Outcomes After Percutaneous Zadek Osteotomy for Insertional Achilles Tendinopathy.

Background: Surgical treatment of insertional Achilles tendinopathy (IAT) historically consists of Achilles tendon debridement with reattachment and excision of the posterosuperior calcaneal prominence with or without a gastrocnemius recession. Zadek osteotomy (ZO) is an alternative to an open midline splitting approach. The purpose of this study was to analyze patient-reported outcomes and complications after percutaneously performed ZO with minimum 2 years' follow-up.

Percutaneous vs Open Zadek Osteotomy for Treatment of Insertional Achilles Tendinopathy and Haglund's Deformity: A Systematic Review.

Background: Percutaneous Zadek osteotomy (ZO) has emerged as a surgical treatment of insertional Achilles tendinopathy (IAT) over the last decade. Existing literature is limited regarding the comparison of this approach with the more established, open ZO technique. This systematic review aims to evaluate and compare the current data on open vs percutaneous ZO approaches to help set evidence-based guidelines.

The Effect of Chilled vs Room-Temperature Irrigation on Thermal Energy Dissipation During Minimally Invasive Calcaneal Osteotomy of Cadaver Specimens.

Background: Minimally invasive (MIS) calcaneal osteotomy has grown in popularity in recent years to address hindfoot deformity. A potential complication is thermal bone necrosis secondary to heat generation from the burr that may lead to osteotomy nonunion. Irrigation is commonly employed to reduce this risk.

Impact of COVID-19 Pandemic on Patients' Perceptions of Safety and Need for Elective Foot and Ankle Surgery in the United States.

Background: With the development of the COVID-19 pandemic, elective foot and ankle surgeries were delayed throughout the United States to divert health care resources and limit exposure. Little is known about the impact of COVID-19 on patient's willingness to proceed with elective procedures once restrictions are lifted and factors contributing to such decision.

Methods: Patients across 6 US orthopedic institutions who had their elective foot and ankle surgeries cancelled secondary to the pandemic were given a questionnaire.

Open Reduction and Primary Subtalar Arthrodesis for Acute Intra-articular Displaced Calcaneal Fractures.

Objective: To evaluate the rate of subtalar arthrodesis based on a computed tomography (CT) scan after open reduction and primary subtalar arthrodesis for acute, displaced, intra-articular calcaneal fractures.

Design: Retrospective chart review.

Setting: Single tertiary care practice.

Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using an Intramedullary-Referencing Implant.

Background: Treatment of failed total ankle arthroplasty (TAA) is challenging. Limited literature is available on options and outcomes of revision arthroplasty despite failure rates ranging from 10% to 23% within 10 years after primary TAA. This study reports the clinical and radiographic outcomes of revision TAA using a fixed-bearing, intramedullary-referencing implant.

Percutaneous Techniques in Orthopedic Foot and Ankle Surgery.

This article presents the indications, contraindications, preoperative surgical planning, surgical technique, and postoperative management of some of the most common percutaneous procedures in orthopedic foot and ankle surgery. The background of each procedure also is presented, supported by the latest in published literature to educate surgeons. Such topics include percutaneous bunionectomy, lesser toe deformity and bunionette correction, calcaneal osteotomy, cheilectomy, and first metatarsophalangeal joint arthrodesis.

Evaluation of Total Ankle Arthroplasty Using Highly Crosslinked Ultrahigh-Molecular-Weight Polyethylene Subjected to Physiological Loading.

Background: Highly crosslinked polyethylene (HXLPE) was developed for its superior wear properties in comparison to conventional polyethylene (CPE). Concern over fatigue resistance has prevented widespread adoption of HXLPE for use in total ankle arthroplasty (TAA). The aim of this study was to determine whether HXLPE has sufficient fatigue strength for total ankle arthroplasty under simulated physiologically relevant motion profiles and loading in the ankle.

Nitinol Compression Staples in Foot and Ankle Surgery.

Nitinol compression implants are fast and simple to insert and have a high radiographic union rate for midfoot and hindfoot arthrodeses. Applications of nitinol technology in orthopedic surgery are rapidly expanding with the improved and broadened portfolio of implants available.

Wear Characteristics of Conventional Ultrahigh-Molecular-Weight Polyethylene Versus Highly Cross-Linked Polyethylene in Total Ankle Arthroplasty.

Background: The aim of this study was to compare the polyethylene wear rate, particle size, and particle shape of primary semiconstrained, fixed-bearing, bone-sparing total ankle arthroplasty using conventional ultrahigh-molecular-weight polyethylene (CPE) versus highly cross-linked polyethylene (HXLPE) by applying a level walking input using a joint simulator.

Methods: Two fixed-bearing total ankle replacement systems with different types of polyethylene liners were tested: (1) CPE sterilized in ethylene oxide, and (2) HXLPE sterilized with gas plasma after electron beam irradiation. Three implants for each design underwent wear testing using gravimetric analysis over 5 million simulated walking cycles.

Outcomes After Primary Repair of Insertional Ruptures of the Achilles Tendon.

Background: Achilles tendon insertional sleeve avulsions occur when the Achilles distal tendon sleeve ruptures off of its insertion into the calcaneal tuberosity, sometimes with a small bony fragment from calcific tendinosis. Little evidence exists describing the outcomes and rerupture rate after operative management of Achilles tendon sleeve avulsions.

Methods: A retrospective chart review was performed to identify patients who sustained an Achilles sleeve avulsion injury treated with operative repair between October 2005 and July 2014.

Radiographic Results of Nitinol Compression Staples for Hindfoot and Midfoot Arthrodeses.

Background: The purpose of this study was to determine the radiographic union rate after midfoot and hindfoot arthrodeses using a new generation of nitinol staples, and to compare outcomes between a nitinol staple construct and a nitinol staple and threaded compression screw construct.

Methods: A retrospective chart review was performed to identify patients who underwent hindfoot or midfoot arthrodesis using a new generation of nitinol compression staples with or without a partially threaded cannulated screw with minimum 3-month radiographic follow-up. The primary outcome variable was radiographic evidence of arthrodesis on radiographs and, when available, computed tomographic scan in patients who underwent midfoot or hindfoot arthrodesis using nitinol staples.

Ankle Block vs Single-Shot Popliteal Fossa Block as Primary Anesthesia for Forefoot Operative Procedures: Prospective, Randomized Comparison.

Background: Postoperative pain is often difficult to control with oral medications, requiring large doses of opioid analgesia. Regional anesthesia may be used for primary anesthesia, reducing the need for general anesthetic and postoperative pain medication requirements in the immediate postoperative period. The purpose of this study was to compare the analgesic effects of an ankle block (AB) to a single-shot popliteal fossa block (PFB) for patients undergoing orthopedic forefoot procedures.

Histological Analysis of Early Osteolysis in Total Ankle Arthroplasty.

Background: The purpose of this study was to perform a histological comparative analysis of tibiotalar joint samples taken from areas of osteolysis adjacent to total ankle arthroplasties vs control synovial specimens to determine the reaction to and presence of polyethylene (PE) particles.

Methods: A total of 57 pathology samples were identified in the osteolysis group, while 11 were identified in the control group. For each sample, hematoxylin and eosin, Oil Red O (ORO), and macrophage marker CD163-stained slides were created.

Effect of Obesity on Total Ankle Arthroplasty Outcomes.

Background: The purpose of this study was to evaluate the effect of obesity on intermediate- to long-term implant failure rates and survivorship after total ankle arthroplasty.

Methods: A chart review was performed for all patients who underwent primary total ankle arthroplasty between 2004 and 2009 with a minimum 5-year follow-up. Patients were separated into a reference group with a body mass index less than 30 kg/m2 and an obese group with an index greater than or equal to 30 kg/m2.

Reduction in Wound Complications After Total Ankle Arthroplasty Using a Compression Wrap Protocol.

Background: The purpose of this study was to evaluate the clinical differences in wound complications after total ankle arthroplasty (TAA) between a cohort of patients that received a compression wrap protocol and a historical control group treated with cast immobilization.

Methods: Patient charts and postoperative wound pictures were reviewed for 42 patients who underwent a compression wrap protocol and 50 patients who underwent circumferential casting after primary TAA from 2008 to 2013. A blinded reviewer graded each wound using a novel postoperative wound classification system, and recorded whether the wound was completely healed by or after 3 months.

Effect of diabetes mellitus on perioperative complications and hospital outcomes after ankle arthrodesis and total ankle arthroplasty.

Background: The aim of this investigation was to analyze a nationally representative admissions database to evaluate the effect of diabetes mellitus on the rate of perioperative complications and hospitalization outcomes after ankle arthrodesis (AAD) and total ankle arthroplasty (TAA).

Methods: Using the Nationwide Inpatient Sample database, 12 122 patients who underwent AAD and 2973 patients who underwent TAA were identified from 2002 to 2011 based on ICD-9 procedure codes. The perioperative complications and hospitalization outcomes were compared between diabetic and nondiabetic patients for each surgery during the index hospital stay.

Comparison of perioperative complications and hospitalization outcomes after ankle arthrodesis versus total ankle arthroplasty from 2002 to 2011.

Background: The aim of this study was to analyze a validated, nationally representative admissions database in order to compare perioperative complications and hospitalization outcomes associated with ankle arthrodesis (AAD) versus ankle arthroplasty (TAA).

Methods: Using the Nationwide Inpatient Sample (NIS) database from 2002 to 2011, 12 250 patients who underwent AAD and 3002 patients who underwent TAA were identified based on International Classification of Diseases, Ninth Revision (ICD-9) codes. The demographics, comorbidities, and perioperative outcomes during the index hospital stay were compared between patients who underwent AAD and TAA.

Nirschl surgical technique for concomitant lateral and medial elbow tendinosis: a retrospective review of 53 elbows with a mean follow-up of 11.7 years.

Background: Combined lateral elbow tendinosis (tennis elbow) and medial elbow tendinosis (golfer's elbow) can be a disabling condition that, if unresponsive to nonoperative treatments, may be effectively treated surgically. The authors are not aware of any study that reports the outcome of a combined operation for lateral and medial elbow tendinosis (country club elbow) performed in the same operative setting.

Hypothesis: Combined surgical treatment of country club elbow in the same operative setting has similar outcomes to those seen in the literature for single operative procedures.