Ankle Osteoarthritis: Etiology, Diagnostics, and Classification
This article reviews the etiology of ankle OA, and describes the onset and development of posttraumatic ankle OA, the most common form of OA in the tibiotalar joint. Various methods of clinical and radiographic assessment are described in detail. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - July 26, 2013 Category: Orthopaedics Authors: Alexej Barg, Geert I. Pagenstert, Thomas Hügle, Marcel Gloyer, Martin Wiewiorski, Heath B. Henninger, Victor Valderrabano Source Type: research

Biomechanics of Asymmetric Ankle Osteoarthritis and Its Joint-Preserving Surgery
This article provides an overview of the effects of asymmetric ankle osteoarthritis on the patients’ biomechanical and neuromuscular gait patterns in comparison to data from healthy subjects. Furthermore, data from gait analyses after joint-preserving realignment surgery are presented that give an indication of the biomechanical and neuromuscular adaptations to supramalleolar osteotomies. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - July 26, 2013 Category: Orthopaedics Authors: Corina Nüesch, Alexej Barg, Geert I. Pagenstert, Victor Valderrabano Source Type: research

Ankle Osteoarthritis: Etiology, Diagnostics, and Classification
This article reviews the etiology of ankle OA, and describes the onset and development of posttraumatic ankle OA, the most common form of OA in the tibiotalar joint. Various methods of clinical and radiographic assessment are described in detail. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - July 26, 2013 Category: Orthopaedics Authors: Alexej Barg, Geert I. Pagenstert, Thomas Hügle, Marcel Gloyer, Martin Wiewiorski, Heath B. Henninger, Victor Valderrabano Source Type: research

Is There Any Value to Arthroscopic Debridement of Ankle Osteoarthritis and Impingement?
This article summarizes the current literature regarding the use of arthroscopy for the various types of ankle osteoarthritis with impingement symptoms. Discussion includes the role of diagnostic arthroscopy and adjunctive use of arthroscopy with other modalities. The section on the authors’ preferred technique describes our current operative and perioperative strategies in detail. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - July 22, 2013 Category: Orthopaedics Authors: Phinit Phisitkul, Joshua N. Tennant, Annunziato Amendola Source Type: research

Joint-Preserving Surgery of Ankle Osteoarthritis
In the last decades, substantial advances in understanding the ankle joint anatomy and biomechanics as well as the pathogenesis of ankle osteoarthritis (OA) have led to new approaches in the treatment of ankle OA. While joint-wide end-stage ankle OA is typically treated by total ankle arthroplasty or ankle arthrodesis (ie, joint-sacrificing surgeries), asymmetric degenerative ankle OA can be treated by joint-preserving surgery (ie, by osteotomies together with possible osteochondral repair, ligament and tendon reconstructions, and others). (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - July 19, 2013 Category: Orthopaedics Authors: Victor Valderrabano Source Type: research

Index
(Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - May 25, 2013 Category: Orthopaedics Source Type: research

Association of Lower Limb Injury with Boot Cleat Design and Playing Surface in Elite Soccer
Reducing external injury risk factors associated with the boot-surface interaction is important in reducing the incidence and severity of foot and ankle injury. A review of prospective football (soccer) injury epidemiology studies determined that the incidence of noncontact ankle sprain injury is relatively high. Research on the impact of cleat shape and configuration and boot design on the boot-surface interaction is providing new understanding of the impact on player biomechanics and injury risk but is not keeping pace with commercial advances in boot design and innovation in natural and synthetic turf surface technology...
Source: Foot and Ankle Clinics - May 25, 2013 Category: Orthopaedics Authors: Anne-Marie O’Connor, Iain T. James Source Type: research

Phases of Rehabilitation
Rehabilitation is easy to do badly and difficult to do well. Many people are involved in the process, and must act as a team to support the patient with good communication and teamwork. The whole process can be satisfying to all concerned when dealing with motivated and enthusiastic patients. Measuring the process is achievable and gives credibility and support to the initial hypothesis of the individual’s rehabilitation program. Rehabilitation involves creativity using science and art, with the end result being the patient’s return to a normal life or ability to excel within their sport. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - May 25, 2013 Category: Orthopaedics Authors: Bryan English Source Type: research

Stress Fractures of the Tibia and Medial Malleolus
Tibial diaphyseal stress fractures are rare in the general population, but are more frequently seen in the athletic and military communities. The diagnosis of this problem may be problematic and needs to be considered in all athletes and military recruits who present with shin or ankle pain. The female triad in athletes (low-energy availability/disordered eating, amenorrhea, and osteoporosis/osteopenia) should be considered in those women who sustain this injury. Management is usually conservative with a variety of rehabilitation programs suggested, but a pragmatic approach is to manage the patient symptomatically. (Source...
Source: Foot and Ankle Clinics - May 25, 2013 Category: Orthopaedics Authors: Benjamin C. Caesar, Graham A. McCollum, Robin Elliot, Andy Williams, James D.F. Calder Source Type: research

Posterior Ankle Impingement in Dancers and Athletes
The diagnosis of posterior ankle impingement requires an accurate history and specific examination. Computed tomography is a useful investigation to diagnose bony impingement, especially where plain radiography and/or magnetic resonance imaging are sometimes inconclusive. Accurate ultrasound-guided steroid/anesthetic injections are useful interventions to locate the symptomatic lesions and reduce symptoms and occasionally prove curative. If surgical debridement or excision is deemed necessary, arthroscopic surgery via a posterior approach is recommended to excise impingement lesions with a quicker return to sport expected ...
Source: Foot and Ankle Clinics - May 25, 2013 Category: Orthopaedics Authors: Andrew J. Roche, James D.F. Calder, R. Lloyd Williams Source Type: research

Tibialis Posterior Tendon and Deltoid and Spring Ligament Injuries in the Elite Athlete
The tibialis posterior tendon and the spring and deltoid ligament complexes combine to provide dynamic and passive stabilization on the medial side of the ankle and hindfoot. Some of the injuries will involve acute injury to previous healthy structures, but many will develop insidiously. The clinician must be aware of new treatment strategies and the level of accompanying scientific evidence regarding injuries sustained by athletes in these areas, while acknowledging that more traditional management applied to nonathletic patients is still likely to be appropriate in the setting of treatment for elite athletes. (Source: Fo...
Source: Foot and Ankle Clinics - May 25, 2013 Category: Orthopaedics Authors: William John Ribbans, Ajit Garde Source Type: research

Fifth Metatarsal Fractures in the Athlete: Evidence for Management
Shortest time to union, and to return to sporting activity, are the goals of management of fifth metatarsal fractures in the athlete. Whereas zone 1 injuries are largely treated conservatively, zone 2 and 3 injuries are best treated with surgical fixation in athletes, most commonly with intramedullary screw fixation. Fixation with the addition of bone graft has also yielded good results. In the chronic setting, good results have been shown with intramedullary screw fixation, surgical debridement and bone grafting alone, and tension band wiring. Shock wave therapy and pulsed electromagnetic fields may have a place in c...
Source: Foot and Ankle Clinics - May 25, 2013 Category: Orthopaedics Authors: Gowreeson Thevendran, Rupinderbir Singh Deol, James D.F. Calder Source Type: research

Management of Syndesmosis Injuries in the Elite Athlete
This article reviews the basics and evidence base thus far on syndesmosis injuries, focusing on its management in the elite sporting population. A syndesmosis injury or “high ankle sprain” is a significant injury, especially in the elite athlete. Among all ankle sprains, the syndesmotic injury is most predictive of persistent symptoms in the athletic population. Late diagnosis of unstable syndesmosis injuries leads to a poor outcome and delayed return to sports. A high index of suspicion and an understanding of the mechanism of injury is required to ensure an early diagnosis. Incomplete/inaccurate reduction lea...
Source: Foot and Ankle Clinics - May 25, 2013 Category: Orthopaedics Authors: May Fong Mak, Louise Gartner, Christopher J. Pearce Source Type: research

Forthcoming Issues
(Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - May 25, 2013 Category: Orthopaedics Source Type: research

Contents
(Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - May 25, 2013 Category: Orthopaedics Source Type: research

Contributors
(Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - May 25, 2013 Category: Orthopaedics Source Type: research

Acute Achilles Tendon Rupture in Athletes
The incidence of AT rupture has increased in recent decades. AT ruptures frequently occur in the third or fourth decade of life in sedentary individuals who play sport occasionally. Ruptures also occur in elite athletes. Clinical examination must be followed by imaging. Conservative management and early mobilization can achieve excellent results, but the rerupture rate is not acceptable for the management of young, active, or athletic individuals. Open surgery is the most common option for AT ruptures, but there are risks of superficial skin breakdown and wound problems. These problems can be prevented with percutaneous re...
Source: Foot and Ankle Clinics - March 25, 2013 Category: Orthopaedics Authors: Umile Giuseppe Longo, Stefano Petrillo, Nicola Maffulli, Vincenzo Denaro Source Type: research

Treatment of Recurring Peroneal Tendon Subluxation in Athletes: Endoscopic Repair of the Retinaculum
Traumatic peroneal tendon subluxation is a rare lesion that occurs most frequently during sporting activities and generally after an ankle sprain. There is consensus regarding the need for surgical stabilization in symptomatic patients, but there is also a general agreement that acute subluxation or dislocations may require surgery in the athlete. Many surgical techniques have been described to treat this lesion. Overall, studies have reported excellent or good results in 90% of cases, although there have been reports of significant complications following open surgical procedures. Endoscopic anatomical retinacular repair ...
Source: Foot and Ankle Clinics - March 25, 2013 Category: Orthopaedics Authors: Stephane Guillo, James D.F. Calder Source Type: research

Preface
Professional athletes may suffer the same injuries as the rest of us mere mortals but the approach taken to ensure that they return to full fitness in a timely manner may be very different. For some injuries, earlier surgical intervention may enable the strength and conditioning staff to maintain overall fitness during the healing process, while for others, specific rehabilitation techniques may safely shave weeks from their return to a sport program, allowing the player to participate in that “crunch” end-of-season match. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 25, 2013 Category: Orthopaedics Authors: James D.F. Calder Source Type: research

Lisfranc Injury in the Athlete: Evidence Supporting Management from Sprain to Fracture Dislocation
Although Lisfranc injuries are uncommon, prompt and accurate diagnosis of such injuries in athletes is essential in preventing career-ending injury. Undisplaced injuries have an excellent result with nonoperative treatment. The presence of any displacement warrants open reduction and anatomic fixation; although current evidence mostly supports screw fixation, plate fixation may avoid joint intrusion. It is imperative to warn athletes with significantly displaced injuries that there is a risk of a poor outcome, although some recent evidence suggests that return to elite competitive sports is still likely after surgical inte...
Source: Foot and Ankle Clinics - March 20, 2013 Category: Orthopaedics Authors: Kyriacos I. Eleftheriou, Peter F. Rosenfeld Source Type: research

Acute Lateral Ankle Ligament Ruptures in the Athlete: The Role of Surgery
This article reviews the treatment of acute lateral ankle ruptures in athletes, with special emphasis on the role of surgical treatment. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 20, 2013 Category: Orthopaedics Authors: Gino M.M.J. Kerkhoffs, C. Niek Van Dijk Source Type: research

The Role of Ankle Arthroscopy in Acute Ankle Injuries of the Athlete
This article discusses the role of ankle arthroscopy in the acute management of ankle trauma in athletes. The rate of intra-articular pathology associated with ankle trauma is high and arthroscopic treatment often has an important role to play. Its major role is in the assessment and treatment of joint surface damage, syndesmotic instability, and intra-articular fractures. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 20, 2013 Category: Orthopaedics Authors: Steve Hepple, Abhijit Guha Source Type: research

Index
(Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 1, 2013 Category: Orthopaedics Source Type: research

Autologous Matrix-induced Chondrogenesis in Osteochondral Lesions of the Talus
This article presents a new surgical technique suitable for treatment osteochondral lesions that combines bone plasty and a collagen matrix. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 1, 2013 Category: Orthopaedics Authors: Martin Wiewiorski, Alexej Barg, Victor Valderrabano Source Type: research

Cell Cultured Chondrocyte Implantation and Scaffold Techniques for Osteochondral Talar Lesions
Cell cultured techniques have gained interest and popularity in osteochondral defects because, unlike bone marrow stimulation methods, where fibrocartilage fills the defect, they allow for the regeneration of “hyaline-like cartilage” with better stiffness, resilience, and wear characteristics. Osteochondral defects in the ankle are a rare but challenging problem to treat in young active patients. If left alone, they can cause pain and reduced function and risk progressive degenerative changes in the joint. Clinical results of cell cultured and scaffold technology in the ankle, although still limited by small st...
Source: Foot and Ankle Clinics - March 1, 2013 Category: Orthopaedics Authors: Ben Johnson, Caroline Lever, Sally Roberts, James Richardson, Helen McCarthy, Paul Harrison, Patrick Laing, Nilesh Makwana Source Type: research

Managing the Cystic Osteochondral Defect: Allograft or Autograft
Osteochondral lesions of the talus are generally benign, and many heal or are not symptomatic. A subset of these defects progress to large cystic lesions, which have a less favorable prognosis. The treatment options are joint preservation or sacrifice. Joint salvage entails marrow stimulation techniques or hyaline cartilage replacement with allograft or autograft. When lesions reach greater than 3 cm2 or Raikin class IV or become uncontained on the shoulders of the talus, autografting techniques become more challenging. Osteochondral allografting may be a better surgical option, often achievable without a malleolar osteoto...
Source: Foot and Ankle Clinics - March 1, 2013 Category: Orthopaedics Authors: Graham A. McCollum, Mark S. Myerson, Jacques Jonck Source Type: research

Why Allograft Reconstruction for Osteochondral Lesion of the Talus? The Osteochondral Autograft Transfer System Seemed to Work Quite Well
This article focuses on the efficacy and determination of the most appropriate graft reconstruction: allograft reconstruction or OATS. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 1, 2013 Category: Orthopaedics Authors: Anish R. Kadakia, Norman Espinosa Source Type: research

Particulated Juvenile Articular Cartilage Allograft Transplantation for Osteochondral Lesions of the Talus
This article reviews the DeNovo NT graft, its usage, and surgical technique. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 1, 2013 Category: Orthopaedics Authors: Rebecca Cerrato Source Type: research

Osteochondral Lesion of the Talus: Prognostic Factors Affecting the Clinical Outcome After Arthroscopic Marrow Stimulation Technique
The treatment of symptomatic osteochondral lesions of the talus (OLT) has difficulties and limitations caused by the poor regeneration of articular cartilage and the limited access to the ankle joint. It is important that the surgeon understand the causes of failure as well as the factors influencing the results of arthroscopic treatment of OLTs. The presence of such a risk factor may encourage surgeons to find new treatment strategies as well as counsel patients differently. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 1, 2013 Category: Orthopaedics Authors: Woo Jin Choi, Joon Jo, Jin Woo Lee Source Type: research

Osteochondral Lesions of the Talus: Defining the Surgical Approach
It has become clear that contrary to the previously held belief that osteochondral lesions of the talus occurred anterolaterally and posteromedially, there is a much wider spread across the talus. Lesions can now be mapped by their biology and geography, and from this the ideal procedure and the ideal surgical approach can be selected. Familiarization with a range of skills, such as posterior ankle arthroscopy and malleolar osteotomies, are required to be able to perform this surgical plan. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 1, 2013 Category: Orthopaedics Authors: Navin Verghese, Amy Morgan, Anthony Perera Source Type: research

Talus Osteochondral Bruises and Defects: Diagnosis and Differentiation
Acute bone bruises of the talus after ankle injury need to be managed differently from osteochondral defects. Bone bruises have a benign course, but there may be persistent edema. A bone bruise should not delay rehabilitation unless symptoms persist or significant edema is close to the subchondral plate. Osteochondral defects have a less predictable prognosis, and rehabilitation should aim at promoting healing of the subchondral fracture. A period of nonweight bearing reduces the cyclical pressure load through the fissure and promotes healing. Surgery should be reserved for chronic symptomatic lesions or for those patients...
Source: Foot and Ankle Clinics - March 1, 2013 Category: Orthopaedics Authors: Graham A. McCollum, James D.F. Calder, Umile Giuseppe Longo, Mattia Loppini, Giovanni Romeo, C. Niek van Dijk, Nicola Maffulli, Vincenzo Denaro Source Type: research

Overview of Cartilage Biology and New Trends in Cartilage Stimulation
This article reviews the basics of articular cartilage biology, which provide a necessary foundation for understanding the evolving field of articular cartilage injury and repair. The currently popular treatment options for osteochondral injury (microfracture, osteochondral autograft transfer system, osteochondral allograft, autologous chondrocyte implantation, and the use of scaffolds with autologous chondrocyte implantation) document the significant advances made in this area in the past 2 decades. Integration of newly available information and technology derived from advances in molecular biology and tissue engineering ...
Source: Foot and Ankle Clinics - March 1, 2013 Category: Orthopaedics Authors: Rachel Triche, Bert R. Mandelbaum Source Type: research

Erratum
An error was made in the December 2012 issue of Foot and Ankle Clinics (Volume 17, number 4) on page 555. Two of the authors of “Total Ankle Replacement for Rheumatoid Arthritis of the Ankle” were listed incorrectly. The correct author names are Sean Y.C. Ng and Xavier Crevoisier. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 1, 2013 Category: Orthopaedics Source Type: research

Osteochondral Lesions of the Talus
I recall when the only treatment for an osteochondral lesion of the talus was arthroscopic debridement. Try to imagine what our treatment alternatives will therefore be in another 30 years! I believe that our understanding of these lesions is still evolving and, while we really cannot predict trends in treatment, I suspect that these will be directed biologically rather than mechanically. Although the outcomes of many of our current surgical procedures are exciting, I remain skeptical about any new trendy procedure since the literature is replete with successes as well as failures of these initiatives. I frequently he...
Source: Foot and Ankle Clinics - March 1, 2013 Category: Orthopaedics Authors: Mark S. Myerson Source Type: research

Forthcoming Issues
(Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 1, 2013 Category: Orthopaedics Source Type: research

Contents
(Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 1, 2013 Category: Orthopaedics Source Type: research

Contributors
(Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - March 1, 2013 Category: Orthopaedics Source Type: research

Osteochondral Lesions of the Talus: Size, Age, and Predictors of Outcomes
In this article, our research on osteochondral lesions of the talus (OLTs) is summarized, the orthopedic literature is reviewed, and the direction of future research and treatment trends are discussed. Our research has explored the role of lesion size, significance of marrow edema, relationship of patient age, importance of lesion containment, and role of a stable cartilage lesion cap in the prognosis and outcomes of these lesions. We have identified smaller sized lesions, younger patients and contained lesions as independent predictors of success for the operative treatment of OLTs. Our data should facilitate the dev...
Source: Foot and Ankle Clinics - January 18, 2013 Category: Orthopaedics Authors: Premjit Pete S. Deol, Daniel J. Cuttica, William Bret Smith, Gregory C. Berlet Source Type: research

Salvage Arthrodesis After Failed Ankle Replacement
This article discusses how to determine whether an isolated ankle or ankle-hindfoot fusion is indicated and presents surgical techniques for filling the bone defect and achieving stable internal fixation. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - September 24, 2012 Category: Orthopaedics Authors: Mark J. Berkowitz, Roy W. Sanders, Arthur K. Walling Source Type: research