Validation of the Foot and Ankle Outcome Score in adult acquired flatfoot deformity.

INTRODUCTION: The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score has been under recent scrutiny. The Foot and Ankle Outcome Score (FAOS) is an alternative subjective survey, assessing outcomes in 5 subscales. It is validated for lateral ankle instability and hallux valgus patients. The aim of our study was to validate the FAOS for assessing outcomes in flexible adult acquired flatfoot deformity (AAFD). METHODS: Patients from the authors' institution diagnosed with flexible AAFD from 2006 to 2011 were eligible for the study. In all, 126 patients who completed the FAOS and the Short-Form 12 (SF-12) on the same visit were included in the construct validity component. Correlation was deemed moderate if the Spearman's correlation coefficient was .4 to .7. Content validity was assessed in 63 patients by a questionnaire that asked patients to rate the relevance of each FAOS question, with a score of 2 or greater considered acceptable. Reliability was measured using intraclass correlation coefficients (ICCs) in 41 patients who completed a second FAOS survey. In 49 patients, preoperative and postoperative FAOS scores were compared to determine responsiveness. RESULTS: All of the FAOS subscales demonstrated moderate correlation with 2 physical health related SF-12 domains. Mental health related domains showed poor correlation. Content validity was high for the Quality of Life (QoL; mean 2.26) and Sports/Recreation subscales (mean 2.12). All subscales exhibited very good test-retest reliability, with ICCs of .7 and above. Symptoms, QoL, pain, and daily activities (ADLs) were responsive to change in postoperative patients (P < .05). CONCLUSION: This study has validated the FAOS for AAFD with acceptable construct and content validity, reliability, and responsiveness. Given its previous validation for patients with ankle instability and hallux valgus, the additional findings in this study support its use as an alternative to less reliable outcome surveys. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Firefighters Have a Higher Incidence of Trochlear Chondral Lesions than the Normal Population.

BACKGROUND: Firefighters' knees are subjected to significant dynamic and static forces, resulting in increased knee complaints and a higher relative risk of osteoarthrosis, compared with aged-matched office workers. Firefighters wear or carry a total of 80 to 100 lbs. of gear while performing intensive physical activity. PURPOSE/QUESTION: The purpose of this study was to determine whether a central femoral trochlear lesion was observed in firefighters undergoing knee arthroscopy for other diagnoses. METHODS: A retrospective chart review of 159 knees in 146 firefighters undergoing arthroscopy for treatment of acute meniscal injury or anterior cruciate ligament reconstruction over a 14-year period was undertaken. Patient demographics, physical examination results, trochlear lesion size and grade, and firehouse type (engine vs. ladder company) and firefighter position (seniority) were recorded. Comparisons of characteristics in those with and without trochlear lesions were performed. RESULTS: The average patient age was 42.2 years (range, 27 to 64 years). Ninety-eight knees (62%) had trochlear lesions and 33 knees (51%) had matching patellar lesions. Patients with lesions were older (43.2 vs. 40.5 years). Mean trochlear lesion size was 19.5 ± 13.7 mm by 18.9 ± 12.4 mm. Lesion grade distribution was grade 1 or 2 in 24 knees (24%) and grade 3 or 4 in 67 knees (44%). Trochlear lesion presence was associated with a body mass index of over 30. Current engine company members had more advanced lesions. CONCLUSIONS: A "firefighter's trochlea" was present in the majority of firefighters undergoing knee arthroscopy. Higher age and longer tenure as a firefighter prior to surgery were associated with more advanced lesions. Firefighters working in engine companies at the time of arthroscopy were at a greater risk of developing low-grade lesions but not high-grade lesions. Firefighters move between ladder and engine companies, thus a definitive association with company type cannot be reached in this retrospective study. This lesion may reflect the increase in patellofemoral biomechanical stresses secondary to the physical demands of the occupation.

Predictors of success of corticosteroid injection for the management of rotator cuff disease.

BACKGROUND: The use of subacromial corticosteroid injection (CSI) to treat rotator cuff tendinopathy is controversial. We hypothesized that characteristics such as activity level, American Shoulder and Elbow Surgeons (ASES) score, duration of symptoms, and status of the rotator cuff may be prognostic factors for resolution of symptoms postinjection. METHODS: During a 12-month period, consecutive patients with rotator cuff disease were analyzed. Patients received subacromial CSI, oral NSAIDs, and physical therapy. Baseline ASES score, simple shoulder test, an activity scale, and demographic data were recorded. Patients who remained symptomatic and were indicated for surgery were considered failures. Patients that did not undergo surgery were reassessed after a minimum of 1 year. RESULTS: Forty-nine patients met our criteria. Follow-up was obtained for 81.6%. Sixteen cases (40%) failed conservative treatment at final follow-up (22.4 ± 11 months). CSI were successful in 76.2% of males and 45% of females (p = 0.04). Full-thickness tears were present in 8% of the patients with symptom resolution and 25% of those that failed conservative treatment (p = 0.29). No significant difference was found in age, hand dominance, duration of symptoms, or any of the scoring systems. CONCLUSION: It is difficult to predict outcomes after CSI. Our treatment strategy showed a 40% failure rate.