Use of Anatomical Landmarks in Ankle Arthroscopy to Determine Accuracy of Syndesmotic Reduction: A Cadaveric Study.

Background. The aim of this study was to determine the accuracy of ankle arthroscopy as a means for diagnosing syndesmotic reduction or malreduction and to determine anatomical landmarks for diagnosis. Methods. Six matched-pair cadavers (n = 12) with through-knee amputations were studied. Component parts of the syndesmosis and distal 10 cm of the interosseous membrane (IOM) were sectioned in each. The 12 specimens were divided into 2 groups: 6 specimens in the in-situ group fixed with suture button technique and 6 specimens in the malreduced group rigidly held with a 3.5-mm screw. Specimens were randomized to undergo diagnostic arthroscopy by 3 fellowship-trained foot and ankle orthopaedic surgeons in a blinded fashion. Surgeons were asked to determine if the syndesmosis was reduced or malreduced and provide arthroscopic measurements of their findings. Results. Of 36 arthroscopic evaluations, 34 (94%) were correctly diagnosed. Arthroscopic measurement of 3.5 mm diastasis or greater at the anterior aspect of the distal tibiofibular syndesmosis correlated with a posteriorly malreduced fibula. Arthroscopic evaluation of the Anterior inferior tibiofibular ligament (AITFL), IOM, Posterior inferior tibiofibular ligament (PITFL), lateral fibular gutter, and the tibia/fibula relationship were found to be reliable landmarks in determining syndesmotic reduction. An intraclass correlation coefficient (ICC) for interrater reliability of 1.00 was determined for each of these landmarks between 2 surgeons (P < .001). The ICCs between 2 surgeons' measurements and the computed tomography measurements were found to be 0.896 (P value < .001). Conclusions. Ankle arthroscopy is a reliable method to assess syndesmotic relationship when reduced in situ or posteriorly malreduced 10 mm. Levels of Evidence: Level V: Cadaveric.

Early Outcomes and Complications of Synthetic Cartilage Implant for Treatment of Hallux Rigidus in the United States.

BACKGROUND: The aim of this study was to determine the early outcomes and complications following the implantation of a hydrogel synthetic cartilage implant (SCI, Cartiva) for the treatment of hallux rigidus by a single surgeon. METHODS: A retrospective chart review was performed of consecutive patients who underwent treatment for hallux rigidus with an SCI between August 2016 and April 2018 by a single surgeon. Demographic information, radiographic assessment, and concomitant operative procedures performed were evaluated for all patients. Postoperatively, PROMIS physical function (PF) and pain interference (PI) scores, patient satisfaction, reoperation, conversion to arthrodesis, and need for further clinical treatment were collected. Sixty-four SCIs were implanted in 60 patients. Follow-up averaged 18.5 months (range 12-30 months). RESULTS: 14% (9/64) of patients were very satisfied, 28% (18/64) satisfied, 20% (13/64) neutral, 11% (7/64) unsatisfied, and 27% (17/64) very unsatisfied with their outcome. In addition, 45% of patients underwent additional procedures at the time of SCI, and 23% had a history of surgery on the hallux before implantation. PROMIS PF scores averaged 42 and PROMIS PI scores averaged 60. Overall, 63% completed PROMIS PI, 66% completed PROMIS PF, and 100% completed a satisfaction survey. In addition, 30% (19/64) underwent magnetic resonance imaging (MRI) postoperatively due to pain. There was a 20% reoperation rate, which included an 8% rate of conversion to arthrodesis. CONCLUSION: Synthetic cartilage implantation yielded neutral patient satisfaction, mild pain, and physical dysfunction at early follow-up. We believe patient selection and counseling regarding early postoperative limitations are important before proceeding with SCI. LEVEL OF EVIDENCE: Level IV, case series.

Distal Metatarsal Osteotomy for Moderate to Severe Hallux Valgus.

Hallux valgus is the most common disorder of the hallux and often results in pain, functional disability, and impaired gait patterns. The goals of surgical management are to correct the deformity while improving patients' pain and function. Traditional treatment of moderate to severe hallux valgus deformities consist of proximal osteotomy and/or arthrodesis given their powerful corrective ability. Despite their corrective power, proximal osteotomies are more technically demanding, have a higher rate of complications, and require a more restricted post-operative recovery. We present an alternative technique for the treatment of moderate to severe hallux valgus. With this operation, a single distal medial incision is utilized to create a chevron osteotomy and lateral release. This procedure can achieve and maintain the desired correction and outcome without the need for a protracted recovery period. LEVEL OF EVIDENCE: Level V, expert opinion.

Delayed Open Reduction Internal Fixation of Missed, Low-Energy Lisfranc Injuries.

BACKGROUND: The aim of this study was to determine the outcome of delayed presentation (at least 6 weeks from the time of injury) of low-energy Lisfranc injuries limited to the first and second tarsometatarsal joints treated with open reduction internal fixation. METHODS: 8 patients with an average age at surgery of 39.8 years were retrospectively reviewed with a mean time to surgery from injury of 15.1 (range of 6.3 to 31.1) weeks. We used radiographic measurements, physical examination, SF-12 scores, Foot and Ankle Ability Measure (FAAM) scores, VAS scores and return to work or sports as outcome measures. Patients were treated with an open reduction and internal fixation as opposed to a formal arthrodesis with a variety of internal fixation. All 8 patients were available for follow-up and outcome reporting at an average of 3.1 years (minimum 2.0) postoperatively. RESULTS: The mean VAS improved from 8.5 to 2.8 postoperatively. The mean postoperative physical and mental SF-12 scores were 46.8 and 57.1, respectively. The mean postoperative overall and sports FAAM scores were 75.4 and 65.9, respectively. There were no radiographic signs of a late diastasis at the Lisfranc joint. All patients including 2 workers compensation cases returned to work and all were able to return to their prior sporting activity. CONCLUSION: A delayed open reduction internal fixation of patients with missed, low-energy Lisfranc injury was performed and resulted in decreased pain. In this series, a fair to good functional outcome was observed, and the ability to return to work or previous sport was possible for all patients studied. LEVEL OF EVIDENCE: Level IV, retrospective case series.