The Classic Three-Month Post-Operative Adaptation Phase in Foot and Ankle Surgery-An Expert Perspective.

Foot and ankle disorders are a common reason for orthopedic surgical intervention. After surgery, specific precautions such as partial weight bearing or complete unloading, and the use of walking aids, coupled with a period of rest, are usually implemented to ensure the surgical outcome. However, when these aids are discontinued and the patients resume load increase and normal daily activities, they may enter a transitional phase characterized by inflammation, swelling, and pain.

Medial oblique malleolar osteotomy for approach of medial osteochondral lesion of the talus.

Purpose: The medial malleolar osteotomy is commonly performed to gain access to the medial talar dome for treatment of osteochondral lesions of the talus. The primary aim of this study was to assess osseous healing based on postoperative radiographs to determine consolidation, non-union and malreduction rates.

Methods: Sixty-seven cases were reviewed where an oblique uniplanar medial malleolar osteotomy was performed to gain access to the medial talar dome for addressing an osteochondral lesion.

Joint-Preserving Surgery in Varus Ankle Osteoarthritis.

Ankle deformity is a disabling condition especially if concomitant with osteoarthritis (OA). Varus ankle OA is one of the most common ankle OA deformities. This deformity usually leads to unequal load distribution in the ankle joint and decreases joint contact surface area, leading to a progressive degenerative arthritic situation.

Two-Staged Revision Total Ankle Arthroplasty Surgery with Primary Total Ankle Arthroplasty System: A Case Report.

Case: Case of a 2-staged revision surgical technique for the treatment of an aseptic total ankle arthroplasty (TAA) loosening: first surgery: removal of the loosened and painful TAA Scandinavian Total Ankle Replacement, with exclusion of infection, and reconstruction of the large bone defect (bone-defect downsizing surgery); proof of successful ankle bone reconstruction by CT-scan imaging; second surgery: implantation of a primary VANTAGE TAA (ankle reconstruction with new primary TAA).

Conclusion: The present case shows the management of a failed TAA with bone defect by performing a 2-step surgical approach: removal of loosened TAA with simultaneous bone stock restoration and then implantation of a new primary TAA. This concept is a possible alternative to a post-TAA ankle arthrodesis or to the use of a TAA revision system.

Is there clinical evidence to support autologous matrix-induced chondrogenesis (AMIC) for chondral defects in the talus? A systematic review and meta-analysis.

Background: The aim of this study is to systematically review the literature on clinical outcomes of patients who have undergone autologous matrix-induced chondrogenesis (AMIC) for treatment of osteochondral lesions of the talus (OCL) and compare the studies' outcomes.

Methods: Pubmed and Embase were searched in January 2020 for articles concerning OCL surgery. Studies were included if they had a minimum 1-year follow-up and the primary measures were functional outcomes.

Neglected Iatrogenic Flexor Hallucis Longus Tendon Rupture After Haglund's Endoscopic Surgery: A Case Report.

Rupture of the flexor hallucis longus (FHL) tendon is a rare condition that can occur with direct or indirect trauma; most of the injuries are complete ruptures resulting from laceration. Endoscopic calcaneoplasty is used for treatment of symptomatic Haglund's deformity, and complications of this procedure are rare. Iatrogenic FHL tendon rupture occurring after endoscopic calcaneoplasty has not been reported previously.

Medial Ankle Instability: The Deltoid Dilemma.

Diagnosis and treatment of medial ankle instability (MAI) are still controversial and poorly discussed in literature. The purpose of this review is to highlight different clinical presentations of MAI and develop a guide for its management. The deltoid ligament complex is injured more commonly than expected, because deltoid ligament injuries may either be isolated or occur in combination with other lesions, such as lateral ankle ligament injury, posterior tibial tendon insufficiency, osteochondral lesion, and others.

Digit-Like Bony Anomaly of the Hindfoot: A Case Report.

We report the case of an asymptomatic digit-like bony anomaly located on the plantar aspect of the calcaneus, which was incidentally found on radiographs of a 50-year-old male with a tibial shaft fracture. To the best of our knowledge, this is the first description of such an anomaly in the foot. The differential diagnosis includes accessory ossicles, polydactyly, heel spur, heterotopic ossification, osteochondroma, and pelvic digits.

[Aseptic loosening of total ankle replacement : Two-stage revision with bone augmentation of osseous defects and secondary prosthesis implantation].

Objective: To remove loosened ankle prosthesis components, perform osseous defect augmentation, and reimplant definitive prosthesis components to preserve ankle range of motion.

Indications: Aseptic loosening of the tibial and/or talar ankle prosthesis components with substantial bone defect.

Contraindications: General surgical/anesthesiological risks, infections, critical soft tissue conditions, nonmanageable hindfoot instability, neurovascular impairment of the lower extremity, neuroarthropathy, substantial nonreconstructable osseous defects with or without cysts on the tibial and/or talar side, noncompliance, primary total ankle replacement (TAR) using intramedullary fixation (stem fixation), severely reduced bone quality, insulin-dependent diabetes mellitus, smoking, unrealistic patients' expectations, high activity in sports.

How To Diagnose and Treat Infection in Total Ankle Arthroplasty.

Periprosthetic infection after total ankle arthroplasty (TAA) is a serious complication, often requiring revision surgery, including revision arthroplasty, conversion to ankle arthrodesis, or even amputation. Risk factors for periprosthetic ankle infection include prior surgery at the site of infection, low functional preoperative score, diabetes, and wound healing problems. The clinical presentation of patients with periprosthetic ankle joint infection can be variable and dependent on infection manifestation: acute versus chronic.

[Supramalleolar osteotomy in asymmetric ankle osteoarthritis : Short-term clinical and radiographic results].

Background: The main indication for the supramalleolar osteotomy is asymmetric ankle osteoarthritis with concomitant supramalleolar valgus or varus deformity. The aim of this prospective study was to analyze short-term clinical and radiographic outcomes in patients with asymmetric ankle osteoarthritis.

Methods: A total of 16 patients with asymmetric ankle osteoarthritis and concomitant supramalleolar deformity - 7 patients with valgus deformity, 9 patients with varus deformity - were treated.

All-Arthroscopic Autologous Matrix-Induced Chondrogenesis-Aided Repair of a Patellar Cartilage Defect Using Dry Arthroscopy and a Retraction System.

The technique of all-arthroscopic autologous matrix-induced chondrogenesis (AMIC)-aided repair of patellar cartilage lesions using a retraction system and dry arthroscopy has been recently described. We report the first clinical and radiological data at a short-term follow-up. Twelve patients underwent AMIC-aided cartilage repair for a patellar lesion.

Surgical Treatment Options for the Diabetic Charcot Midfoot Deformity.

Management of diabetic Charcot midfoot deformity is one of the most demanding aspects of foot and ankle surgery. Its treatment should aim at reducing the rate of complications, including foot and ankle amputations or limb loss. Attempting reconstruction at Eichenholtz stages I and II carries the risk of infection and loss of fixation.

Sports Activity After Reconstruction of Osteochondral Lesions of the Talus With Autologous Spongiosa Grafts and Autologous Matrix-Induced Chondrogenesis.

Background: For the treatment of osteochondral lesions of the talus (OCLTs), autologous matrix-induced chondrogenesis (AMIC) is a safe 1-step procedure with good clinical and radiological results. However, data regarding postoperative sports activity after AMIC are limited.

Purpose: To identify significant factors influencing the rate of postoperative sports and recreational activities.

[Bizarre parosteal osteochondromatous proliferation of the metatarsal bone].

A bizarre parosteal osteochondromatous proliferation (BPOP), also known as a Nora lesion, is a rare benign bone formation. It emanates mainly from the intact cortex of the metaphysis of short tubular bones (hands or feet). Conventional radiographs should be complemented using cross-sectional imaging modalities (CT/MRI).

Computed Tomographic Evaluation of Joint Geometry in Patients With End-Stage Ankle Osteoarthritis.

Background: Deformation of the talus and the distal tibia can be frequently observed during ankle joint osteoarthritis (OA). The aim of this study was to objectify these morphologic changes. We hypothesized that a flattening of the talus and a broadening of the distal tibia surface occurs in end-stage OA of the ankle joint.

[Dwyer osteotomy : Lateral sliding osteotomy of calcaneus].

Objective: To correct the underlying inframalleolar varus deformity and to restore physiologic biomechanics of the hindfoot.

Indications: Neurologic, posttraumatic, congenital, and idiopathic cavovarus deformity. In patients with end-stage ankle osteoarthritis with varus heel malposition as additional single-stage procedure complementing total ankle replacement.

A cationic gadolinium contrast agent for magnetic resonance imaging of cartilage.

A new cationic gadolinium contrast agent is reported for delayed gadolinium enhanced magnetic resonance imaging of cartilage (dGEMRIC). The agent partitions into the glycosaminoglycan rich matrix of articular cartilage, based on Donnan equilibrium theory, and its use enables imaging of the human cadaveric metacarpal phalangeal joint.

Ankle Joint Fusion With an Anatomically Preshaped Anterior Locking Plate.

We present a novel fixation plate for primary ankle joint fusion. A single anatomically preshaped angular stable plate was used with an anterior approach. An excellent result with good bone consolidation was present at the 1-year follow-up examination.

[Total ankle replacement in patients with bleeding disorders].

Background: Total ankle replacement (TAR) is a well-accepted treatment option in patients with end-stage ankle osteoarthritis. However, published literature on patients with bleeding disorders treated with TAR is limited. Therefore, we carried out this prospective study to analyze mid-term postoperative results in patients with bleeding disorders treated by TAR.

Transcutaneous pleural biopsy with a retrograde forceps: a novel approach.

Purpose: Pleural biopsies are commonly performed to investigate the cause of exudative pleural effusion. Biopsy needles (e.g.

Total ankle replacement.

Background: About 1% of adults suffer from painful osteoarthritis of the ankle. The current literature contains no information on the percentage of such patients who derive long-term relief of symptoms from conservative treatment. Advanced ankle osteoarthritis can be treated with non-joint-preserving measures, such as total ankle replacement and ankle fusion.

Total ankle replacement in patients with von Willebrand disease: mid-term results of 18 procedures.

von Willebrand disease (VWD) is a recognized cause of secondary ankle osteoarthritis (OA). Few studies have examined orthopaedic complications and outcomes in VWD patients treated for end-stage ankle OA with total ankle replacement (TAR). To determine the clinical presentation, intraoperative and postoperative complications and evaluate the mid-term outcome in VWD patients treated with TAR.