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Three-dimensional analysis of the talocrural joint axis: Relation to the talar articular surface
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Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
Group 1. The radiological PASA was 10.17±2.03 less than at MRI and intraoperative parameters. MRI and intraoperative parameters of PASA coincided each other. Postoperative PASA was 4.33±0.34 degrees. After 6 months postoperative M1P1 8.83±1.22 degrees. Correction loss scored 2.5±0.66 degrees. A recurrence of hallux valgus at all patients was absent. Group 2. After 6 months there was a loss of correction M1P1 by 5.5±0.84 degrees and reached in 10.83±1.34 degrees. Significant loss of correction was observed at 87.5% of the patients, there was hallux valgus recurrence in four cases. Conclusion: MRI is the most exact method of PASA visualization and allows to choose an adequate surgical technique of hallux valgus treatment. The offered new surgical technique allows to increase efficiency of treatment due to more exact correction of PASA. http://dx.doi.org/10.1016/j.fas.2017.07.452
364 Short-term outcomes of arthroscopic surgery in patients with metatarsophalangeal joint pathology H. Tanaka 1,∗ , T. Sakai 2 , S. Eto 3 , K. Nishifuru 1 , K. Hyakutake 1,2,3 1 Hyakutake Orthopedic Surgery and Sports Clinic, Japan 2 Saga Central Hospital, Japan 3 Taku City Hospital, Japan
We evaluated arthroscopic findings and short-term clinical outcomes in patients with metatarsophalangeal joint pathology, who underwent arthroscopic surgery between 2011 and 2016. Overall, 11 patients (4 men, 7 women; 14 joints) with a mean age of 42.8 years were included in the analysis. Three cases presented with hallux rigidus, two cases were treated after hallux valgus surgery, two with post-traumatic arthritis, three with sesamoid disorder, and one with arthritis of an unknown cause. Surgical procedures consisted of five synovectomies, four loose body removals, one sesamoidectomy, and one sesamoid drilling. We used a 1.9-mm 30◦ arthroscope and indirect traction. Surgery was performed on two dorsal portals and one plantar portal. Clinical evaluation was done using the hallux score of the American Orthopedic Foot and Ankle Society (AOFAS). The mean operative time was 106.6 min. No complications were reported in any of the cases. According to the arthroscopic findings, synovitis was seen in all toes (100%). Loose bodies were found in four (28.6%) toes and articular cartilage disappearance was observed in nine (64.3%) toes. Mean follow-up duration was 11.4 months (range, 6–23). American Orthopedic Foot and Ankle Society score improved from 65.0 points (range, 42–95) to 86.1 points (range, 42–100). Patient outcomes differed depending on the selected surgical techniques; only synovectomy had inferior outcomes, as compared with other surgeries. Arthroscopy in patients with metatarsophalangeal joint pathology is useful, but surgical indications should be carefully determined. http://dx.doi.org/10.1016/j.fas.2017.07.453
365 Ankle fractures – funcional and quality of life results K. Stéfani ∗ , M. Pereira Filho, R. Lago, B. Amim Hospital do Servidor Público Estadual de São Paulo, Brazil Introduction: The objective of this study was to evaluate the functional and quality of life outcomes of ankle fractures surgically treated in our hospital. Methods: This is a prospective study of patients with unstable ankle fractures undergoing surgical treatment at our hospital in the 11-year period (until December, 2015). Results: A total of 697 ankle fractures, with the majority of women (488 patients, 65.9%). The mean age was 53 ± 16 years (13–89 years), and among women was 56.5 + 14.9 years, significantly higher than that of men, which was 46.37 + 15.7 years (p < 0.01). We evaluated a group of 139 patients with a mean age of 47 years (16 and 64 years). The majority were female (71.2%) and 48.2% were post-menopausal. The mechanism of trauma in this group was low energy. The mean body mass index (BMI) was 29.5 ± 4.7, with the majority of patients being overweight (43.9%), followed by obese patients (41.0%). We obtained a mean of 88.7 ± 14.1 points in the AOFAS score and presented statistical correlation (p < 0.005) with the World Health Organization Quality of Life (WHQUOL) and Short Form Musculoskeletal Function Assessment (SFMA). Conclusion: Overweight women are the primary victims of ankle fractures. Osteoporosis, present mainly in postmenopausal women, is probably related to the occurrence of these fractures, since the mechanism of trauma was low energy. The best functional results also presented the best quality of life results both with respect to the musculoskeletal health and the overall health of the patient. http://dx.doi.org/10.1016/j.fas.2017.07.454
366 Three-dimensional analysis of the talocrural joint axis: Relation to the talar articular surface L. Claassen 1,∗ , P. Luedtke 1 , D. Yao 1 , S. Ettinger 1 , K. Daniilidis 1 , A.M. Nowakowski 2 , M. Müller-Gerbl 3 , C. Stukenborg-Colsman 1 , C. Plaass 1 1 Hannover Medical School, Orthopedic Department, Germany 2 University Hospital Basel, Orthopedic Department, Switzerland 3 University of Basel, Department of Biomedicine, Switzerland
Background: The total ankle replacement (TAR) is increasingly used in cases of severe ankle arthritis. Although the knowledge about joint kinematics is crucial for designing and positioning of TAR there is no consensus about the talocrural joint axis. Aim: The aim of the present study was the determination of the kinematic rotational axis of the talocrural joint as an orientation for prosthesis positioning. Methods: We analyzed 96 CT-scans of full cadaver caucasien legs. With the software Mimic, 3-Matic (both Materialize) and GOM inspect we generated three-dimensional reconstruction models of the talus and a best fitting cone orientated to the talar articular
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
surface. The kinematic rotational axis was defined to be the axis of this cone. Results: The determination of the kinematic rotational axis showed a high inter- and intrarater reliability. The kinematic rotational axis of the talocrural joint is orientated from lateraldistal to medial-proximal (84.9◦ ± 8.5 compared to mechanical tibial axis in frontal plane), from dorsal-proximal to anterior-distal (93.1◦ ± 42.3 compared to mechanical tibial axis in sagittal plane) and from dorsal-lateral to anterior-medial (169.0◦ ± 6.7 compared to mechanical tibial axis in axial plane). A high standard deviation especially in the sagittal plane was noteworthy. Conclusions: With the present study we present a new reproducable single-axis model of the talocrural joint. Our data showed relevant interindividual variations. The consideration of these variations might support the development of patient-specific TAR implantation techniques. http://dx.doi.org/10.1016/j.fas.2017.07.455
367 Ankle morphometry based on computerized tomography L. Claassen 1,∗ , P. Luedtke 1 , D. Yao 1 , S. Ettinger 1 , K. Daniilidis 1 , A.M. Nowakowski 2 , M. Müller-Gerbl 3 , C. Stukenborg-Colsman 1 , C. Plaass 1 1 Hannover Medical School, Orthopedic Department, Germany 2 University Hospital Basel, Orthopedic Department, Switzerland 3 University of Basel, Department of Biomedicine, Switzerland
Background: Understanding the morphometry of the ankle joint is crucial to improve total ankle replacement (TAR). Despite improvements of the implant material TAR did not reach comparable success rates to total hip or knee arthroplasty. Recent studies queried whether current designs match with the articular geometry. Aim: The present study was performed to evaluate the ankle morphometry and thereby gain information about the joint axis. Material and methods: We analyzed 96 high-resolution CTscans of complete caucasian cadaver legs. Using the software Mimics and 3-Matic (Materialize) 22 anatomic parameters of the talocrural joint were assessed, including the length, width and surface area of the tibial and talar bearing areas. Additionally the radii of the bearing areas, the medial distal tibial angle and the height of the talar dome were determined. Therefore we analyzed defined sagittal, axial and frontal planes. Results: The radius of the central trochlea tali was 44.6 ± 4.1 mm (mean ± SD). The central trochlea tali arc length was 40.8 ± 3.0 mm and its width was 27.4 ± 2.5 mm. Additionally we determined 47.0 ± 4.4 mm for the tibial sagittal radius, 27.6 ± 3.0 mm for the tibial arc length and 27.4 ± 2.5 mm for the central tibial width. Conclusion: The present study describes the three-dimensional morphometry of the caucasian ankle joint. Our results might be considered for the development of total ankle replacements. http://dx.doi.org/10.1016/j.fas.2017.07.456
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368 Professional soccer players; Return to play and performance after Achilles tendon ruptures D. Trofa, P. Noback, C. Ahmad, J. Greisberg, J. Turner Vosseller ∗ Columbia University Medical Center, United States Introduction: Most Achilles tendon ruptures are sports-related; however, no study has examined the impact of surgical repair for complete ruptures on professional soccer players. Our purpose was to examine the return-to-play (RTP), playtime, and performance of professional soccer players following Achilles tendon repair. Methods: Union of European Football Associations and Major League Soccer athletes who sustained a primary complete Achilles tendon rupture treated surgically between 1989 and 2014 were identified via public injury reports. Demographic information and performance-related statistics were recorded for the season before and two seasons after surgery. Results: Of 29 athletes screened, 23 met inclusion criteria. 19 (82.6%) athletes with an isolated Achilles rupture were able to RTP. Players who ruptured their Achilles tendon had played professionally for an average 8.3 years. Among athletes that successfully returned to play, game participation averaged 83.6% (p > 0.05) and 76.1% (p = 0.049) of the total games played the season prior to injury at 1 and 2 years post-operatively, respectively. Minutes played at 1 and 2 years post-injury was 77.1% (p > 0.05) and 65.1% (p = 0.024), respectively. There was no difference in games started or goals scored at 1 or 2 years post-injury compared to the index season. Conclusions: An Achilles rupture is a rare yet devastating injury among professional soccer players; however, 82.6% of professional soccer players in Europe and America are able to RTP after surgical treatment. Professional athletes that do RTP have statistically significant reduced playtime 2 years after surgical management. http://dx.doi.org/10.1016/j.fas.2017.07.457
369 Prospective study matching minimally invasive and open surgery calcaneal osteotomies in terms of intra- and postoperative parameters V. Andric ∗ , H. Waizy Hessing Stiftung, Germany Introduction: The indication for a calcaneal osteotomy is the pathology of the hindfoot which can be corrected by the open surgery procedure or minimally invasive calcaneal osteotomy (MICO). The current literature describes very promising results and clinical outcome after minimally invasive surgery. In a prospective study we are matching minimally invasive and open surgery calcaneal osteotomies and evaluate different intra- and postoperative parameters and compare them with the results in the literature. This is the first study that evaluates intraoperative parameters just isolated for the calcaneal osteotomy without any additional procedures. Methods: The present study was performed between 01 July 2015 and 31 December 2016. We treated 60 patients in total with a calcaneal osteotomy: For 33 patients we used the lateral incision approach. 27 patients were treated by MICO. Intraoperatively we measured the operation time, the fluoroscopy time and the radiation dose – postoperatively the length of the lateral incision. Conclusion: Our results support the MICO-technique:
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
Group 1. The radiological PASA was 10.17±2.03 less than at MRI and intraoperative parameters. MRI and intraoperative parameters of PASA coincided each other. Postoperative PASA was 4.33±0.34 degrees. After 6 months postoperative M1P1 8.83±1.22 degrees. Correction loss scored 2.5±0.66 degrees. A recurrence of hallux valgus at all patients was absent. Group 2. After 6 months there was a loss of correction M1P1 by 5.5±0.84 degrees and reached in 10.83±1.34 degrees. Significant loss of correction was observed at 87.5% of the patients, there was hallux valgus recurrence in four cases. Conclusion: MRI is the most exact method of PASA visualization and allows to choose an adequate surgical technique of hallux valgus treatment. The offered new surgical technique allows to increase efficiency of treatment due to more exact correction of PASA. http://dx.doi.org/10.1016/j.fas.2017.07.452
364 Short-term outcomes of arthroscopic surgery in patients with metatarsophalangeal joint pathology H. Tanaka 1,∗ , T. Sakai 2 , S. Eto 3 , K. Nishifuru 1 , K. Hyakutake 1,2,3 1 Hyakutake Orthopedic Surgery and Sports Clinic, Japan 2 Saga Central Hospital, Japan 3 Taku City Hospital, Japan
We evaluated arthroscopic findings and short-term clinical outcomes in patients with metatarsophalangeal joint pathology, who underwent arthroscopic surgery between 2011 and 2016. Overall, 11 patients (4 men, 7 women; 14 joints) with a mean age of 42.8 years were included in the analysis. Three cases presented with hallux rigidus, two cases were treated after hallux valgus surgery, two with post-traumatic arthritis, three with sesamoid disorder, and one with arthritis of an unknown cause. Surgical procedures consisted of five synovectomies, four loose body removals, one sesamoidectomy, and one sesamoid drilling. We used a 1.9-mm 30◦ arthroscope and indirect traction. Surgery was performed on two dorsal portals and one plantar portal. Clinical evaluation was done using the hallux score of the American Orthopedic Foot and Ankle Society (AOFAS). The mean operative time was 106.6 min. No complications were reported in any of the cases. According to the arthroscopic findings, synovitis was seen in all toes (100%). Loose bodies were found in four (28.6%) toes and articular cartilage disappearance was observed in nine (64.3%) toes. Mean follow-up duration was 11.4 months (range, 6–23). American Orthopedic Foot and Ankle Society score improved from 65.0 points (range, 42–95) to 86.1 points (range, 42–100). Patient outcomes differed depending on the selected surgical techniques; only synovectomy had inferior outcomes, as compared with other surgeries. Arthroscopy in patients with metatarsophalangeal joint pathology is useful, but surgical indications should be carefully determined. http://dx.doi.org/10.1016/j.fas.2017.07.453
365 Ankle fractures – funcional and quality of life results K. Stéfani ∗ , M. Pereira Filho, R. Lago, B. Amim Hospital do Servidor Público Estadual de São Paulo, Brazil Introduction: The objective of this study was to evaluate the functional and quality of life outcomes of ankle fractures surgically treated in our hospital. Methods: This is a prospective study of patients with unstable ankle fractures undergoing surgical treatment at our hospital in the 11-year period (until December, 2015). Results: A total of 697 ankle fractures, with the majority of women (488 patients, 65.9%). The mean age was 53 ± 16 years (13–89 years), and among women was 56.5 + 14.9 years, significantly higher than that of men, which was 46.37 + 15.7 years (p < 0.01). We evaluated a group of 139 patients with a mean age of 47 years (16 and 64 years). The majority were female (71.2%) and 48.2% were post-menopausal. The mechanism of trauma in this group was low energy. The mean body mass index (BMI) was 29.5 ± 4.7, with the majority of patients being overweight (43.9%), followed by obese patients (41.0%). We obtained a mean of 88.7 ± 14.1 points in the AOFAS score and presented statistical correlation (p < 0.005) with the World Health Organization Quality of Life (WHQUOL) and Short Form Musculoskeletal Function Assessment (SFMA). Conclusion: Overweight women are the primary victims of ankle fractures. Osteoporosis, present mainly in postmenopausal women, is probably related to the occurrence of these fractures, since the mechanism of trauma was low energy. The best functional results also presented the best quality of life results both with respect to the musculoskeletal health and the overall health of the patient. http://dx.doi.org/10.1016/j.fas.2017.07.454
366 Three-dimensional analysis of the talocrural joint axis: Relation to the talar articular surface L. Claassen 1,∗ , P. Luedtke 1 , D. Yao 1 , S. Ettinger 1 , K. Daniilidis 1 , A.M. Nowakowski 2 , M. Müller-Gerbl 3 , C. Stukenborg-Colsman 1 , C. Plaass 1 1 Hannover Medical School, Orthopedic Department, Germany 2 University Hospital Basel, Orthopedic Department, Switzerland 3 University of Basel, Department of Biomedicine, Switzerland
Background: The total ankle replacement (TAR) is increasingly used in cases of severe ankle arthritis. Although the knowledge about joint kinematics is crucial for designing and positioning of TAR there is no consensus about the talocrural joint axis. Aim: The aim of the present study was the determination of the kinematic rotational axis of the talocrural joint as an orientation for prosthesis positioning. Methods: We analyzed 96 CT-scans of full cadaver caucasien legs. With the software Mimic, 3-Matic (both Materialize) and GOM inspect we generated three-dimensional reconstruction models of the talus and a best fitting cone orientated to the talar articular
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
surface. The kinematic rotational axis was defined to be the axis of this cone. Results: The determination of the kinematic rotational axis showed a high inter- and intrarater reliability. The kinematic rotational axis of the talocrural joint is orientated from lateraldistal to medial-proximal (84.9◦ ± 8.5 compared to mechanical tibial axis in frontal plane), from dorsal-proximal to anterior-distal (93.1◦ ± 42.3 compared to mechanical tibial axis in sagittal plane) and from dorsal-lateral to anterior-medial (169.0◦ ± 6.7 compared to mechanical tibial axis in axial plane). A high standard deviation especially in the sagittal plane was noteworthy. Conclusions: With the present study we present a new reproducable single-axis model of the talocrural joint. Our data showed relevant interindividual variations. The consideration of these variations might support the development of patient-specific TAR implantation techniques. http://dx.doi.org/10.1016/j.fas.2017.07.455
367 Ankle morphometry based on computerized tomography L. Claassen 1,∗ , P. Luedtke 1 , D. Yao 1 , S. Ettinger 1 , K. Daniilidis 1 , A.M. Nowakowski 2 , M. Müller-Gerbl 3 , C. Stukenborg-Colsman 1 , C. Plaass 1 1 Hannover Medical School, Orthopedic Department, Germany 2 University Hospital Basel, Orthopedic Department, Switzerland 3 University of Basel, Department of Biomedicine, Switzerland
Background: Understanding the morphometry of the ankle joint is crucial to improve total ankle replacement (TAR). Despite improvements of the implant material TAR did not reach comparable success rates to total hip or knee arthroplasty. Recent studies queried whether current designs match with the articular geometry. Aim: The present study was performed to evaluate the ankle morphometry and thereby gain information about the joint axis. Material and methods: We analyzed 96 high-resolution CTscans of complete caucasian cadaver legs. Using the software Mimics and 3-Matic (Materialize) 22 anatomic parameters of the talocrural joint were assessed, including the length, width and surface area of the tibial and talar bearing areas. Additionally the radii of the bearing areas, the medial distal tibial angle and the height of the talar dome were determined. Therefore we analyzed defined sagittal, axial and frontal planes. Results: The radius of the central trochlea tali was 44.6 ± 4.1 mm (mean ± SD). The central trochlea tali arc length was 40.8 ± 3.0 mm and its width was 27.4 ± 2.5 mm. Additionally we determined 47.0 ± 4.4 mm for the tibial sagittal radius, 27.6 ± 3.0 mm for the tibial arc length and 27.4 ± 2.5 mm for the central tibial width. Conclusion: The present study describes the three-dimensional morphometry of the caucasian ankle joint. Our results might be considered for the development of total ankle replacements. http://dx.doi.org/10.1016/j.fas.2017.07.456
121
368 Professional soccer players; Return to play and performance after Achilles tendon ruptures D. Trofa, P. Noback, C. Ahmad, J. Greisberg, J. Turner Vosseller ∗ Columbia University Medical Center, United States Introduction: Most Achilles tendon ruptures are sports-related; however, no study has examined the impact of surgical repair for complete ruptures on professional soccer players. Our purpose was to examine the return-to-play (RTP), playtime, and performance of professional soccer players following Achilles tendon repair. Methods: Union of European Football Associations and Major League Soccer athletes who sustained a primary complete Achilles tendon rupture treated surgically between 1989 and 2014 were identified via public injury reports. Demographic information and performance-related statistics were recorded for the season before and two seasons after surgery. Results: Of 29 athletes screened, 23 met inclusion criteria. 19 (82.6%) athletes with an isolated Achilles rupture were able to RTP. Players who ruptured their Achilles tendon had played professionally for an average 8.3 years. Among athletes that successfully returned to play, game participation averaged 83.6% (p > 0.05) and 76.1% (p = 0.049) of the total games played the season prior to injury at 1 and 2 years post-operatively, respectively. Minutes played at 1 and 2 years post-injury was 77.1% (p > 0.05) and 65.1% (p = 0.024), respectively. There was no difference in games started or goals scored at 1 or 2 years post-injury compared to the index season. Conclusions: An Achilles rupture is a rare yet devastating injury among professional soccer players; however, 82.6% of professional soccer players in Europe and America are able to RTP after surgical treatment. Professional athletes that do RTP have statistically significant reduced playtime 2 years after surgical management. http://dx.doi.org/10.1016/j.fas.2017.07.457
369 Prospective study matching minimally invasive and open surgery calcaneal osteotomies in terms of intra- and postoperative parameters V. Andric ∗ , H. Waizy Hessing Stiftung, Germany Introduction: The indication for a calcaneal osteotomy is the pathology of the hindfoot which can be corrected by the open surgery procedure or minimally invasive calcaneal osteotomy (MICO). The current literature describes very promising results and clinical outcome after minimally invasive surgery. In a prospective study we are matching minimally invasive and open surgery calcaneal osteotomies and evaluate different intra- and postoperative parameters and compare them with the results in the literature. This is the first study that evaluates intraoperative parameters just isolated for the calcaneal osteotomy without any additional procedures. Methods: The present study was performed between 01 July 2015 and 31 December 2016. We treated 60 patients in total with a calcaneal osteotomy: For 33 patients we used the lateral incision approach. 27 patients were treated by MICO. Intraoperatively we measured the operation time, the fluoroscopy time and the radiation dose – postoperatively the length of the lateral incision. Conclusion: Our results support the MICO-technique: