The majority of orthopaedic surgeons even currently agree that primary total arthroplasty in valgus knees with a deformity of more than ten degrees may prove challenging. The unique sets of bone and soft tissue abnormalities that must be addressed at the time of the operation make accurate axis restoration, component orientation and joint stability attainment a difficult task. Understanding the specific pathologic anatomic changes associated with the valgus knee is a prerequisite so as to select the proper surgical method, to optimize component position and restore soft-tissue balance. The purpose of this article is to review the valgus knee anatomical variations, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. It will also be underlying the up-to-date main approaches and surgical techniques be proposed in the English literature both for bone cuts and soft tissue management of valgus knees.

Lower extremities peripheral neuropathies caused by ganglion cysts are rare. The most frequent location of occurrence is the common peroneal nerve and its branches, at the level of the fibular neck. We report the case of a 57-year-old patient admitted with foot drop, due to an extraneural ganglion of the upper tibiofibular syndesmosis, compressing the deep branch of the peroneal nerve. Although there have been many previous reports of intraneural ganglion involvement with the lower limb nerves, to our knowledge, this is the second reported occurrence of an extraneural ganglion distinctly localized to the upper tibiofibular syndesmosis and palsying deep peroneal nerve. The diagnosis was made preoperatively using MRI. The common peroneal nerve and its branches were recognized and traced to its bifurcation during the operation, and the ganglion cyst was removed. Two months after surgery, the patient was pain-free and asymptomatic except for cutaneous anesthesia in the distribution of the deep peroneal nerve.

Background: The os trigonum (OT)—the most common accessory bone of the foot—although usually asymptomatic, may cause posterior ankle impingement syndrome (PAIS), which may be a severely debilitating problem for recreational or competitive athletes. The aim of the present study was to evaluate effectiveness of posterior ankle arthroscopy and to assess the outcome in the treatment of PAIS secondary to OT impingement or OT fractures within a group of young athletes and their return to previous sports level. Methods: From 2011 to 2018, a retrospective review of 81 recreational athletes of mean age 27.8 years was performed. All patients were diagnosed with PAIS due to OT pathology and were operated on endoscopically with resection of the OT. Pre- and postoperative clinical evaluation were performed at 3 months, 1 year, and 2 years based on visual analog scale (VAS), ankle range of motion (ROM), American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, and the Foot & Ankle Disability Index (FADI) scores, in a follow-up of at least 2 years. Results: VAS score was significantly improved from an average of 7.5 (5-9) preoperatively to 1.9 (1-3) at 3 months postoperatively and to 0.6 (0-2) and 0.3 (0 -1) at 1 and 2 years postoperatively. Ankle ROM was significantly improved from an average of 24.8 (10-35) preoperatively to 58.0 (50-65) at 3 months postoperatively and to 64.0 (50-65) at 1 year and 64.7 (60-65) at 2 years postoperatively. AOFAS and FADI scores were significantly improved from 39.4 (18-55) and 49.7 (42.3-62.5) preoperatively to 85.2 (74-89) and 87.3 (81.7-88.5) postoperatively at 3 months to 97.7 (85-100) and 97.9 (93.3-100) postoperatively at 1 year, respectively ( P < .001). Only 5 patients dropped to a lower activity level. There were 5 complications (4 transient). Conclusion: Endoscopic treatment of PAIS due to OT pathology demonstrated excellent results. Posterior ankle arthroscopy was an effective treatment and allowed for a prompt return to a high activity level of their athletic performance. Level of Evidence: Level IV, therapeutic study / retrospective case series.

is a sports medicine-specialized orthopedic surgeon and arthroscopist. He focuses on sports injuries and mainly in shoulder, hip, knee, foot, and ankle pathology. He has performed arthroscopic restoration of hip, knee, and ankle cartilage, as well as treatment and surgical correction of foot disorders. He has published 42 original scientific articles in prestigious scientific journals in the United States, Europe, and Greece referring to knee (valgus knee) and shoulder (arthroscopic and minimally invasive new techniques) surgery, osteoporotic spine and hip fractures, and research into the in vitro environment of bone and cartilage metabolism. He has more than 180 citations in research projects on valgus knee and cartilage ankle restoration. He has also presented over 180 oral and poster presentations internationally.Dr. George K. Safos (MD) specializes in orthopedic surgery and traumatology with interest in sports medicine (knee, hip, ankle, elbow, and shoulder arthroscopic surgery) as well as total hip and knee replacement surgery. As a well-published doctor, he now serves as a medical orthopedic consultant and primary doctor to various athletic teams, dance groups, as well as foreign diplomatic missions. He is a graduate of Athens University Medical School and completed his residency in orthopedic surgery and traumatology at the General Hospital of Asklepeion Voulas. He then completed two fellowships in the United States, namely at the National Institutes of Health (NIH) in Bethesda, Maryland, as well as at the University of Miami-Orthopedic Department. A postgraduate degree in Tissue Banking at the National University of Singapore with a United Nations scholarship soon followed. Dr. John Michos has been Director of the 4th Orthopaedic Department in Asklepion Voulas Hospital since 2004. He studied in Athens University Medical School and qualified as an orthopedic surgeon in 1985. He worked in UK hospitals from 1985 to 1989 and thereafter in the Asklepion Voulas Hospital in Athens. His special interest is knee surgery, including arthroplasty and ligament reconstruction surgery. He established the Sports Medicine Clinic of Asklepion Voulas Hospital. He also served as President of the Hellenic Orthopaedic Association in 2011.

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