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1.
Foot Ankle Spec ; : 19386400221133410, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36330662

RESUMO

BACKGROUND: Gastrocnemius recession is a popular procedure utilized to treat chronic conditions related to isolated gastrocnemius contracture (IGC). Recent anatomical research detailing variable gastrocsoleus tendon morphology has raised important questions regarding the safety of some traditional recession procedures. Alternative gastrocnemius recession strategies may produce comparable dorsiflexion improvement results while avoiding the surgical risk related to conjoint tendon anatomical variability. METHODS: Ten matched cadaver pairs were randomized to receive either a medial gastrocnemius recession (MGR) procedure or a gastrocnemius intramuscular recession "Baumann" procedure. Postoperative dorsiflexion improvement was measured and then compared between groups. Detailed postoperative surgical dissections were performed to assess structures at risk, conjoint tendon morphology, and anatomical symmetry. RESULTS: Medial gastrocnemius recession and Baumann procedures were equally effective at producing significant increases in passive ankle dorsiflexion. No sural nerve injuries were observed. Thirty-five percent of specimens showed direct muscular fusion of at least a portion of the distal gastrocnemius muscular tissue to the adjacent soleus. CONCLUSION: The MGR procedure produced comparable dorsiflexion improvement results to the Baumann procedure in our cadaver model. Surgeons must account for certain conjoint tendon anatomical variants when surgically treating IGC as traditional recession methods risk tendo-Achilles overlengthening. LEVELS OF EVIDENCE: Level V: Cadaver Study.

2.
Foot Ankle Orthop ; 6(4): 24730114211061493, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35097485

RESUMO

BACKGROUND: Total ankle arthroplasty (TAA) is a popular and viable option for end-stage ankle arthritis. Posttraumatic arthritis is the most common etiology of ankle arthritis, which creates the additional challenge of osseus deformity. Accuracy and reproducibility in placing the implant on the mechanical axis has been shown to be paramount in all joint arthroplasty including total ankle replacement. Patient-specific preoperative navigation is a relatively new technology for TAA, and up until this past year has been based off of nonweightbearing (NWBCT) or simulated weightbearing computed tomography (WBCT). Our institution has created a protocol to use WBCT in the preoperative patient-specific navigation for TAA using the Prophecy system. The purpose of our study was to compare the accuracy and reproducibility of implant alignment and size using WBCT vs prior studies using NWBCT for the Prophecy reports. METHODS: All patients from July 2019 through October 2020 who underwent TAA were evaluated. Inclusion criteria consisted of primary TAA using patient-specific preoperative navigation who had postoperative radiographs in the 4-6-week time frame. Prophecy predictions and measurements were then compared to actual implant placement and size. RESULTS: Ten patients met our inclusion criteria of WBCT Prophecy preoperative planning using 2 different implant systems. Preoperative deformities in this cohort were small. The average postoperative coronal alignment was 0.84 degrees, range 0.19 to 2.4 degrees. Average postoperative sagittal plane deformity was 1.9 degrees, range 0.33 to 5.05 degrees. Tibial component size was properly predicted in all patients, talar component in 9 of 10. CONCLUSION: This initial report supports accuracy and reproducibility in preoperative patient-specific navigation when using WBCT for TAA with these implants. All TAAs were within the intended target of less than 5 degrees varus or valgus. LEVEL OF EVIDENCE: Level III, retrospective comparative analysis.

3.
Clin Podiatr Med Surg ; 37(3): 533-551, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32471617

RESUMO

Osteochondral lesion of the talar dome (OCLT) can be a devastating injury that affects mobility. Etiology of these lesions is debated but trauma seems the most supported etiology. Diagnosis of lesions is based on imaging. Conservative management, including weight-bearing restrictions, physical therapy, and supportive measures, often is first-line treatment. Nonsurgical modalities have mixed results and surgical measures often are necessitated for symptom relief. Surgical treatments vary in invasiveness and often are dictated by OCLT size. Studies show patient satisfaction increases substantially after having these procedures performed after failing nonsurgical measures. Results are encouraging, although thorough work-up and discussion should be undertaken.


Assuntos
Cartilagem Articular/lesões , Osteocondrite/cirurgia , Tálus/cirurgia , Adolescente , Adulto , Feminino , Humanos , Osteocondrite/etiologia , Amplitude de Movimento Articular
4.
Clin Podiatr Med Surg ; 36(2): 307-321, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30784539

RESUMO

One of the most severe complications in calcaneal fractures is a malunion. When a malunion occurs, subtalar bone block distraction arthrodesis provides restoration of calcaneal height, length, correction of varus deformity, and elimination of subtalar joint arthritis. A systematic review showed the union rate for all procedures was 95.78%. The overall complication rate was 38% for all procedures. This is the first study to categorically break down complications with statistical analysis. The data presented indicate the level of difficulty of the subtalar distraction bone block arthrodesis for calcaneal malunions and may even suggest the need for newer techniques.


Assuntos
Artrodese , Calcâneo/lesões , Fixação Interna de Fraturas , Fraturas Mal-Unidas/cirurgia , Osteogênese por Distração , Articulação Talocalcânea , Calcâneo/cirurgia , Humanos
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