Early to medium term outcomes of osteochondral lesions of the talus treated by autologous matrix induced chondrogenesis (AMIC).

BACKGROUND: The primary aim of the study is to evaluate the functional outcome following AMIC procedure in patients with osteochondral injury of the talus. The secondary aim is to evaluate if size of the lesion and patient's age influence outcome. MATERIALS AND METHODS: This is a retrospective study of 25 patients who underwent AMIC procedure of the talus treated by a single surgeon. Functional outcomes were evaluated using pre and post operative AOFAS and VAS scores. RESULTS: The mean lesion size was 1.74 cms with 88% of lesions in the study more than 1.4 cms. There was a significant improvement in AOFAS score with mean improvement of 49.40 (p < 0.05) and VAS score of 5.36 (p < 0.05). We could not find any correlation between either age or lesion size with functional outcome for AMIC procedure. CONCLUSION: AMIC procedure seems to be a reliable treatment method for larger diameter osteochondral lesions of the talus up to 2.5 cms in diameter.

Osteomyelitis complicating Sever's disease: A report of two cases.

Sever's disease is a common cause of heel pain in young children and it has a self-limiting course without long term complications. Osteomyelitis of calcaneus is a sinister condition which can lead to serious complication if treatment is delayed. Indolent nature of calcaneus osteomyelitis leads to overlap in its clinical picture with Sever's disease. Two cases of Sever's disease which were later diagnosed and managed for osteomyelitis are reported. Salient differentiating features of Sever's disease and calcaneus osteomyelitis along with management strategy are discussed.

Fractures of the Lateral Process of the Talus With Associated Ankle Instability: A Report of 2 Cases.

Fractures of the lateral process of the talus are uncommon, but often overlooked. They can result in significant functional deficit with residual nonunion and arthritis if not recognized and treated appropriately. We describe 2 cases of such injuries, one with acute recognition and management, and one with delayed diagnosis and nonunion. In both cases, pain from the fracture was accompanied by symptoms of instability requiring simultaneous lateral ligament reconstruction along with fracture fixation. Evaluation of patients with lateral process fractures should include assessment of the lateral ligaments; ankle instability may need to be surgically addressed along with intervention for fracture fixation. LEVELS OF EVIDENCE: Level IV: Case report.

Early results of Roto-glide joint arthroplasty for treatment of hallux rigidus.

BACKGROUND: Traditionally severe hallux rigidus is treated with arthrodesis. Recently arthroplasty has been used in order to retain motion at the metatarsophalangeal joint. AIM: To assess the early to mid-term functional and radiological outcomes in patients undergoing first metatarsophalangeal arthroplasty using the Rotoglide implant. MATERIALS AND METHODS: A prospective review was undertaken to assess functional and radiological outcomes of all patients undergoing an un-cemented three-component first metatarsophalangeal arthroplasty for hallux rigidus. Thirty four implants were performed in 28 patients over a 2-year period. Mean age was 60.5 years (range 45-77 years). Mean follow-up was 27.7 months (range 7-44 months). RESULTS: Mean AOFAS score improved from 41.2 pre-operatively to 89.1 at final follow-up (47.9; 95% CI=43.6-54.3; p<0.0001). The mean metatarsophalangeal (MTP) range of motion improved from 29.5° pre-operatively to 68.2° post-operatively (38.7; 95% CI=35.1-42.2; p<0.0001). The mean AOFAS pain scores improved from 8.8 preoperatively to 35.0 postoperatively (26.2; 95% CI=22.4-29.9; p<0.0001). Three patients required revision surgery. No radiological complications were observed in any other patients. CONCLUSIONS: This un-cemented prosthesis provides pain relief, while maintaining range of motion of the joint. The authors have observed clinically and statistically significant improvement in functional outcomes, with a low early complication rate and high patient satisfaction levels.

Shortening Scarf osteotomy for correction of severe hallux valgus. Does shortening affect the outcome?

BACKGROUND: Translation and shortening of Scarf osteotomy allows correction of severe hallux valgus deformity. Shortening may result in transfer metatarsalgia. AIM: To evaluate outcome of patients undergoing shortening Scarf osteotomy for severe hallux valgus deformities. MATERIALS AND METHODS: Fifteen patients (20feet, mean age 58 years) underwent shortening Scarf osteotomy for severe hallux valgus deformities. Outcomes were pre and postoperative AOFAS scores, IM and HV angles, patient satisfaction. RESULTS: Mean follow-up was 25 months (range 22-30). The IM angle improved from a median of 18.60 (range 13.4-26.20) preoperatively to 9.70 (range 8.0-13.70) postoperatively (8.9; 95% CI=7.6-10.3; p<0.001). The HV angle improved from a mean of 43.2 (range 27.4-68.2) preoperatively to 13.6 (range 3.0-37.4) postoperatively (29.6; 95% CI=26.1-33.2; p<0.001). The median AOFAS score improved from 29.2 (range 14-60) preoperatively to 82.2 (range 55-100) postoperatively (53.0; 95% CI=48.0-58.5; p<0.001). All patients rated their satisfaction as either satisfied or very satisfied. None had symptoms of transfer metatarsalgia at final follow-up. All osteotomies united. CONCLUSIONS: Shortening Scarf osteotomy is a viable option for treating severe hallux valgus deformities with no transfer metatarsalgia.

Plantar approach for Morton's neuroma: An effective technique for primary excision.

BACKGROUND: Morton's neuroma is a common cause of inter-metatarsal foot pain. Surgical excision is generally indicated when non-operative measures have been unsuccessful; various surgical techniques have been described in the literature for excision, with no consensus on the overall ideal surgical approach. AIM: To assess patient outcomes and complications following plantar surgical approach to neurectomy in a consecutive series of patients. METHOD: An analysis of consecutive patients undergoing excision of Morton's neuroma using a plantar approach by a single surgeon over a 12 month period. Pre- and post-operative AOFAS and VAS scores were completed during outpatient visits. RESULTS: 20 patients were included in the study, with pre-operative confirmation of a soft tissue mass on ultrasound scan. All patients demonstrated improvement in their post-operative functional scores; 2 patients (10%) did not have full resolution of their symptoms post-operatively. Mean AOFAS scores improved from 39 to 80 post-operatively and VAS from 40 to 92. No patients had wound complications or scar pain. CONCLUSION: Neurectomy performed via a plantar approach provides good exposure, adequate soft tissue healing, with rapid resolution of pain and return to normal activities post-operatively.

Conservative management of psoas haematoma following complex lumbar surgery.

We report psoas hematoma communicating with extradural hematoma and compressing on lumbar nerve roots during the postoperative period in a patient who underwent L3/4 level dynamic stabilization and L4/5 and L5/S1 posterior lumbar interbody fusion. Persistent radicular symptoms occurring soon after posterior lumbar surgery are not an unknown entity. However, psoas hematoma communicating with the extradural hematoma and compressing on L4 and L5 nerve roots soon after surgery, leading to radicular symptoms has not been reported. In addition to the conservative approach in managing such cases, this case report also emphasizes the importance of clinical evaluation and utilization of necessary imaging techniques such as computed tomography (CT) scan and magnetic resonance imaging (MRI) scan to diagnose the cause of persistent severe radicular pain in the postoperative period.