s u m m a r yObjective: To determine if individuals with chronic ankle instability (CAI) demonstrate different talar cartilage T1r relaxation times compared to uninjured controls. Design: Fifteen CAI (21.13 ± 1.81 years, 4.00 ± 2.07 previous ankle sprains) and fifteen controls (21.07 ± 2.55 years, no previous ankle sprains) participated. CAI inclusion criteria was in accordance with the International Ankle Consortium guidelines. Greater T1r relaxation times were interpreted as greater degenerative changes. Participants were non-weight bearing for 30-minutes prior to scanning to unload the cartilage. Voxel by voxel T1r relaxation times were calculated from a five image sequence. Segmentation of the talar cartilage was performed manually using ITK-SNAP software. T1r relaxation time means and variability across the entire talus and in the anteromeidal, anterolateral, posteromedial, and posterolateral regions of interest (ROIs) were compared between groups using mean differences and effect sizes (ES) with their corresponding 95% confidence intervals (95%CI). Results: Individuals with CAI demonstrated higher T1r relaxation times (mean ± standard deviation) across the entire talus (CAI: 65.97 ± 10.45 ms, Control: 58.84 ± 7.68 ms; ES ¼ 0.76, 95%CI ¼ 0.02e1.50), in the anterolateral (ES ¼ 1.00, 95%CI ¼ 0.24e1.48), posteromedial (ES ¼ 0.74, 95%CI ¼ 0.01e1.49), and posterolateral region of interest (ES ¼ 3.84, 95%CI ¼ 2.63e5.04). The T1r relaxation time variability (mean ± standard deviation) also differed across the overall talus (CAI: 32.78 ± 4.06 ms, Control: 28.23 ± 4.45 ms; ES ¼ 1.04, 95%CI ¼ 0.28e1.80), in the anteriolateral, (ES ¼ 1.07, 95%CI ¼ 0.31, 1.84) and posteriolateral (ES ¼ 1.00, 95%CI ¼ 0.24e1.75) ROIs. Conclusions: Individuals with CAI demonstrate greater T1r relaxation times and higher T1r variability compared to uninjured controls. This finding supports the existing literature illustrating early degenerative joint tissue changes consistent with early onset posttraumatic osteoarthritis in individuals with CAI.

Objective The primary aim was to determine differences in talocrural and subtalar joint (STJ) articular cartilage composition, using T1ρ magnetic resonance imaging (MRI) relaxation times, between limbs in individuals with unilateral chronic ankle instability (CAI) and compare with an uninjured control. Our secondary purpose was to determine the association between talocrural and STJ composition in limbs with and without CAI. Design T1ρ MRI relaxation times were collected on 15 CAI (11 females, 21.13 ± 1.81 years, body mass index [BMI] = 23.96 ± 2.74 kg/m2) and 15 uninjured control individuals (11 females, 21.07 ± 2.55 years, BMI = 24.59 ± 3.44 kg/m2). Talocrural cartilage was segmented manually to identify the overall talar dome. The SJT cartilage was segmented manually to identify the anterior, medial, and posterior regions of interest consistent with STJ anatomical articulations. For each segmented area, a T1ρ relaxation time mean and variability value was calculated. Greater T1ρ relaxation times were interpreted as decreased proteoglycan content. Results Individuals with CAI demonstrated a higher involved limb talocrural T1ρ mean and variability relative to their contralateral limb ( P < 0.05) and the healthy control limb ( P < 0.05). The CAI-involved limb also had a higher posterior STJ T1ρ mean relative to the healthy control limb ( P < 0.05). In healthy controls ( P < 0.05), but not the CAI-involved or contralateral limbs (p>0.05), talocrural and posterior STJ composition measures were positively associated. Conclusions Individuals with CAI have lower proteoglycan content in both the talocrural and posterior STJ in their involved limbs relative to the contralateral and a healthy control limb. Cartilage composition findings may be consistent with the early development of posttraumatic osteoarthritis.

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Background: Percutaneous repair of acute Achilles tendon rupture (ATR) continues to gain in popularity. The primary aim of the study was to review the outcomes of a patient cohort undergoing a novel technique of endoscopic percutaneous Achilles tendon repair with absorbable suture. A secondary purpose of this study was to evaluate the basic biomechanical properties of the technique. Methods: A cohort of 30 patients who underwent percutaneous ATR repair was retrospectively analyzed with Achilles Tendon Rupture Scores (ATRS), complications, and additional outcome measures. For a biomechanical analysis portion of the study, 12 cadaveric specimens were paired and randomized to either novel percutaneous repair or open Kessler repair with absorbable suture. These specimens were subjected to 2 phases of cyclical testing (100 cycles 10-43 N followed by 200 cycles 10-86 N) and ultimate strength testing. Results: In the clinical portion of the study we report excellent patient reported outcomes (mean ATRS 94.1), high level of return to sport, and high patient satisfaction. One partial re-rupture was reported but with no major wound or neurologic complications. In the biomechanical portion of the study we found no significant difference in tendon gapping between percutaneous and open repairs in phase 1 of testing. In phase 2, increased gapping occurred between percutaneous (17.8 mm [range 10.7-24.1, SD 6.4]) and open repairs (10.8 mm [range 7.6-14.9, SD 2.7, P = .037]). The ultimate load at failure was not statistically different between the 2 repairs. Conclusions: A percutaneous ATR repair technique using endoscopic assistance and absorbable suture demonstrated low complications and good outcomes in a cohort of patients, with high satisfaction, and excellent functional outcomes including high rates of return to sport. Cadaveric biomechanical testing demonstrated excellent survival during testing and minimal increase in gapping compared with open repair technique, representing sufficient strength to withstand forces seen in early rehabilitation. A percutaneous Achilles tendon repair technique with absorbable suture may minimize risks associated with operative repair while still maintaining the benefit of operative repair. Level of Evidence: Level IV, retrospective case series.

Category: Arthroscopy, Sports, Trauma Introduction/Purpose: Achilles tendon rupture treatment includes non-operative, minimally invasive, and open repair techniques. Clinical outcomes of a cohort of patients undergoing a percutaneous endoscopically assisted technique (PEAT) were compared to those of a cohort of non-operatively treated Achilles tendon ruptures. The PEAT repair technique described is a novel method which avoids a proximal lateral incision. We sought to determine clinical outcomes from a cohort undergoing this procedure as well as its basic biomechanical properties. Methods: Clinical: With IRB approval a cohort of operatively treated patients was assessed with the following PROs: Return to sport, VAS pain score, Satisfaction Likert, patient reported complications, single heel lift, patient reported medical & smoking history, ATRS (Achilles Tendon Rupture Score). Chart review of diagnostic modality, injury mechanism, time to surgery, tourniquet times, and surgeon reported complications were also collected. Biomechanical: 6 pairs (12) of age and sex matched fresh frozen lower extremity specimens (mid tibia to toes) with average age 71.5 (48-89) (8 F specimens, 4 M specimens) underwent either open (Kessler) repair or percutaneous repair. Specimens were cycled 10N-43 N for 100 cycles, and 20N-86 N for 200 cycles, measuring displacement and ultimate load to failure. Results: Clinical: 30 patients operatively treated with the PEAT procedure, 22 contacted by phone. Avg. follow up 2.5 years (1.2- 3.8); Avg ATRS 94.1 (81-100, SD 4.8); “very satisfied” 19/20; Avg VAS 0.3. We had a re-rupture rate of 3.33% (1/30). Biomechanical data: At 10-43 N for 100 cycles, all 12 specimens survived for duration of testing with biomechanical equivalence. At 20-86 N for 200 cycles, percutaneous repairs with greater cyclical displacement (1.7 cm vs 1.0 cm); 1/6 percutaneous with early failure; 11/12 specimens survived. Conclusion: The PEAT repair of Achilles tendon rupture showed excellent clinical outcomes with low complications and with biomechanical testing suggesting equivalent strength at low loads.