Arthroscopic versus open ankle arthrodesis: a multicenter comparative case series.

BACKGROUND: Ankle arthrodesis results in measurable improvements in terms of pain and function in patients with end-stage ankle arthritis. Arthroscopic ankle arthrodesis has gained increasing popularity, with reports of shorter hospital stays, shorter time to solid fusion, and equivalent union rates when compared with open arthrodesis. However, there remains a lack of high-quality prospective data. METHODS: We evaluated the results of open and arthroscopic ankle arthrodesis in a comparative case series of patients who were managed at two institutions and followed for two years. The primary outcome was the Ankle Osteoarthritis Scale score, and secondary outcomes included the Short Form-36 physical and mental component scores, the length of hospital stay, and radiographic alignment. There were thirty patients in each group. RESULTS: Both groups showed significant improvement in the Ankle Osteoarthritis Scale score and the Short Form-36 physical component score at one and two years. There was significantly greater improvement in the Ankle Osteoarthritis Scale score at one year and two years and shorter hospital stay in the arthroscopic arthrodesis group. Complications, surgical time, and radiographic alignment were similar between the two groups. CONCLUSIONS: Open and arthroscopic ankle arthrodesis were associated with significant improvement in terms of pain and function as measured with the Ankle Osteoarthritis Scale score. Arthroscopic arthrodesis resulted in a shorter hospital stay and showed better outcomes at one and two years.

The postoperative COFAS end-stage ankle arthritis classification system: interobserver and intraobserver reliability.

End-stage ankle arthritis is operatively treated with numerous designs of total ankle replacement and different techniques for ankle fusion. For superior comparison of these procedures, outcome research requires a classification system to stratify patients appropriately. A postoperative 4-type classification system was designed by 6 fellowship-trained foot and ankle surgeons. Four surgeons reviewed blinded patient profiles and radiographs on 2 occasions to determine the interobserver and intraobserver reliability of the classification. Excellent interobserver reliability (κ = .89) and intraobserver reproducibility (κ = .87) were demonstrated for the postoperative classification system. In conclusion, the postoperative Canadian Orthopaedic Foot and Ankle Society (COFAS) end-stage ankle arthritis classification system appears to be a valid tool to evaluate the outcome of patients operated for end-stage ankle arthritis.

Inter- and intraobserver reliability of the COFAS end-stage ankle arthritis classification system.

BACKGROUND: End-stage ankle arthritis should have an appropriate classification to assist surgeons in the management of end-stage ankle arthritis. Outcomes research also requires a classification system to stratify patients appropriately. MATERIALS AND METHODS: Six fellowship trained foot and ankle surgeons met on two occasions to derive a classification system for end-stage ankle arthritis. A four-part classification system was designed. Four surgeons reviewed blinded patient profiles and radiographs on two occasions to determine the inter- and intraobserver reliability. RESULTS: Good interobserver reliability (kappa = 0.62) and intraobserver reproducibility (kappa = 0.72) was demonstrated for the classification system. CONCLUSION: The COFAS classification system appears to be a valid tool for the management and research of end-stage ankle arthritis.

Patients undergoing stabilization surgery for recurrent, traumatic anterior shoulder instability commonly have restricted passive external rotation.

An important component in the surgical treatment of recurrent anterior shoulder dislocations is the Bankart repair. This is often supplemented with ligament plication for perceived laxity. The glenohumeral ligaments define translational laxity and restrict glenohumeral range of motion. The purpose of this study was to measure the external rotation (ER) range of motion of patients under anesthesia for glenohumeral stabilization surgery. A blinded observer measured bilateral shoulder ER in 15 patients by use of a standardized torque and goniometry. ER in the unstable shoulder with the arm abducted 90 degrees averaged 14 degrees less than that in the uninjured shoulder, and this was statistically significant. There was a significant loss of 11 degrees ER in the unstable shoulder with the arm at the side. The findings indicate that the glenohumeral joint in patients with a Bankart lesion is commonly rotationally stiff.