Revisiting the original Akin technique: A comparative analysis of radiographic outcome.

BACKGROUND: The Akin osteotomy is widely used to correct the hallux valgus and different fixation techniques have been proposed. Currently most of these procedures coexist, with disagreement on which offers the best results. The aim of this study is to compare the radiological outcome of the original Akin's technique with one in which a staple was used to stabilize the osteotomy. We also assessed whether other factors unrelated to the osteosynthesis could influence the radiological outcome. METHODS: We retrospectively reviewed data from 118 patients who underwent a scarf and Akin osteotomy. In 60 patients the Akin osteotomy was fixed with a staple and in 58 cases no staple was used. Hallux valgus angle (HVA), distal articular set angle (DASA), interphalangeal angle (IPA) and tibial sesamoid position were measured. The presence of lateral cortex disruption of the phalanx was also included in the analysis. RESULTS: Six variables significantly influenced the radiological results of the Akin osteotomy: preoperative HVA, IPA and tibial sesamoid position, laterality, postoperative cortical disruption and use of a staple. CONCLUSION: Ours results suggest that the original Akin's technique seems to offer equal or better results than a variation in which a staple is added to stabilize the osteotomy. LEVEL OF EVIDENCE: This is a level III retrospective case-control study.

Arthroscopic Flexor Halluces Longus Transfer and Percutaneous Achilles Tendon Repair for Distal Traumatic Ruptures.

The Achilles tendon is the largest and strongest tendon in the human body. It is the tendon that most often suffers injury and accounts for 20% of all tendon ruptures. These types of ruptures often occur 2 to 6 cm proximal to the stumps in an area of reduced vascularity. One such injury, the distal acute Achilles tendon rupture, is quite uncommon. For distal repairs, there have been studies that used a pullout technique, a button technique, and the use of local tendons for open-fashion augmentation. Although percutaneous repair and endoscopic flexor hallucis longus (FHL) tendon transfer techniques have been described for both acute midportion and chronic Achilles tendon rupture repair, there are no studies that describe the use of percutaneous sutures and biological augmentation with FHL transfer as a treatment option for acute distal injuries. The purpose of this Technical Note is to describe a novel approach to repair. It combines arthroscopic FHL tendon transfer with a percutaneous Achilles tendon repair technique for traumatic distal ruptures.

Two-Portal Endoscopic Plantar Fascia Release: Step-by-Step Surgical Technique.

Plantar fasciitis is a common condition of heel pain with a lifetime incidence up to 10%. For this entity, conservative treatment is considered the gold standard, involving non-steroidal anti-inflammatory drugs, stretching exercises of the plantar fascia, activity modifications, ice, and insoles. When patients do not respond to these treatments, partial or total plantar fascia release has been the mainstay of treatment, with success rates of approximately 70% to 90%. For this purpose, several techniques have been described, including open, percutaneous, and endoscopic release. The objective of this Technical Note is to describe the nonassisted 2-portal endoscopic plantar fascia release in a patient with recalcitrant plantar fasciitis.

Local Percutaneous Radiofrequency for Chronic Plantar Fasciitis.

Plantar fasciitis is the most common cause of heel pain. It accounts for 80% of the cases and has an estimated prevalence rate of up to 7% in the general population, with bilateral involvement in 20% to 30% of those patients. This condition affects people of working age, thereby limiting and diminishing their quality of life. There are a wide range of treatment options for the management of plantar fasciitis that include both conservative and surgical treatments. Although surgical treatment based on partial or total plantar fascia release has success rates of some 70% to 90%, it is not free of complications. These complications, soft-tissue healing problems, superficial infection, or longitudinal arch collapse in cases of a greater than 40% release of the fascia. Bipolar radiofrequency appears to be a safe procedure for refractory plantar fasciitis that can provide outcomes equivalent to open plantar fascia release with less morbidity. The purpose of this article is to describe the local percutaneous radiofrequency technique for patients with chronic, recalcitrant plantar fasciitis.

Retrograde Drilling With Tibial Autograft in Osteochondral Lesions of the Talar Dome.

Osteochondral lesions that compromise the ankle are rare, with an incidence between 0.02% and 1.5% according to different series. This location is the third in frequency, after knee and elbow. The location of the osteochondral lesion allows one to infer the producing mechanism. Lateral defects are produced by inversion and dorsiflexion of the ankle (usually anterior, affecting 3 and 6 talar zones), whereas medial defects are produced by plantar flexion, inversion, and internal rotation (most commonly posterior, affecting 4 and 7 talar zones). The injury causes pain associated with weight load, impaired function, limited range of motion, stiffness, blockage, and edema. Early diagnosis of an osteochondral lesion is particularly important because the lack of diagnosis can lead to the evolution of a small and stable lesion in a larger lesion or an unstable fragment, which can result in chronic pain, instability of the joint, and premature osteoarthritis. Multiple therapeutic strategies have been described, including conservative and surgical treatment. The purpose of this Technical Note is to describe arthroscopic-assisted retrograde drilling with tibial autograft procedure for osteochondral lesions of the talar dome.