Functional limitations after lateral column lengthening osteotomy of the calcaneus are associated with lower quality of life.

Purpose: The purpose of this study was to quantify limitations in sagittal ankle range of motion (ROM) at least two years after lateral column lengthening osteotomy of the calcaneus (LLC) and their implications regarding quality of life.

Methods: Fifteen patients with a mean follow-up of 80 ± 27 months after LLC and 15 age-matched healthy persons participated in this study. Ankle joint complex ROM in plantarflexion and dorsiflexion was measured bilaterally using a goniometer and fluoroscopy (patients only).

Survival of the Scandinavian total ankle replacement (STAR): results of ten to nineteen years follow-up.

Purpose: The purpose of this study was to evaluate survival and clinical outcome of the Scandinavian total ankle replacement (STAR) prosthesis after a minimum of ten years up to a maximum of 19 years.

Methods: Fifty STAR prostheses in 46 patients with end stage ankle osteoarthritis operated between 1996 and 2006 by the same surgeon (MH) were included. Minimal follow-up was ten years (median 14.

Painful stress reaction in the posterior subtalar joint after resection of os trigonum or posterior talar process.

Introduction: The resection of os trigonum or posterior talar process as treatment for posterior ankle impingement is an established operation. However, the authors encountered several painful stress reactions in the posterior subtalar joint during follow-up resulting in persisting incapacity to do sports.

Methods: From March 2011 to July 2015, 29 patients with 30 feet were operated (22 endoscopic, 8 open resections).

Radiographic Study of Pes Planovarus.

Background: Depending on the direction of the subtalar joint, a foot deformity generally tends towards pronation (pes planovalgus) or supination (pes cavovarus). However, the combination of hindfoot varus and flat midfoot/forefoot (pes planovarus) is an exception to this rule. Pes planovarus has so far only been referred to in connection with Müller-Weiss disease and congenital disease.

Facilitating the interpretation of pedobarography: the relative midfoot index as marker for pathologic gait in ankle osteoarthritic and contralateral feet.

Background: Pedobarography offers dynamic information about the foot, but the interpretation of its large data is challenging. In a prior study it was shown that attention can be restricted to pedobarographic midfoot load data. We aim to verify this observation in ankle osteoarthritic and contralateral feet.

Mid-term functional outcome of a total arthroplasty of the first metatarsophalangeal joint.

Background: Arthroplasty of the first metatarsophalangeal joint is an alternative treatment option for end-stage hallux rigidus to the current gold standard of arthrodesis. The aim of this study was to investigate the mid-term functional outcome of an anatomically shaped prosthesis for the first metatarsophalangeal joint using pedobarography.

Methods: Ten patients (12 affected feet; age at surgery: 62.

Total Arthroplasty of the Metatarsophalangeal Joint of the Hallux.

Background: The current gold standard in the treatment of severe hallux rigidus is arthrodesis of the first metatarsophalangeal (MTP-I) joint. We present the results of a new 3-component MTP-I prosthesis. We determined (1) the intraoperative and perioperative complications; (2) survivorship of prosthesis components and rate of secondary surgeries for any reason; (3) prosthetic component stability and radiographic alignment; (4) the degree of pain relief; and (5) the midterm functional outcomes including radiographic range of motion (ROM).

Medial malleolar osteotomy for the treatment of talar osteochondral lesions: anatomical and morbidity considerations.

Purpose: Osteochondral lesions of the talus are often located posteromedially requiring open surgery to facilitate solid and complete osteochondral reconstruction. The aim of the study was to identify the optimal anatomical site for medial malleolar osteotomy based on the criteria of minimal cartilage damage (Study I) and to report on the morbidity in patients receiving osteotomy performed at the previously identified site (Study II).

Methods: For Study I, cartilage coverage of the tibiofibular ankle joint facet was measured in 40 cadaveric ankles (20 cadaver specimens).

Ankle fusion with a trabecular metal spacer and an anterior fusion plate.

We present a novel operative technique for ankle joint fusion in a case of severe talar bone loss. Fusion was achieved with a trabecular metal spacer combined with a single anterior, anatomically preshaped, angular, stable plate. Excellent postoperative results with good bone consolidation and preservation of lower leg length were present shown at 1 year of follow-up.

Revision Subtalar Joint Fusion With a Porous Metal Spacer and an Intramedullary Nail: A Case Report.

Nonunion of hindfoot arthrodesis can be difficult to successfully treat and will often require bone graft techniques. Large amounts of autogenous bone graft can be difficult to procure and will be associated with donor site morbidity. The use of porous metal implants has been shown to satisfactorily bridge segmental bone defects and to work in conjunction with allogeneic bone graft material, without the risks associated with autogenous bone graft donor site morbidity.

Ankle salvage surgery with autologous circular pillar fibula augmentation and intramedullary hindfoot nail.

Tibiotalocalcaneal arthrodesis with an intramedullary hindfoot nail is an established procedure for fusion of the ankle and subtalar joints. In cases involving ankle bone loss, such as in failed total ankle replacement, it can be difficult to salvage with sufficient bone restoration stability and a physiologic leg length and avoiding below the knee amputation. In addition to the alternatives of using a structural allograft or metal bone substitution, we describe the use of autologous ipsilateral circular pillar fibula augmentation in tibiotalocalcaneal retrograde nail arthrodesis combined with a ventral (anterior) plate in a prospective series of 6 consecutive cases with a mean follow-up duration of 26 ± 9.

Joint-preserving surgery of valgus ankle osteoarthritis.

Patients with posttraumatic ankle osteoarthritis (OA) typically present with asymmetric involvement of the tibiotalar joint, resulting in valgus or varus deformity of the ankle and hindfoot. Without appropriate treatment, patients with asymmetric ankle OA typically develop full end-stage ankle OA. Ankles with valgus deformities suffer from a lateral joint overload with subsequent lateral tibiotalar joint degeneration, which causes further lateral load shift.

Supramalleolar osteotomies for degenerative joint disease of the ankle joint: indication, technique and results.

Patients with varus or valgus hindfoot deformities usually present with asymmetric ankle osteoarthritis. In-vitro biomechanical studies have shown that varus or valgus hindfoot deformity may lead to altered load distribution in the tibiotalar joint which may result in medial (varus) or lateral (valgus) tibiotalar joint degeneration in the short or medium term. The treatment of asymmetric ankle osteoarthritis remains challenging, because more than half of the tibiotalar joint surface is usually preserved.

Do skeletal muscle properties recover following repeat onabotulinum toxin A injections?

Onabotulinum toxin A (BTX-A) is a frequently used treatment modality to relax spastic muscles by preventing acetylcholine release at the motor nerve endings. Although considered safe, previous studies have shown that BTX-A injections cause muscle atrophy and deterioration in target and non-target muscles. Ideally, muscles should fully recover following BTX-A treatments, so that muscle strength and performance are not affected in the long-term.

Long-term repetitive mechanical loading of the knee joint by in vivo muscle stimulation accelerates cartilage degeneration and increases chondrocyte death in a rabbit model.

Background: Excessive chronic loading is thought to be one factor responsible for the onset of osteoarthritis. For example, studies using treadmill running have shown an increased risk for osteoarthritis, thereby suggesting that muscle-induced joint loading may play a role in osteoarthritis onset and progression. However, in these studies, muscle-induced loading was not carefully quantified.

The effects of electrical stimulation exercise on muscles injected with botulinum toxin type-A (botox).

Botulinum toxin type A (BTX-A) is a frequently used treatment modality for a variety of neuromuscular disorders. It acts by preventing acetylcholine release at the motor nerve endings, inducing muscle paralysis. Although considered safe, studies suggest that BTX-A injections create adverse effects on target and non-target muscles.

The influence of cyclic concentric and eccentric submaximal muscle loading on cell viability in the rabbit knee joint.

Background: Cartilage loading is associated with the onset and progression of osteoarthritis and cell death may play an important role in these processes. Although much is known about cell death in joint impact loading, there is no information on joints loaded by muscular contractions. The aim of this study was to evaluate the influence of muscle generated eccentric and concentric submaximal joint loading on chondrocyte viability.

Does the source of hemarthrosis influence posttraumatic joint contracture and biomechanical properties of the joint?

Background: Posttraumatic joint contracture is a common complication of intraarticular injuries and an associated traumatic hemarthrosis could be of importance for its development. The purpose of this investigation was to determine whether the source of the hemarthrosis (peripheral blood vs. bleeding from the bone marrow) affects the amount of contracture and its reversibility and biomechanical properties.

Distinctive pain course during first year after total ankle arthroplasty: a prospective, observational study.

Background: Patients and health care professionals alike are often surprised by the course of pain after total ankle arthroplasty (TAA). The current study aimed to determine the baseline patterns of postoperative symptoms during the first year following uncomplicated TAA.

Materials And Methods: In a prospective observational study 28 patients with unilateral posttraumatic osteoarthritis were tested for pain with a visual analogue scale, swelling (min grade, 0; max grade, 4), ankle range of motion, and AOFAS ankle score.

Arthroscopic treatment of femoral acetabular impingement in patients with preoperative generalized degenerative changes.

Purpose: The aim of this study was to evaluate the short-term results after arthroscopic femoroacetabular impingement (FAI) correction combined with additional procedures addressing labral and chondral damages in patients who showed generalized severe cartilage lesions intraoperatively.

Methods: Between 2004 and 2007, 20 patients (16 men and 4 women) could be included in the study. Clinical parameters, the pain score on a visual analog scale, initial radiologic degenerative changes, the alpha angle, and the Nonarthritic Hip Score were prospectively documented.

Cartilage lesions and the development of osteoarthritis after internal fixation of ankle fractures: a prospective study.

Background: The role of the location and severity of the initial cartilage lesions associated with an ankle fracture in the development of posttraumatic osteoarthritis has not been established, to our knowledge.

Methods: We performed a long-term follow-up study of a consecutive, prospectively included cohort of 288 ankle fractures that were treated operatively between June 1993 and November 1997. Arthroscopy had been performed in all cases in order to classify the extent and location of cartilage damage.