Outcomes of bone marrow aspirate concentrate and matrix-induced chondrogenesis (BMIC) for treatment of osteochondral lesions of the talus.

BACKGROUND: To analyze the outcomes of Bone marrow aspirate concentrate and Matrix-Induced Chondrogenesis (BMIC) in Osteochondral Lesions of the Talus (OLTs). METHODS: Patients with OLTs treated with BMIC from June 2013 to July 2020 were included. Visual Analogue Scale (VAS), Foot Function Index (FFI), and Foot Ankle Outcome Score (FAOS) before treatment and at last follow-up were subjected to analysis. RESULTS: Forty-five patients were included and mean follow-up was 39.1 months (range, 13-97 months). Mean lesion size and depth were 180.7 ± 110.4 mm2 and 9.6 ± 3.7 mm, respectively. BMIC was performed without malleolar osteotomy in 36 patients (80%) and bone graft was performed in 42 (93.3%). VAS, FFI, and FAOS improved significantly. No complication occurred and no revision was required. CONCLUSIONS: The BMIC procedure is feasible and should be considered a viable treatment option for OLTs associated with large subchondral bone defects.

Arthroscopic Synovectomy and Excision of a Sesamoid in the Management of an Atypical Presentation of Avascular Necrosis of Bone: A Case Report.

Avascular necrosis of a sesamoid bone is a rare and incompletely understood entity. Furthermore, associated lesions secondary to sesamoid pathology have seldom been described in the literature. We report a case of avascular necrosis of the medial sesamoid, accompanied by severe synovitis of the first metatarsophalangeal joint, that was successfully managed with arthroscopic synovectomy and open excision of the sesamoid.

Effects of Human Placenta Extract (Laennec) on Ligament Healing in a Rodent Model.

Rich in bioactive substances such as amino acids and peptides, Laennec (human placenta hydrolysate) has been widely used to control various types of musculoskeletal pain. However, the effects of Laennec on tendon and ligament injuries are not clearly understood. In the present study, Laennec was tested to identify its in vivo effects on ligament injury in an animal model and its in vitro effects on tendon-derived fibrocytes. A total of 99 Sprague Dawley rats were divided into the negative control (normal) group (n = 11) and the ligament injury group (n = 88). The ligament injury group was subdivided into normal saline-treated group, Laennec-treated group, polydeoxyribonucleotide-treated group, and 20% dextrose-treated group. Ligaments were collected at 1 week and 4 weeks after treatment. Histologic and biomechanical properties were analyzed. In vitro effects of Laennec and polydeoxyribonucleotide on fibrocytes were also analyzed. Although all other treatment groups showed increased inflammatory cells, the Laennec-treated group maintained cell counts and activated macrophage levels that were similar to the normal group. Unlike the saline-treated group and dextrose-treated group, the Laennec-treated group had low levels of degenerative changes at 4 weeks after treatment. Supportively, in vitro results showed that the Laennec-treated group had increased collagen type I, scleraxis (Scx) and tenomodulin (Tnmd) expression (p < 0.05). Our study demonstrates that Laennec treatment enhances wound healing of damaged ligament by suppressing immune responses and reducing degenerative changes of damaged ligament. In addition, we found that Laennec induces the gene expression of type I collagen, Scx and Tnmd in fibrocytes, suggesting that Laennec may facilitate regeneration of damaged ligaments. Therefore, we expect that Laennec can be a useful drug to treat injured ligament.

Topical administration of tranexamic acid in hip arthroplasty.

PURPOSE: The purpose of this study was to assess the efficacy of a newly designed topical administration of tranexamic acid (TXA) in reducing post-operative bleeding in total hip arthroplasty (THA) and bipolar hip hemiarthroplasty (BHA). METHODS: A consecutive series of 160 patients who underwent hip arthroplasty was enrolled in this study. Topical administration of TXA was done in group 1 (40 patients underwent THA and 40 BHA). We compared the amount of blood loss and rates of post-operative transfusion in group 1 with those of group 2 (40 cases of THA and 40 cases of BHA) in which TXA solution was not applied. RESULTS: The total amount of blood loss in THA group 1 and THA group 2 was 793 ± 50 mL and 1086 ± 73 mL, respectively (p = 0.001). The transfusion rates of THA group 1 and THA group 2 was 27.5 % and 50 %, respectively (p = 0.039). The transfusion rates of BHA group 1 and BHA group 2 was 45 % and 60 %, respectively (p = 0.179). The amounts of blood loss through the drainage tube were 186 ± 22 mL and 257 ± 24 mL in THA group 1 and THA group 2, respectively, and 101 ± 11 mL and 147 ± 16 mL in BHA group 1 and BHA group 2, respectively, showing statistical significance. No complications such as infection, deep vein thrombosis or cardiovascular disease were observed during the hospital stay and the last follow-up. CONCLUSION: Topical administration of TXA is an effective and safe method to reduce post-operative bleeding and transfusion rates in hip arthroplasty.

Concomitant Contracture of the Knee and Ankle Joint After Gastrocnemius Muscle Rupture: A Case Report.

Injury of the medial head of the gastrocnemius, also called "tennis leg," is known to heal uneventfully in most cases with compression and immobilization therapy. Failure to heal or long-term complications, including ongoing pain and pes equinus, have been documented in only a limited number of case reports. To the best of our knowledge, a severe concomitant contracture of the knee and ankle joint as a consequence of a maltreated gastrocnemius muscle rupture has not been previously reported in English-language reports. The purpose of the present study was to report a serious complication of neglected tennis leg with a review of the published data.

Skyrmions and Hall Transport.

We derive a generalized set of Ward identities that captures the effects of topological charge on Hall transport. The Ward identities follow from the (2+1)-dimensional momentum algebra, which includes a central extension proportional to the topological charge density. In the presence of topological objects like Skyrmions, we observe that the central term leads to a direct relation between the thermal Hall conductivity and the topological charge density. We extend this relation to incorporate the effects of a magnetic field and an electric current. The topological charge density produces a distinct signature in the electric Hall conductivity, which is identified in existing experimental data and yields further novel predictions. For insulating materials with translation invariance, the Hall viscosity can be directly determined from the Skyrmion density and the thermal Hall conductivity to be measured as a function of momentum.

Arthroscopic evaluation of persistent pain following supramalleolar osteotomy for varus ankle osteoarthritis.

PURPOSE: The purposes of this study were to investigate pain experienced by patients after supramalleolar osteotomy for varus ankle osteoarthritis and to analyse correlations between this pain and arthroscopic findings. METHODS: Twenty-nine patients (31 ankles) who underwent arthroscopic evaluation after supramalleolar osteotomy were reviewed retrospectively. The visual analog scale (VAS) was used to assess pain, and the patients were instructed to record the time point, location, and character of the pain. The tibial-ankle surface angle, talar tilt, and tibial-lateral surface angle were measured on radiographs. RESULTS: The location, time point, and character of the pain experienced by the patients changed after supramalleolar osteotomy. The mean VAS score was significantly improved after supramalleolar osteotomy at the time of the arthroscopic evaluation (P < 0.001) and improved further after the arthroscopic procedures (P = 0.026). During arthroscopy, pathologic lesions such as adhesions, synovitis, and soft-tissue impingement were identified. A significant correlation was found between adhesions and dull pain and pain at rest (P = 0.016 and P = 0.005, respectively). In addition, soft-tissue impingement in the lateral gutter was significantly correlated with dull pain, pain at rest, and clicking pain (P = 0.001, P = 0.035, and P = 0.042, respectively). No significant correlations were found between post-operative radiographic measurements and development of pathologic lesions. CONCLUSIONS: With the use of arthroscopy, persistent pain experienced after supramalleolar osteotomy was found to be associated with adhesions, synovitis, and soft-tissue impingement in medial and lateral gutters of the ankle. Arthroscopy can be helpful in identifying and treating painful lesions commonly seen after supramalleolar osteotomy. An understanding of these painful lesions will help patients have more realistic expectations regarding the supramalleolar osteotomy. LEVEL OF EVIDENCE: Case series study, Level IV.

Efficacy of multimodal drug injection after supramalleolar osteotomy for varus ankle osteoarthritis: A prospective randomized study.

BACKGROUND: Optimal management of postoperative pain is important to ensure patient comfort and functional improvement. Despite the frequent use of multimodal drug injection for pain control after orthopedic surgery, few studies have evaluated its use after supramalleolar osteotomy. METHODS: Supramalleolar osteotomy was performed in 62 patients (65 ankles). Thirty patients (31 ankles) were randomly assigned to receive multimodal drug injection (injection group) and 32 patients (34 ankles) were assigned to receive no multimodal drug injection (control group). The two groups were compared with regard to the degree of postoperative pain, the number of times patients pushed the patient-controlled analgesia (PCA) button, the total amount of fentanyl administered, and the frequency of additional diclofenac sodium injections. RESULTS: The injection group had significant pain reduction during the first 36 postoperative hours compared to the control group. There were significant differences between the groups in the number of times that patients pushed the PCA button as well as the total amount of fentanyl administered up to 24 h postoperatively. The mean frequency of additional diclofenac sodium injections in the first 12 postoperative hours was significantly less in the injection group compared to that in the control group. CONCLUSION: Multimodal drug injection was effective in reducing pain and decreasing both fentanyl and diclofenac sodium usage in patients undergoing supramalleolar osteotomy. Therefore, multimodal drug injection should be considered for improved pain control and patient comfort in the early postoperative period after supramalleolar osteotomy.

The effect of dry needling and treadmill running on inducing pathological changes in rat Achilles tendon.

Achilles tendinopathy is a common degenerative condition without a definitive treatment. An adequate chronic animal model of Achilles tendinopathy has not yet been developed. The purpose of this study was to evaluate the individual and combined effects of dry needling and treadmill running on the Achilles tendon of rats. Percutaneous dry needling, designed to physically replicate microrupture of collagen fibers in overloaded tendons, was performed on the right Achilles tendon of 80 Sprague-Dawley rats. The rats were randomly divided into two groups: a treadmill group, which included rats that underwent daily uphill treadmill running (n = 40), and a cage group, which included rats that could move freely within their cages (n = 40). At the end of weeks 1 and 4, 20 rats from each group were sacrificed, and bilateral Achilles tendons were collected. The harvested tendons were subjected to mechanical testing and histological analysis. Dry needling induced histological and mechanical changes in the Achilles tendons at week 1, and the changes persisted at week 4. The needled Achilles tendons of the treadmill group tended to show more severe histological and mechanical changes than those of the cage group, although these differences were not statistically significant. Dry needling combined with free cage activity or treadmill running produced tendinopathy-like changes in rat Achilles tendons up to 4 weeks after injury. Dry needling is an easy procedure with a short induction period and a high success rate, suggesting it may have relevance in the design of an Achilles tendinopathy model.

Generalizing Thiele equation.

We generalize the Thiele equation with a transverse velocity to the skyrmion motion described by the collective coordinate of magnetization vector. It is applied to investigate a significant disparity in the existing data sets of skyrmion and antiskyrmion Hall angles. Our analysis further reveals interesting differences of these Hall angles near the angular momentum compensation point. We identify a possible physical quantity that is responsible for the disparity.

Factors influencing successful bone union of isolated subtalar arthrodesis for posttraumatic subtalar arthritis: a multicenter case series.

BACKGROUND: The purpose of this study was to find the factors influencing successful bone union for isolated subtalar arthrodesis in posttraumatic subtalar arthritis following calcaneal fracture. MATERIAL AND METHODS: We retrospectively analyzed the rate of successful bone union of 119 cases of isolated subtalar arthrodesis for posttraumatic subtalar arthritis performed at five university hospitals between January 2010 and December 2019. Multivariate logistic regression analysis was used to find the factors associated with successful bone union. Successful bone union was defined as resolution of hindfoot pain with the presence of osseous trabecular bridging involving more than 50% of the posterior facet within 6 months postoperatively. RESULTS: There were 77 (64.7%) cases of successful bone union, 11 (9.2%) cases of delayed union, 8 (6.7%) cases of questionable union, and 23 (19.3%) cases of nonunion. Use of fully threaded screws was 5.90 times [odds ratio (OR) = 5.90, 95% confidence interval (CI) = 1.42-24.49, p = 0.02] more likely to achieve successful bone union compared to the use of partially threaded screws. Use of two parallel screws or the two divergent screws were 3.71 times (OR = 3.71, 95% CI = 1.05-13.14, p = 0.04) and 4.65 times (OR = 4.65, 95% CI = 1.23-17.53, p = 0.02) more likely to achieve successful bone union compared to the use of a single screw. Use of cancellous autograft or structural autograft was 4.72 times (OR = 4.72, 95% CI = 1.17-19.06, p = 0.03) and 7.12 times (OR = 7.12, 95% CI = 1.46-34.68, p = 0.02) more likely to achieve successful bone union compared to no graft use. CONCLUSION: Use of fully threaded screws, autograft, and two screws compared to a single screw were the factors associated with successful bone union within six postoperative months after subtalar arthrodesis for the posttraumatic arthritis.

Osteochondral Repair with Autologous Cartilage Transplantation with or without Bone Grafting: A Short Pilot Study in Mini-Pigs.

OBJECTIVE: Treatment strategies for osteochondral defects, for which particulated autologous cartilage transplantation (PACT) is an emerging treatment strategy, aim to restore the structure and function of the hyaline cartilage. Herein, we compared the efficacy of PACT with control or human transforming growth factor-ß (rhTGF-ß), and clarified the necessity of bone graft (BG) with PACT to treat shallow osteochondral defects in a porcine model. DESIGN: Two skeletally mature male micropigs received 4 osteochondral defects in each knee. The 16 defects were randomized to (1) empty control, (2) PACT, (3) PACT with BG, or (4) rhTGF-ß. Animals were euthanized after 2 months and histomorphometry, immunofluorescence analysis, semiquantitative evaluation (O'Driscoll score), and magnetic resonance observation of cartilage repair tissue (MOCART) score were performed. RESULTS: Hyaline cartilages, glycosaminoglycan synthesis, and collagen type II staining were more abundant in the PACT than in the control and rhTGF-ß groups. The O'Driscoll score was significantly different between groups (P < 0.001), with both PACT groups showing superiority (P = 0.002). PACT had the highest score (P = 0.002), with improved restoration of subchondral bone compared with PACT with BG. The MOCART score showed significant differences between groups (P = 0.021); MOCART and O'Driscoll scores showed high correlation (r = 0.847, P < 0.001). CONCLUSION: Treatment of osteochondral defects with PACT improved tissue quality compared with that with control or rhTGF-ß in a porcine model. BG, in addition to PACT, may be unnecessary for shallow osteochondral defects. Clinical Relevance. BG may not be necessary while performing PACT.

Preoperative planning and surgical technique: how do I balance my ankle?

Ligament balancing during total ankle arthroplasty is an important step in optimizing the mechanical balance of the ankle joint. Soft-tissue contractures that result from varus or valgus coronal plane deformity can pose a difficult problem, and the surgeon should have a standard procedure for managing such situations in the operating room. Balance may be assessed intraoperatively with the use of spacer blocks, laminar spreaders, and tensioning devices as well as by placement of trial components. Techniques used to balance the varus or valgus ankle during primary total ankle arthroplasty include osteophyte resection, soft-tissue release, and bone resection. Mediolateral ligament balancing is crucial for long-term success and patient satisfaction.

Second-look arthroscopic and magnetic resonance analysis after internal fixation of osteochondral lesions of the talus.

The purpose of this study was to evaluate cartilage quality after internal fixation of osteochondral lesion of the talus (OLT) using second-look arthroscopies and MRIs. Thirty-four patients underwent internal fixation of OLTs involving large bone fragments. Twenty-one of these patients underwent second-look arthroscopies and 23 patients underwent MRIs postoperatively. The arthroscopic findings were assessed using the International Cartilage Repair Society (ICRS) grading system, and the MRI findings were evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Five of the patients who underwent second-look arthroscopies showed normal cartilage, 12 showed nearly normal cartilage, 3 showed abnormal cartilage, and 1 showed severely abnormal cartilage, according to the overall ICRS repair grades. All the patients who achieved bone fragment union showed normal, or nearly normal cartilage upon second-look arthroscopy. The ICRS and MOCART scores were significantly higher for the patients with bone fragment union compared to those with nonunion (ICRS scores: 10.3 ± 1.5 vs. 6.0 ± 2.0, p < 0.001, MOCART score: 88.3 ± 10.0 vs. 39.0 ± 20.4, p < 0.001). Low signal intensities of the bone fragments on preoperative T1-weighted MRIs were not associated with nonunion (Fisher's exact test, p = 0.55), and the signal intensities increased postoperatively to levels similar to the underlying talus when bone union was achieved. Second-look arthroscopy and MRI showed normal, or nearly normal, cartilage after internal fixation of OLTs when bone union was achieved. The nonunion of bone fragments resulted in inferior cartilage quality.

Clinical Features and Treatment of Intra-Tendinous Suture Reaction Following Achilles Tendon Repair Using Nonabsorbable Suture Material: A Retrospective Case Series Study.

We aimed to investigate the clinical manifestations, radiological findings, and therapeutic outcome of treatment for patients with surgically confirmed foreign body reaction following an Achilles tendon repair using non-absorbable suture material. Eight consecutive patients who were confirmed as having an intra-tendinous suture foreign body reaction in the histopathological report were enrolled in this study. Medical records of all patients in terms of clinical and radiological features were retrieved. Also, the outcome of treatment was evaluated at a follow-up of at least 12 months. All the patients complained of pain and a palpable mass around a previous surgical site at mean 25.1 months (range, 4-72 months) after the initial surgery. Magnetic resonance imaging (MRI) or ultrasound were used to detect the lesion. All the patients underwent surgical excision of foreign body reaction tissue and primary repair using absorbable suture material. After the treatment, the wounds were healed completely in all, and the average FAOS (foot and ankle outcome score) was 91.32 at mean follow-up for 22.4 months. In conclusion, intra-tendinous suture reaction is a rare complication following an Achilles tendon repair using nonabsorbable suture material, but it can be treated adequately with only surgical excision of foreign body reaction tissue and primary repair using absorbable suture material.

Limb salvage in severe diabetic foot infection.

BACKGROUND: The purpose of our study was to determine the efficacy of a management algorithm that includes negative pressure wound therapy (NPWT) in diabetic feet with limb-threatening infection. MATERIALS AND METHODS: Forty-five septic diabetic feet were treated with NPWT between 2006 and 2008. After emergent abscess evacuation, early vascular intervention was performed if necessary. Debridement, with or without partial foot amputation, was followed by NPWT. Wound progress was measured using a digital scanner. A limb was considered salvaged if complete healing was achieved without any or with minor amputation through or below the ankle. The mean followup after complete wound healing was 17 (range, 6 to 35) months. RESULTS: Thirty-two cases (71%) were infected with two or more organisms. Negative pressure wound therapy was applied for 26.2±14.3 days. The median time to achieve more than 75% wound area granulation was 23 (range, 4 to 55) days and 104 (range, 38 to 255) days to complete wound healing. Successful limb salvage was achieved in 44 cases (98%); 14 (31%) without any amputation and 30 (67%) with partial foot amputations. Total number of operations per limb was 2.4±1.3. One case of repeated infection and necrosis was managed with a transtibial amputation. There were no complications associated with NPWT. CONCLUSION: This study provides the outcome of a management algorithm which includes NPWT in salvaging severely infected diabetic feet. With emergent evacuation of abscess, early vascular intervention and appropriate debridement, NPWT can be a useful adjunct to the management of limb-threatening diabetic foot infections.

Validation of Remote Collection of Patient-Reported Outcomes Using Patients' Smartphones.

BACKGROUD: The purpose of this study was to examine the between-mode equivalence and the relative efficiency of the 2 available modes of patient-reported outcome (PRO) data collection: a web-enabled touch screen tablet and a smartphone in a sample of patients who underwent foot and ankle orthopedic surgery. METHODS: A total of 136 patients who visited the clinic after foot/ankle surgery participated in the study. All patients completed the PRO questionnaire set using tablets at the hospital. After 24 hours of completing the first PRO questionnaire, the patients completed the same PRO questionnaire at home using their personal smartphones. The outcomes were statistically compared, and the patients' preferences were surveyed. RESULTS: The intraclass correlation coefficients for comparing the results of PRO measurements between the 2 modes were 0.970 for the visual analog scale, 0.952 for the Foot Function Index, 0.959 for the foot and ankle outcome scale, and 0.957 for the patient's satisfaction. Sixty-eight participants (58.6%) responded that they were able to answer the questionnaires with more honesty at home using their smartphones. Regarding the mode, 60 participants (48.1%) responded that they have no preference between the devices. CONCLUSIONS: The results of this study showed the equivalence of the 2 modes of PRO data collection: web-enabled touch screen tablets and smartphones. Smartphones may be the preferred mode of PRO measurement, due to their easy accessibility, increased privacy, and the patients' increased honesty in answering questionnaires.

Hard-Soled Shoe Versus Short Leg Cast for a Fifth Metatarsal Base Avulsion Fracture: A Multicenter, Noninferiority, Randomized Controlled Trial.

BACKGROUND: The purpose of this study was to determine whether tolerated weight-bearing in a hard-soled shoe was noninferior to the use of a short leg cast for the treatment of a fifth metatarsal base avulsion fracture, as assessed with use of a 100-mm visual analog scale (VAS) for pain at 6 months after the fracture. METHODS: A total of 145 patients were assessed for eligibility. Of these, 96 patients were randomly assigned to either the hard-soled shoe group (46 patients) or the cast group (50 patients). The primary outcome measure was the mean difference on the 100-mm VAS between groups at 6 months after the fracture. Secondary outcome measures included the time to return to preinjury activity and patient-reported satisfaction. Analysis was performed according to both an intention-to-treat basis (i.e., patients were included in the assessment of their assigned treatment arm, even if they crossed over to the other treatment arm prior to completing the 6-month follow-up) and a per-protocol basis (i.e., patients who completed the 6-month follow-up were analyzed according to the treatment they received). RESULTS: At 6 months after the fracture, the mean 100-mm VAS was 8.6 ± 7.0 mm in the hard-soled shoe group and 9.8 ± 7.3 mm in the cast group (p = 0.41) according to intention-to-treat analysis. The mean difference in 100-mm VAS between the 2 groups was -1.3 mm (95% confidence interval, -4.3 to 1.8 mm). The upper limit of the 95% confidence interval did not exceed the noninferiority margin of 10 mm, indicating that treatment with the hard-soled shoe was noninferior to treatment with the short leg cast. The proportion of patients who reported satisfaction with their treatment was similar between the hard-soled shoe and cast groups (89.5% compared with 87.5%, respectively; p = 0.79), but the time to return to preinjury activity was significantly shorter in the hard-soled shoe group (37.2 ± 14.4 days compared with 43.0 ± 11.1 days in the cast group; p = 0.04). There were no cases of nonunion in either group. CONCLUSIONS: Weight-bearing as tolerated in a hard-soled shoe for a fifth metatarsal base avulsion fracture was noninferior to the use of a short leg cast as assessed with use of a 100-mm VAS at 6 months after the fracture. Patient-reported satisfaction was similar between groups, but the time to return to preinjury activity was shorter in the hard-soled shoe group. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Early Weightbearing Versus Nonweightbearing After Operative Treatment of an Ankle Fracture: A Multicenter, Noninferiority, Randomized Controlled Trial.

BACKGROUND: Acute ankle fractures can occur during sports activities, and unstable ankle fractures are commonly treated operatively. However, controversy exists about the optimal time to allow weightbearing. HYPOTHESIS: Early weightbearing after the stable fixation of an ankle fracture is not inferior to nonweightbearing in terms of ankle function assessed at 12 months after injury. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 258 patients were assessed for eligibility. Of these patients, 194 were randomly allocated to either the early weightbearing group (95 patients who were allowed weightbearing at 2 weeks postoperatively) or the nonweightbearing group (99 patients who were not allowed weightbearing until 6 weeks postoperatively). The primary outcome measure was the mean difference in the Olerud-Molander ankle score (OMAS) between the groups, assessed at the 12-month follow-up examination. The secondary outcome measures were the time to return to preinjury activities and patients' subjective satisfaction. Complications such as hardware loosening or failure, fracture displacement, and nonunion were evaluated. RESULTS: The mean difference in the OMAS for the early weightbearing group compared with the nonweightbearing group was 1.6 (95% CI, -1.9 to 5.0) in the intention-to-treat analysis. The lower limit of the 95% CI (-1.9) exceeded the noninferiority margin of -8, indicating that early weightbearing was not inferior to nonweightbearing. The difference in the proportion of patients who were satisfied or very satisfied with their treatment was not statistically significant (84.3% vs 76.2%; P = .19); however, the time taken to return to preinjury activities was shorter with early weightbearing than with nonweightbearing (9.1 ± 3.0 vs 11.0 ± 3.0 weeks; P < .001). No cases of nonunion were observed in either group. CONCLUSION: Early weightbearing after the operative treatment of an unstable ankle fracture was not inferior to nonweightbearing in terms of OMAS assessed at 12 months after injury. The patients' subjective satisfaction was similar between the groups, although the time taken to return to preinjury activities was shorter in the early weightbearing group. REGISTRATION: NCT02029170 (ClinicalTrials.gov identifier).

The effect of an ossicle of the lateral malleolus on ligament reconstruction of chronic lateral ankle instability.

BACKGROUND: Ossicles at the tip of the lateral malleolus are frequently found in patients with chronic lateral ankle instability (CLAI). However, the relationship between the presence or the size of an ossicle and the outcome of ligament reconstruction is poorly understood. Therefore, this study aimed to evaluate the effect of an ossicle at the tip of the lateral malleolus on ligament reconstruction in CLAI. MATERIALS AND METHODS: Seventy-four ankles with chronic lateral instability that received lateral ligament reconstruction using a modified Broström technique between January 2001 and March 2007 were included. The mean followup was 47 (range, 25 to 89) months. Ankles were divided into 2 groups: the ossicle group (26 ankles, 35.1%) and the non-ossicle group (48 ankles, 64.9%). Then, depending on the size, the ossicle group was subdivided into small (less than 10 mm, 14 ankles) and large ossicles (greater than 10 mm, 12 ankles). Pre- and postoperative Karlsson-Peterson ankle scores and findings on stress radiographs were compared between the groups. RESULTS: Both the ossicle and non-ossicle groups improved significantly on stress radiographs without difference between the groups. Karlsson-Peterson ankle scores showed functional improvement in each group, however, the mean score at last followup was significantly lower in the ossicle group (p=0.01). The prevalence of an osteochondral lesion of the talus was significantly higher in the ossicle group (p=0.046). In ankles with large ossicles, varus stability was achieved but anterior displacement of the talus was not improved after ligament reconstruction. CONCLUSION: The surgeon should be aware of the inferior functional outcome in ankles with ossicles. Also, when the ossicle is large, excision and modified Broström technique may not be suitable to achieve mechanical anteroposterior stability. Therefore, fusing the ossicle to the fibular tip or using other methods of ligament reconstruction can be considered when performing ligament reconstruction in CLAI with associated large ossicles.