Deformity Correction
Malalignment of the lower limb, distal tibia, foot, and hindfoot can all contribute to altered biomechanics in the ankle joint, resulting in increased focal pressure. The development of some osteochondral lesions of the ankle joint may share a similar pathophysiology, where eccentric loading to the talus or tibia within the ankle joint can lead to cartilage injury or adaptive changes. While the association between malalignment and the development of osteochondral lesions of the ankle joint may seem intuitive, the impact of realignment procedures on these lesions and patient symptoms remains a relatively underexplored topic...
Source: Foot and Ankle Clinics - September 16, 2023 Category: Orthopaedics Authors: Jaeyoung Kim, Woo-Chun Lee Source Type: research
Outcomes of Total Ankle Arthroplasty After Periprosthetic Cyst Curettage and Bone Grafting
Total ankle arthroplasty (TAA) has become a popular management option for ankle arthritis. Periprosthetic osteolysis is one of the most common causes for reoperation in TAA. A CT scan should be done in all suspected osteolysis cases to confirm location, quantify size and aid in surgical planning. These patients are often asymptomatic with limited evidence regarding appropriate management. Smaller lesions should be monitored for progression in size. Periprosthetic cysts measuring 10-15mm in all three axes should be considered for debridment and curettage with autogenous bone grafting. The authors believe that bone grafting ...
Source: Foot and Ankle Clinics - September 16, 2023 Category: Orthopaedics Authors: Paulo N.F. Ferrao, Nikiforos P. Saragas, Jaco J. Naude Source Type: research
Outcomes of Lateral Transfibular Approach for Total Ankle Replacement
Total ankle replacement through a lateral transfibular approach with trabecular metal implants was introduced in 2012 and originally was advertised as a safer approach in terms of wound healing issues. Further studies showed no significant difference comparing anterior and lateral approach for infections and would healing issues, whereas the main advantage is deformity correction, acting on coronal, sagittal, and rotational deformities and on fibular length issues. It showed a survival rate of 97.7% at 5 years follow-up. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - September 15, 2023 Category: Orthopaedics Authors: Federico G. Usuelli, Camilla Maccario, Cristian Indino Source Type: research
Complications in Total Ankle Replacement
The debate between ankle arthrodesis and total ankle replacement for patients with end-stage arthritis of the ankle joint is an ongoing topic in orthopedic surgery. Ankle arthrodesis, or fusion, has been the traditional treatment for ankle arthritis. It involves fusing the bones of the ankle joint together, eliminating the joint and creating a solid bony union. Arthrodesis is effective in reducing pain in the ankle, but it results in a loss of ankle motion. This can increase the load on adjacent joints, such as the subtalar joint, which may lead to accelerated degeneration and arthritis in those joints over time. (Source: ...
Source: Foot and Ankle Clinics - September 14, 2023 Category: Orthopaedics Authors: Joris P.S. Hermus Source Type: research
Results of Total Ankle Arthroplasty Versus Ankle Arthrodesis
No differences have been found between total ankle arthroplasty (TAA) and ankle arthrodesis (AA) with respect to patient-reported outcome measures (PROMs), although both interventions were shown to improve PROMs with respect to the preoperative situation. That is, both interventions (AA and TAA) were effective in improving preoperative symptoms. On the other hand, 2-year complication rates were higher after AA (27%) than after TAA (16%); however, infection rates were similar (4%). The published revision rate after AA is 16% versus 11% after TAA. In short, TAA and AA appear to offer the same PROMs, but TAA has a lower rate ...
Source: Foot and Ankle Clinics - September 14, 2023 Category: Orthopaedics Authors: Emerito Carlos Rodriguez-Merchan, Inmaculada Moracia-Ochagavia Source Type: research
Fresh Osteochondral Allograft for Large Talar Osteochondral Lesions
Osteochondral lesions of the talus are being recognized as an increasingly common injury. Large osteochondral lesions have significant biomechanical consequences and often require resurfacing with both boney and cartilaginous graft. The current treatment options include osteochondral autograft transfer, mosaicplasty, autologous chondrocyte implantation, or osteochondral allograft transplantation. Allograft procedures have the advantage of no donor site morbidity and ability to match the defect line to line. Careful transportation, storage, and handling of the allograft are critical to success. The failure of nonoperative m...
Source: Foot and Ankle Clinics - September 13, 2023 Category: Orthopaedics Authors: Christopher Edward Gross, Ariel Palanca Source Type: research
Outcomes of Conversion of Ankle Fusion to Total Ankle Arthroplasty
With ankle replacements gaining popularity and documented good functional outcomes, there is an increasing number of patients inquiring about the possibility of converting an ankle fusion to a replacement. This could be due to pain, limited function, or increasing adjacent joint arthritis. There is an increasing body of evidence in the literature that a conversion to a replacement is possible and that the outcomes are positive. There are also absolute contradictions for a conversion. An absent fibula, pain of unknown origin, and recent infection fall in this category. Long-term follow-up is needed to see if conversions of ...
Source: Foot and Ankle Clinics - September 13, 2023 Category: Orthopaedics Authors: Christopher Traynor, J. Chris Coetzee Source Type: research
Total Ankle Arthroplasty in Young Patients
With continuing advancements in total ankle arthroplasty (TAA), it is quickly becoming the procedure of choice for older patients with end-stage ankle arthritis. Multiple studies have been conducted on younger patients who have undergone TAA with promising results, but is it the procedure of choice? Considerations of TAA versus ankle arthrodesis, TAA implant longevity, outcomes of revision TAA, and whether patients should be offered an arthrodesis with plans for conversion to arthroplasty may help elucidate whether pursuing ankle arthroplasty in a younger, more active population is the correct approach for surgeons. (Sourc...
Source: Foot and Ankle Clinics - September 13, 2023 Category: Orthopaedics Authors: M. Pierce Ebaugh, William C. McGarvey Source Type: research
Personalized Resurfacing for Osteochondral Lesions of the Talus
This article describes a novel customized patient-specific metal inlay as a treatment option for OLTs. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - September 7, 2023 Category: Orthopaedics Authors: Federico Giuseppe Usuelli, Ben Efrima, Niek Van Dijk Source Type: research
Osteochondral Lesion of the Talus
Osteochondral lesions of the talus (OLTs) are the lesions that affect the articular cartilage and the subchondral bone of the talus. Symptoms develop between 6 and 12 months after the index trauma and are associated with degradation of quality of life. Two-thirds of the lesions (73%) are located on the medial part of the talus, 28% of the lesions are posteromedial, and 31% of the lesions are centromedial. Currently, OLT of up to 100 mm2 can behave in a more in dolent condition, and above that area, the defect tends to transmit more shearing forces to adjacent cartilage and is more symptomatic. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - August 30, 2023 Category: Orthopaedics Authors: Tania Szejnfeld Mann, Caio Nery Source Type: research
Regeneration
Osteochondral lesion of the talus (OLT) is a commune cause of chronic ankle pain. Symptomatic lesions require surgical treatment. Currently, lesions with diameter less than 107.4 mm2 are treated with bone marrow stimulating technique with notable success rate. However, more extensive lesions show less predictable surgical results. Autologous matrix-induced chondrogenesis has proven to provide satisfactory medium and long-term results on OLTs. In the current review, we describe an all-arthroscopic technique and the Milan-Tel Aviv lesion assessment protocol. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - August 30, 2023 Category: Orthopaedics Authors: Camilla Maccario, Agust ín Barbero, Cristian Indino Source Type: research
Conservative Treatment for Ankle Cartilage: Cellular and Acellular Therapies
Biological agents like growth factors (ie, platelet rich plasma) and mesenchymal stem cells are rising in popularity among orthopedics. Orthobiologics therapy aims to fill the gap between conventional conservative therapies like hyaluronic acid and surgery, especially for cartilage disease. Ankle cartilage defects are very symptomatic and could lead to a severe decrease of quality of life in patients, because of pain, swelling, and inability to walk without pain. In this scenario, this paper aims to systematically review the current literature available about biological therapies for ankle cartilage. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - August 29, 2023 Category: Orthopaedics Authors: Daniele Altomare, Berardo Di Matteo, Elizaveta Kon Source Type: research
Ankle Instability
The majority of patients with an osteochondral lesion of the talus (OLT) report a history of trauma. Therefore, it is important to assess for concomitant ankle instability when dealing with patients with a symptomatic OLT. The History; Alignment; Ligaments; Others “(HALO)” approach can be a helpful tool in the evaluation of patients with an OLT. If conservative treatment fails, surgery may be indicated. Although there is a lack of comparative studies investigating the effect of stabilization procedures on cartilage repair, we believe that addressing insta bility is a key factor in improving patient outcome. (Source: Fo...
Source: Foot and Ankle Clinics - August 26, 2023 Category: Orthopaedics Authors: Yuhan Tan, Kristian Buedts Source Type: research
Subtalar Osteochondral Lesions
Although most commonly found in the knee, elbow, and talar dome, osteochondral lesions can also be found in the subtalar joint and can occur due to either high or low energy trauma. Diagnosis of these lesions in the subtalar joint is typically confirmed with advanced imaging such as computerized tomography and MRI. Although there are a few published case reports, there is otherwise very limited literature on the prevalence, treatment options, prognosis, or outcomes for patients with osteochondral lesions of the subtalar joint, and thus further research is required in this area. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - August 23, 2023 Category: Orthopaedics Authors: Allison L. Boden, Jonathan Kaplan, Amiethab Aiyer Source Type: research
Fixation of Osteochondral Lesions of the Talus
The treatment of osteochondral lesions of the talus (OLT) remains a topic of debate as no superior treatment has yet been identified. The current consensus is that it is crucial to incorporate lesion and patient characteristics into the treatment algorithm. One such lesion type is the OLT with a fragment, which may benefit from in situ fixation. Fixation preserves the native hyaline cartilage and offers a direct stabilization of the fragment with high-quality subchondral bone repair. This current concepts review describes the evidence-based clinical work-up, indications, surgical techniques, outcomes, and clinical pearls...
Source: Foot and Ankle Clinics - August 23, 2023 Category: Orthopaedics Authors: Quinten G.H. Rikken, Gino M.M.J. Kerkhoffs Source Type: research
