J.M. Burdeus, S. Losco Hospital Universitario Sagrado Corazon, Barcelona, Spain *Corresponding author. Background: First metatarsophalangeal joint arthroscopy is a recent technique and its indications are still discussed. Patient: A 35-years-old man, carpenter with no history of diseases, complains of left food pain during walking following traumatic episode two years sooner. The pain has gradually worsened such needing crutches and leaves his job. The patient is derived to Food and Ankle unity of our hospital. MRI which reports a subchondral lesion of the first metatarsal head, compatible with a posttraumaticosteochondritis dissecans with degenerative changes of the articulation. AOFAS score 46. After the failure of conservative measures we propose the treatment by arthroscopy. Materials and Methods: After leg ischemia and peripheral nerve blocking, two portals are channeled on either side of the extensor longus tendon (dorsolateral and dorsomedial). Using a 2.7 mm optical 308 angled we access the MTP articulation identifying an intraarticular osteochondral fragment of 13  6 mm and degenerative joint changes. The fragment is debrided with the 2.7 shaver and extracted with tweezers. Finally, radiofrequency is performed to stabilize the lesion and microperforations are made in the metatarsal head. Results: After hospital discharge the patient reports complete pain relief, walks without crutches and has returned to his job few days after surgery (AOFAS score of 92p). Conclusions: First MTP joint arthroscopy is a recent technique and therefore with limited diagnostic and therapeutic indications. However, the experience found so far supports the progress of this technique and encourages its consolidation as an alternative to open surgery. http://dx.doi.org/10.1016/j.fas.2016.05.235

214 FI2016_E-Poster_37 Ankle morphometry based on computerized tomography L. Claassen 1,*, P. Ludtke 1, S. Ettinger 1, M. Mu¨ller-Gerbl 2, A. Nowakowski 3, K. Daniilidis 1, C. Stukenborg-Colsman 1, C. Plaass 1 1

Hannover Medical School, Orthopedic Department, Germany University of Basel, Department of Biomedicine, Switzerland 3 University Hospital of Basel, Orthopedic Department, Switzerland *Corresponding author. 2

Background: Understanding the morphometry of the ankle joint is crucial to improve total ankle replacement (TAR). Despite