- Email: [email protected]
Preliminary clinical and radiological evaluation with transfibular total ankle replacement
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
243 Reconstruction of stage; posterior tibial tendon dysfunction with the artificial ligament N. Takatori 1,∗ , N. Usami 1 , E. Hiraishi 2 , H. Ikezawa 2 , T. Ashida 1 , T. Yamada 1 1 2
Usami Orthopedic Clinic, Japan Eiju Hospital, Tokyo, Japan
Background: Flexor digitorum longus (FDL) transfer in addition to calcaneal osteotomy or lateral column lengthening has been considered the standard procedure for Stage posterior tibial tendon dysfunction (PTTD). As the flexor halluces longus covers part of the FDL’s function, it’s not deemed a serious matter to lose FDL function. Japanese who don’t wear shoes indoors sometimes feel inconvenience standing up from sitting in the ‘seiza’style without FDL function. Aims: We describe a new method for reconstruction of the posterior tibial tendon (PTT) using the Leeds-Keio artificial ligament. Methods: The procedure has been performed on 10 feet in 10 female patients whose average age was 60.4 years. The average follow-up period was 14.7months. A medial incision along the PTT exposes from the tuberosity of the navicular through the healthy portion of the PTT. After resection of the degenerated part, the distal margin of the normal portion is inserted into the proximal part of the artificial ligament. The distal end of the implant is then passed through a tunnel drilled through the tuberosity of the navicular. The range of motion exercise is started 2 weeks postoperatively. Partial weight-bearing is permitted at 4 weeks. Results: The average AOFAS hindfoot score was improved from 52.9 to 84.7. There was no case of major complications. Conclusions: The reconstruction of the PTT using the artificial ligament has the advantages that autogenous graft material is not required and that the implant has sufficient strength to start early rehabilitation and weight bearing without any brace. http://dx.doi.org/10.1016/j.fas.2017.07.332
244 Endoscopic treatment for the peroneal tendon dislocation-aiming anatomical repair A. Waseda Ogikubo Hospital, Japan Introduction: Although many studies of operative treatment for the peroneal tendon dislocation have reported good or excellent results, there have been reports of significant complications following open surgical procedures. This retrospective study was conducted to analyze the clinical results for seven patients treated endoscopically for peroneal tendon dislocation between 2015 and 2016. Materials & methods: Two portals are made. The proximal portal is made first, 3 cm above the tip of the lateral malleolus and the other 2 cm distal to the lateral malleolus. Based on the Eckert and Davis classification, all cases were Grade 1. Six patients were treated with the superior peroneal retinaculum repair alone. One patient was treated with superior peroneal retinaculum repair with fibular groove deepening. The SPR were reattached to the fibula using 2 anchors after refreshing the lateral malleolus surface. For postoperative treatment, cast were applied for 2–6 weeks and after which ankle range-of motion exercise are encouraged.
81
Results: On final examination, there were no re-dislocations of the tendon. The mean AOFAS score increased from 79 to 100, and Visual Analog Score was 0 in all patients. Conclusions: To repair peroneal tendon sheath anatomically and to decrease the complications, it’s important not to incise the tendon sheath. An endoscopic approach was successful in treatment of the peroneal tendon dislocations. http://dx.doi.org/10.1016/j.fas.2017.07.333
245 Spectrum of pathological conditions of posterior ankle impingement due to ballet dancing E. Hiraishi 1,∗ , H. Ikezawa 1 , N. Usami 2 1 2
Eiju General Hospital, Japan Usami Orthopaedic Surgery, Japan
Background: It is well known that ballet dancers are frequently affected by posterior ankle impingement syndrome (PAIS). There have been reported many pathological conditions about PAIS. Aim: To clarify the characteristics of pathological conditions of PAIS due to ballet activities. Methods: 132 feet of 117 patients, who underwent hindfoot endoscopic surgery between September 2007 and December 2016, except revision cases, were retrospectively examined mainly by operative findings, X-P, and MRI. They consisted of 110 female and 7 male, and the average age at the surgery was 20.8 years (ranging 11–56). Most of them had received ballet lessons more than five times a week. Results: Bony impingement (BI) was the major cause, and flexor hallucis longus tendinopathy (FHLT) was the second. BI consisted of synchondrosis injury, reactive synovitis caused by movable Os trigonum (OT) or small ossicles, fracture or micro-fracture, and localized osteoarthritis. 92 ft of 83 patients were affected both BI and FHLT, and 35 ft of 34 patients were BI only, 5 ft of 5 patients were only FHLT. Tubularization through small incision was applied to 3 ft of severe FHLT. Posterior intermalleolar ligament was observed in 94 ft, marsupial meniscus in 8 ft, and obvious tear in one foot. Alternative conditions such as osteochondral lesion, anterior ankle impingement, chronic lateral ankle instability, and etc. were also seen concomitantly in several feet. Conclusion: The conditions of PAIS by ballet dancing is usually complicated and proper treatments shall be necessary. http://dx.doi.org/10.1016/j.fas.2017.07.334
246 Preliminary clinical and radiological evaluation with transfibular total ankle replacement A. Bianchi ∗ , J. Flore, G. Romeo, E. Sartorelli, N. Martinelli, F. Malerba IRCCS Galeazzi, Milan, Italy Introduction: Total ankle replacement (TAR) is mainly performed by an anterior approach; the Zimmer Trabecular Metal ® (Zimmer TM) TAR was developed to be used through a lateral approach with a peroneal osteotomy. This study describes early clinical and radiological outcomes in patients who underwent this procedure. Methods: A group of twenty-seven consecutive patients who underwent TAR surgery between July 2013 and January 2016 were
82
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
enrolled in this study; clinical assessment was collected pre- and post-operatively from each patient using American Orthopaedic Foot and Ankle Society score (AOFASs), Foot Function Index (FFI) and VAS score. Lateral radiographs of the ankle with the foot in maximal dorsiflexion and plantarflexion were taken for all patients. Results: All patients were followed up with final radiographic analysis and clinical evaluation for a mean period of 22.6 months. After surgery, the mean FFI improved from 52.9 ± 14.8 to 16.4 ± 8.3 for the pain subscale and from 63.6 ± 18.8 to 18.3 ± 13.7 for the disability subscale (p < 0.01). The mean preoperative VAS score was 7.8 points, mean AOFAS score was 42 points. At the last follow-up visit, VAS was 2.1 points, AOFAS was 87 points which was significantly improved (p < .01). The average postoperative tibiotalar ROM was 20◦ in plantarflexion and 5◦ in dorsiflexion. Most participants (90%) were satisfied or very satisfied after surgery. Conclusion: These early results show high levels of patient satisfaction and good clinical outcomes, and we are encouraged to continue with lateral approach total ankle arthroplasty. http://dx.doi.org/10.1016/j.fas.2017.07.335
247 Outcome of operative treatment of acquired adult flatfoot deformity in stage 2 patients K. Takeuchi 1,∗ , M. Noguchi 2 , H. Maruki 1 , M. Tazaki 1 1
Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, Japan 2 Department of Orthopaedic Surgery, Tokyo Women’s Medical University, Japan Introduction: For acquired adult flatfoot deformity, there are various operative procedures on different clinical stages. We investigated the clinical results of stage 2 patients after surgery. Patients and methods: Twenty-three feet (14 right, 9 left) of 21 patients (6 male, 16 female) on stage 2 were evaluated. The average age was 54.1 (range 18–80) years and the mean follow-up period was 32.1 (range 12–55) months. Operative procedures included posterior tibial tendon plasty (PTTP), medial displacement calcaneal osteotomy (MDCO), flexor digitorum longus transfer (FDLT), calcaneal cuboid joint distraction arthroplasty (CCDA), selective arthrodesis (SA). The patient underwent PTTP in 2 ft, MDCO in 1 foot, MDCO and FDLT in 9 ft, CCDA and FDLT in 3 ft, MDCO, CCDA and FDLT in 6 ft, MDCO, CCDA, FDLT and SA in 2 ft. Outcomes were assessed using the Japanese Society for Surgery of the Foot (JSSF) Scale and Japanese Orthopaedic Association/JSSF, Self-Administered Foot Evaluation Questionnaire (SAFE-Q). Results: The average JSSF scale improved from 52.1 points preoperatively to 86.6 points at follow-up. For SAFE-Q, the mean preoperative and postoperative values related to pain were 42.1 points and 76.2 points, those related to activities of daily livings were 56.4 points and 79.4 points, those related to social living function were 34.8 points and 76.7 points, those related to shoes were 38.1 points and 68.1 points, and those related to general health and well-being were 40.1 points and 75.9 points, respectively. Conclusion: Even on late stage 2, combination surgery led to satisfactory clinical results. http://dx.doi.org/10.1016/j.fas.2017.07.336
248 Lateral approach for the displaced sustentacular fragment in intra-articular calcaneal fractures K. Tsunoda 1,∗ , N. Hio 2 , A. Hasegawa 2 , S. Monden 1 1
Kiryu Orthopedic Surgery Hospital, Japan Higashi Maebashi Orthopedic Surgery Hospital, Japan 2
Introduction: The sustentacular fragment has been conventionally considered as a “constant fragment”. However it is not always “constant”, and we have often experienced varus displacement of its. We typically reduce the displaced sustentacular fragments using a medial approach. We herein report the reduction and fixation of the sustentacular fragment in intra-articular calcaneal fractures through only a lateral approach. Method: Eight patients (all men, mean age at operation of 61.9 years) who suffered intra-articular calcaneal fractures with the displaced sustentacular fragment and were treated with only a lateral approach. The clinical outcome was assessed at one year after operation, and anatomical reduction was evaluated before and after surgery. Results: The Creighton–Nebraska scale averaged 92 ± 9.1 points. The transverse diameter of the calcaneus decreased from 124 ± 15% to 110 ± 14%, the height increased from 87 ± 5% to 99 ± 3% (ratio to the healthy side). The step-off of the subtalar joint surface decreased from 9.0 ± 6.4 mm to 0.5 ± 0.6 mm, and the inclination angle of the sustentacular fragment improved from 9.5 ± 4.7◦ to 5.6 ± 4.6◦ . We had a single case of peroneal tenosynovitis and a single case of transient sural nerve neuropathy. Conclusion: Our lateral approach can be performed by looking directly at the joint surface. Therefore the sustentacular fragment can be sufficiently anatomically reduced. Using our lateral approach to reduce the displaced sustentacular fragment, good results were obtained in the treatment of intra-articular calcaneal fractures. http://dx.doi.org/10.1016/j.fas.2017.07.337
249 Clinical and radiological outcomes after Weil osteotomy and distal metatarsal metaphyseal osteotomy M. Thomas 1,∗ , J.K. Johansen 2 , M. Jordan 1 1
Hessing Park Clinic, Department of Foot and Ankle Surgery, Augsburg, Germany 2 Zealand University Hospital, Foot and Ankle Department, Koege, Denmark Introduction: The distal metatarsal metaphyseal osteotomy (DMMO) may have lower complication rates than the Weil osteotomy (WO). This study compares the clinical and radiological outcomes and complications after DMMO and WO. Methods: We compared 30 patients with WO (Group A) to 30 patients with DMMO (Group B). Ten males and 50 females with a mean age of 57.7 were included. 45 WOs and 73 DMMOs were evaluated in 60 patients. The outcome was measured clinically using the Visual Analogue Scale Foot and Ankle (VAS-FA) and radiologically with an average follow up period of 13 months. Results: Clinical examination six weeks postoperatively showed swelling of the forefoot in 66.7% for Group A and in 73.3% for Group
243 Reconstruction of stage; posterior tibial tendon dysfunction with the artificial ligament N. Takatori 1,∗ , N. Usami 1 , E. Hiraishi 2 , H. Ikezawa 2 , T. Ashida 1 , T. Yamada 1 1 2
Usami Orthopedic Clinic, Japan Eiju Hospital, Tokyo, Japan
Background: Flexor digitorum longus (FDL) transfer in addition to calcaneal osteotomy or lateral column lengthening has been considered the standard procedure for Stage posterior tibial tendon dysfunction (PTTD). As the flexor halluces longus covers part of the FDL’s function, it’s not deemed a serious matter to lose FDL function. Japanese who don’t wear shoes indoors sometimes feel inconvenience standing up from sitting in the ‘seiza’style without FDL function. Aims: We describe a new method for reconstruction of the posterior tibial tendon (PTT) using the Leeds-Keio artificial ligament. Methods: The procedure has been performed on 10 feet in 10 female patients whose average age was 60.4 years. The average follow-up period was 14.7months. A medial incision along the PTT exposes from the tuberosity of the navicular through the healthy portion of the PTT. After resection of the degenerated part, the distal margin of the normal portion is inserted into the proximal part of the artificial ligament. The distal end of the implant is then passed through a tunnel drilled through the tuberosity of the navicular. The range of motion exercise is started 2 weeks postoperatively. Partial weight-bearing is permitted at 4 weeks. Results: The average AOFAS hindfoot score was improved from 52.9 to 84.7. There was no case of major complications. Conclusions: The reconstruction of the PTT using the artificial ligament has the advantages that autogenous graft material is not required and that the implant has sufficient strength to start early rehabilitation and weight bearing without any brace. http://dx.doi.org/10.1016/j.fas.2017.07.332
244 Endoscopic treatment for the peroneal tendon dislocation-aiming anatomical repair A. Waseda Ogikubo Hospital, Japan Introduction: Although many studies of operative treatment for the peroneal tendon dislocation have reported good or excellent results, there have been reports of significant complications following open surgical procedures. This retrospective study was conducted to analyze the clinical results for seven patients treated endoscopically for peroneal tendon dislocation between 2015 and 2016. Materials & methods: Two portals are made. The proximal portal is made first, 3 cm above the tip of the lateral malleolus and the other 2 cm distal to the lateral malleolus. Based on the Eckert and Davis classification, all cases were Grade 1. Six patients were treated with the superior peroneal retinaculum repair alone. One patient was treated with superior peroneal retinaculum repair with fibular groove deepening. The SPR were reattached to the fibula using 2 anchors after refreshing the lateral malleolus surface. For postoperative treatment, cast were applied for 2–6 weeks and after which ankle range-of motion exercise are encouraged.
81
Results: On final examination, there were no re-dislocations of the tendon. The mean AOFAS score increased from 79 to 100, and Visual Analog Score was 0 in all patients. Conclusions: To repair peroneal tendon sheath anatomically and to decrease the complications, it’s important not to incise the tendon sheath. An endoscopic approach was successful in treatment of the peroneal tendon dislocations. http://dx.doi.org/10.1016/j.fas.2017.07.333
245 Spectrum of pathological conditions of posterior ankle impingement due to ballet dancing E. Hiraishi 1,∗ , H. Ikezawa 1 , N. Usami 2 1 2
Eiju General Hospital, Japan Usami Orthopaedic Surgery, Japan
Background: It is well known that ballet dancers are frequently affected by posterior ankle impingement syndrome (PAIS). There have been reported many pathological conditions about PAIS. Aim: To clarify the characteristics of pathological conditions of PAIS due to ballet activities. Methods: 132 feet of 117 patients, who underwent hindfoot endoscopic surgery between September 2007 and December 2016, except revision cases, were retrospectively examined mainly by operative findings, X-P, and MRI. They consisted of 110 female and 7 male, and the average age at the surgery was 20.8 years (ranging 11–56). Most of them had received ballet lessons more than five times a week. Results: Bony impingement (BI) was the major cause, and flexor hallucis longus tendinopathy (FHLT) was the second. BI consisted of synchondrosis injury, reactive synovitis caused by movable Os trigonum (OT) or small ossicles, fracture or micro-fracture, and localized osteoarthritis. 92 ft of 83 patients were affected both BI and FHLT, and 35 ft of 34 patients were BI only, 5 ft of 5 patients were only FHLT. Tubularization through small incision was applied to 3 ft of severe FHLT. Posterior intermalleolar ligament was observed in 94 ft, marsupial meniscus in 8 ft, and obvious tear in one foot. Alternative conditions such as osteochondral lesion, anterior ankle impingement, chronic lateral ankle instability, and etc. were also seen concomitantly in several feet. Conclusion: The conditions of PAIS by ballet dancing is usually complicated and proper treatments shall be necessary. http://dx.doi.org/10.1016/j.fas.2017.07.334
246 Preliminary clinical and radiological evaluation with transfibular total ankle replacement A. Bianchi ∗ , J. Flore, G. Romeo, E. Sartorelli, N. Martinelli, F. Malerba IRCCS Galeazzi, Milan, Italy Introduction: Total ankle replacement (TAR) is mainly performed by an anterior approach; the Zimmer Trabecular Metal ® (Zimmer TM) TAR was developed to be used through a lateral approach with a peroneal osteotomy. This study describes early clinical and radiological outcomes in patients who underwent this procedure. Methods: A group of twenty-seven consecutive patients who underwent TAR surgery between July 2013 and January 2016 were
82
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
enrolled in this study; clinical assessment was collected pre- and post-operatively from each patient using American Orthopaedic Foot and Ankle Society score (AOFASs), Foot Function Index (FFI) and VAS score. Lateral radiographs of the ankle with the foot in maximal dorsiflexion and plantarflexion were taken for all patients. Results: All patients were followed up with final radiographic analysis and clinical evaluation for a mean period of 22.6 months. After surgery, the mean FFI improved from 52.9 ± 14.8 to 16.4 ± 8.3 for the pain subscale and from 63.6 ± 18.8 to 18.3 ± 13.7 for the disability subscale (p < 0.01). The mean preoperative VAS score was 7.8 points, mean AOFAS score was 42 points. At the last follow-up visit, VAS was 2.1 points, AOFAS was 87 points which was significantly improved (p < .01). The average postoperative tibiotalar ROM was 20◦ in plantarflexion and 5◦ in dorsiflexion. Most participants (90%) were satisfied or very satisfied after surgery. Conclusion: These early results show high levels of patient satisfaction and good clinical outcomes, and we are encouraged to continue with lateral approach total ankle arthroplasty. http://dx.doi.org/10.1016/j.fas.2017.07.335
247 Outcome of operative treatment of acquired adult flatfoot deformity in stage 2 patients K. Takeuchi 1,∗ , M. Noguchi 2 , H. Maruki 1 , M. Tazaki 1 1
Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, Japan 2 Department of Orthopaedic Surgery, Tokyo Women’s Medical University, Japan Introduction: For acquired adult flatfoot deformity, there are various operative procedures on different clinical stages. We investigated the clinical results of stage 2 patients after surgery. Patients and methods: Twenty-three feet (14 right, 9 left) of 21 patients (6 male, 16 female) on stage 2 were evaluated. The average age was 54.1 (range 18–80) years and the mean follow-up period was 32.1 (range 12–55) months. Operative procedures included posterior tibial tendon plasty (PTTP), medial displacement calcaneal osteotomy (MDCO), flexor digitorum longus transfer (FDLT), calcaneal cuboid joint distraction arthroplasty (CCDA), selective arthrodesis (SA). The patient underwent PTTP in 2 ft, MDCO in 1 foot, MDCO and FDLT in 9 ft, CCDA and FDLT in 3 ft, MDCO, CCDA and FDLT in 6 ft, MDCO, CCDA, FDLT and SA in 2 ft. Outcomes were assessed using the Japanese Society for Surgery of the Foot (JSSF) Scale and Japanese Orthopaedic Association/JSSF, Self-Administered Foot Evaluation Questionnaire (SAFE-Q). Results: The average JSSF scale improved from 52.1 points preoperatively to 86.6 points at follow-up. For SAFE-Q, the mean preoperative and postoperative values related to pain were 42.1 points and 76.2 points, those related to activities of daily livings were 56.4 points and 79.4 points, those related to social living function were 34.8 points and 76.7 points, those related to shoes were 38.1 points and 68.1 points, and those related to general health and well-being were 40.1 points and 75.9 points, respectively. Conclusion: Even on late stage 2, combination surgery led to satisfactory clinical results. http://dx.doi.org/10.1016/j.fas.2017.07.336
248 Lateral approach for the displaced sustentacular fragment in intra-articular calcaneal fractures K. Tsunoda 1,∗ , N. Hio 2 , A. Hasegawa 2 , S. Monden 1 1
Kiryu Orthopedic Surgery Hospital, Japan Higashi Maebashi Orthopedic Surgery Hospital, Japan 2
Introduction: The sustentacular fragment has been conventionally considered as a “constant fragment”. However it is not always “constant”, and we have often experienced varus displacement of its. We typically reduce the displaced sustentacular fragments using a medial approach. We herein report the reduction and fixation of the sustentacular fragment in intra-articular calcaneal fractures through only a lateral approach. Method: Eight patients (all men, mean age at operation of 61.9 years) who suffered intra-articular calcaneal fractures with the displaced sustentacular fragment and were treated with only a lateral approach. The clinical outcome was assessed at one year after operation, and anatomical reduction was evaluated before and after surgery. Results: The Creighton–Nebraska scale averaged 92 ± 9.1 points. The transverse diameter of the calcaneus decreased from 124 ± 15% to 110 ± 14%, the height increased from 87 ± 5% to 99 ± 3% (ratio to the healthy side). The step-off of the subtalar joint surface decreased from 9.0 ± 6.4 mm to 0.5 ± 0.6 mm, and the inclination angle of the sustentacular fragment improved from 9.5 ± 4.7◦ to 5.6 ± 4.6◦ . We had a single case of peroneal tenosynovitis and a single case of transient sural nerve neuropathy. Conclusion: Our lateral approach can be performed by looking directly at the joint surface. Therefore the sustentacular fragment can be sufficiently anatomically reduced. Using our lateral approach to reduce the displaced sustentacular fragment, good results were obtained in the treatment of intra-articular calcaneal fractures. http://dx.doi.org/10.1016/j.fas.2017.07.337
249 Clinical and radiological outcomes after Weil osteotomy and distal metatarsal metaphyseal osteotomy M. Thomas 1,∗ , J.K. Johansen 2 , M. Jordan 1 1
Hessing Park Clinic, Department of Foot and Ankle Surgery, Augsburg, Germany 2 Zealand University Hospital, Foot and Ankle Department, Koege, Denmark Introduction: The distal metatarsal metaphyseal osteotomy (DMMO) may have lower complication rates than the Weil osteotomy (WO). This study compares the clinical and radiological outcomes and complications after DMMO and WO. Methods: We compared 30 patients with WO (Group A) to 30 patients with DMMO (Group B). Ten males and 50 females with a mean age of 57.7 were included. 45 WOs and 73 DMMOs were evaluated in 60 patients. The outcome was measured clinically using the Visual Analogue Scale Foot and Ankle (VAS-FA) and radiologically with an average follow up period of 13 months. Results: Clinical examination six weeks postoperatively showed swelling of the forefoot in 66.7% for Group A and in 73.3% for Group