Endoscopic Flexor Hallucis Longus Tendon Transfer for the Treatment of Chronic Achilles Tendon Defects.

Background: An all-inside endoscopic flexor hallucis longus (FHL) tendon transfer is indicated for the treatment of chronic, full-thickness Achilles tendon defects. The aim of this procedure is to restore function of the gastrocnemius-soleus complex while avoiding the wound complications associated with open procedures.

Description: This procedure can be performed through 2 endoscopic portals, a posteromedial portal (the working portal) and a posterolateral portal (the visualization portal).

Spastic Equinovarus Foot Deformity.

Acute brain injuries are caused by a variety of etiologies, each potentially disrupting neurological function. The neurologic impairments are on a spectrum of severity often creating functional barriers to completing activities of daily living. Initial treatment starts immediately upon diagnosis and requires a multimodal approach working to prevent systemic changes.

Stability of One-Step Spray-on Splint for Lower Extremity Fractures During Splinting, MEDEVAC, and Impact.

Introduction: Military transport can induce whole-body vibrations, and combat almost always involves high impact between lower extremities and the ground. Therefore, robust splinting technology is necessary for lower extremity fractures in these settings. Our team compared a novel one-step spray-on foam splint (FastCast) to the current military standard structured aluminum malleable (SAM) splint.

Talar Arthroscopic Reduction and Internal Fixation (TARIF): A Novel All-Inside Soft-Tissue-Preserving Technique.

Background: Talar arthroscopic reduction and internal fixation (TARIF) is an alternative approach for the operative fixation of talar fractures that may be utilized instead of more traditional open approaches such as medial, lateral, or even dual anterolateral. The TARIF approach allows for nearly anatomic fracture reduction and fixation of talar neck, body, and posterior dome fractures while minimizing the soft-tissue stripping and vascular injury associated with the standard anterolateral approach.

Description: Following initial closed fracture reduction and any associated procedures, we recommend obtaining computed tomography scans of the injured ankle in order to evaluate the fracture pattern and allow for preoperative planning.

Arthroscopic Releases and Hindfoot Fusion for Spastic Equinovarus Foot Deformities, An All-Inside Technique.

Neurologic foot contractures pose a challenging situation for orthopaedic surgeons. These deformities are long-standing problems for patients with acute brain injuries, ultimately affecting their quality of life. We report our experience with using arthroscopic assisted, minimally invasive contracture tenotomies paired with a tibio-talo-calcaneal arthrodesis to achieve improved alignment and functional reconstruction of spastic equinovarus foot deformities.

Modified Low-Flow Arthroscopic Sandwich Technique for Complex Osteochondral Lesions of the Talus.

Treatment of osteochondral lesions of the talus proves to be challenging given the unique anatomy of the intra-articular surface and associated complexity of larger lesions. Simple bone marrow-stimulating procedures for large complex lesions often lead to poor results with increased risk of lesion progression, refractory pain, and associated functional limitations. Other methods of osteochondral autografts or allografts often require osteotomies, bone windows, or fibrin glue, which are associated with donor pain and nonunion.

Arthroscopic Assisted, Lateral Ligament Reconstruction with Suture Tape Augmentation and Knotless All Suture Anchors: A Technique Guide.

More than 30,000 ankle sprains occur each day in the United States, and the majority of ankle sprains involve the anterior talofibular ligament. Up to 30% of patients develop functional ankle instability and chronic pain after a severe ankle sprain. When nonoperative measures are unsuccessful, operative reconstruction of the lateral ankle ligaments is recommended.

Technique Variation in the Surgical Treatment of Lateral Ankle Instability.

Introduction: Lateral ankle sprains are the most common type of injury to the ankle and can lead to ankle instability. There are many described techniques for the surgical treatment of lateral ankle instability. The purpose of this study is to quantify the variation in surgeon technique for lateral ankle instability treatment.

Dorsal Cheilectomy Using Great Toe Metatarsophalangeal Joint Arthroscopy for the Treatment of Hallux Rigidus.

Great toe metatarsophalangeal joint (MTPJ) arthroscopy has been described in the literature for more than 50 years for treatment of a multitude of first MTPJ pathologies, including hallux rigidus, hallux valgus, and osteochondritis dissecans, among others. Despite this, the use of great toe MTPJ arthroscopy has not become widely used for treatment of these conditions as the result of reported difficulties with adequate visualization of the joint surface and manipulation of surrounding soft-tissue structures with the instruments available. We propose a simple technique with illustrations of the operating room setup and procedural steps to perform a dorsal cheilectomy in those with early-stage hallux rigidus using great toe MTPJ arthroscopy and a minimally invasive surgical burr in a way that is reproducible by foot and ankle surgeons.

Cervical Spinal Immobilization: A Head-to-Head Comparison of a One-Step Spray-on Foam Splint Versus Structural Aluminum Malleable Splint Immobilization.

Introduction: Cervical spine immobilization in a low-resource environment is difficult secondary to limited equipment, prolonged transportation, and secondary complications. A structural aluminum malleable (SAM) splint is commonly utilized because of its availability and multipurpose intention. A one-step spray-on foam immobilization technique (Fast Cast) has been shown to be effective in lower-extremity splinting.

Minimally Invasive Mid-Substance Achilles Tendon Repair Using the Percutaneous Achilles Repair System (PARS).

Unlabelled: Achilles tendon ruptures commonly occur in physically active individuals and drastically alter the ability to perform recreational activities. Many patients want to continue participating in recreational activities, which can be facilitated by operatively treating the injury in a timely fashion, maximizing their functional recovery. The Percutaneous Achilles Repair System (PARS) Jig (Arthrex) can be utilized in patients with acute mid-substance Achilles tendon ruptures.

Use of the External Fixator Calcaneus Pin: Using the TRIMANO to Its Full Potential.

Joint-spanning external fixation in acute ankle trauma is a means to provide temporary stability and restoration of length, alignment, and articular congruency. This allows for soft-tissue consolidation before definitive fixation to decrease the risk of wound complications. Traction is commonly used during definitive fixation to aid in fracture reduction and to maintain reduction during placement of internal hardware.

Utilizing A Percutaneous Versus Open Achilles Tendon Repair Technique for Treating Acute Achilles Tendon Ruptures in Physically Active Adults: A Critically Appraised Topic.

Clinical Scenario: Acute Achilles tendon ruptures can be devastating injuries with the potential to significantly alter an individual's ability to perform functional activities. Given the rise in the incidence of acute Achilles tendon ruptures, it is important to determine whether percutaneous versus open Achilles tendon repair facilitates superior outcomes.

Clinical Question: In physically active adults with an acute Achilles tendon rupture, does performing percutaneous Achilles tendon repair result in improved outcomes compared with open Achilles tendon repair?

Summary Of Key Findings: Percutaneous Achilles tendon repair has similar efficacy as open Achilles tendon repair in facilitating return to activity/sport, and demonstrates improvement in short-term functional outcomes with potentially lower wound complication rates.

EMG Activity With Use of a Hands-Free Single Crutch vs a Knee Scooter.

Background: Foot and ankle injuries frequently require a period of nonweightbearing, resulting in muscle atrophy. Our previous study compared a hands-free single crutch (HFSC) to standard axillary crutches and found increased muscle recruitment and intensity while using the HFSC. Knee scooters are another commonly prescribed nonweightbearing device.

Lower Extremity Splinting: A Head-to-Head Comparison of A Novel One-Step Spray-on Splint Versus Standard Splinting.

Introduction: Splinting is an essential component of treating many lower extremity musculoskeletal injuries; however, little development has been made in splinting technology. The purpose of this study is to evaluate the efficacy of current immobilization equipment for lower extremity fractures by testing a novel one-step spray-on foam splint (Fast Cast) against structural aluminum malleable (SAM) lower extremity musculoskeletal injuries and 6-inch ACE (3M Corp., Minneapolis, MN, USA) bandage splints.

Outcomes of Posterior Arthroscopic Reduction and Internal Fixation (PARIF) for the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures.

Background: Posterior malleolar fractures within a trimalleolar ankle fracture pattern are challenging to manage. Posterior ankle arthroscopy provides a means to assess the intra-articular and syndesmotic reductions, while removing loose bodies. The purpose of this study was to determine the radiographic and patient reported outcomes of posterior arthroscopic reduction and internal fixation (PARIF) in trimalleolar ankle fractures.

Visual Analog Pain Scores Reported to a Nurse and a Physician in a Postoperative Setting.

Background: The purpose of this study was to compare postoperative foot and ankle patient-reported visual analog pain scores (VAS) to nursing staff and the treating surgeon during a single encounter. Prior literature established preoperative patients reported higher pain scores to a surgeon as compared to nursing staff. We hypothesized that there will be no differences in postoperative patients' pain scores when reporting to nursing staff vs a surgeon.

Validation of 9-Grid Scheme for Localizing Osteochondral Lesions of the Talus.

Background: A 9-grid scheme has been integrated into the foot and ankle literature to help clinicians and researchers localize osteochondral lesions of the talus (OLTs). We hypothesized that fellowship-trained orthopedic foot and ankle surgeons would have a high rate of intra/inter-observer reliability when localizing OLTs, therefore validating the scheme.

Methods: We queried our institution's foot and ankle radiographic database for magnetic resonance images with OLTs.