No abstract

Between January 1, 2011, and January 1, 2017, an orthopaedic foot and ankle surgeon performed tibiotalar arthrodesis on 221 patients. Thirty-two were included in this study. Inclusion criteria included patients with at least one risk factor for nonunion and/or malunion, isolated anterior ankle arthrodesis with plate fixation, patients older than 18, and a minimum of 1-year follow-up. Risk factors were avascular necrosis of the talus, severe segmental bone defect, smoking, inflammatory arthropathy, coronal deformity greater than 15°, diabetes mellitus, septic nonunion, failed ankle arthrodesis, and body mass index greater than 35. Functional outcome questionnaires (Ankle Osteoarthritis Score [AOS] and Foot Function Index [FFI]) were collected at the latest visit or by phone. Twenty-six (26/32, 81.2%) patients included in the study had computed tomography images available for review at an average of 3.2 months after surgery. The rate of successful arthrodesis was 93.8% (30/32) at an average of 78 days. Overall, 14 patients (14/32, 43.8%) developed a postoperative complication, including 1 patient that had a delayed nonunion and 2 patients that proceeded to nonunion. Twenty-three patients (23/32, 71.9%) completed the functional outcome questionnaires at an average of 26.8 months. Mean AOS and FFI scores improved significantly postoperatively ( P < .001). Sagittal tibiotalar and coronal tibiotalar alignment improved significantly in patients with severe preoperative deformity ( P < .001). Tibiotalar arthrodesis with anterior plate fixation in a high-risk cohort results in high union rates and significantly improved functional outcomes. Levels of Evidence: Therapeutic, Level IV: Prospective, comparative trial.

Background: Screw head prominence in the heel following fixation for calcaneal osteotomy or subtalar arthrodesis has resulted in high rates of symptomatic hardware and screw removal. A cost analysis was performed to determine the financial implications of screw removal. Furthermore, we compared the rate of nonunion following fixation. Methods: Current Procedural Terminology codes were used to identify all patients who had a subtalar arthrodesis or calcaneal osteotomy (with screw fixation) performed between 2010 and 2016. The cohort was divided into 2 groups: 7.0-mm headless screw or 6.7-mm headed screw. The primary outcome measure was the rate of symptomatic screw removal. Secondary outcomes included the rate of nonunion. The expense associated with symptomatic hardware removal was determined by cost analysis. Results: Seventy-six patients underwent headless screw fixation, and 2 patients (2.6%) required screw removal. Fifty-four patients underwent headed screw fixation and 12 patients (22.2%) required screw removal. Symptomatic hardware removal was performed more frequently in the headed screw group ( P < .001). There was no difference in the rate of nonunion after subtalar arthrodesis between the 2 groups ( P = .363). The calcaneal osteotomy united in 100% of patients. There was a $51 755 cost savings per 100 cases using headless screw fixation. Conclusion: The rate of symptomatic screw removal was lower with headless screw fixation. The calcaneal osteotomy healed in 100% of patients, and there was no difference in the rate of subtalar nonunion between the 2 groups. Cost analysis demonstrated a significant benefit when the expense of hardware removal was considered. Level of Evidence: Level III, retrospective cohort study.

Category: Sports; Ankle; Arthroscopy Introduction/Purpose: The modified Brostrom (MB) procedure has long been the mainstay for the treatment of chronic lateral ankle instability (CLAI) despite concerns about the strength of the repair. Recently, the InternalBraceTM (IB) has emerged as augmentation for this repair. The clinical benefit of such augmentation has yet to be established. The purpose of this study is to determine whether or not IB augmentation provides an advantage over the traditional MB. The preliminary results of this study are presented. Methods: Patients were identified for inclusion in the study based on indications for primary lateral ligament reconstruction for CLAI, age over 18, and able to provide informed consent. Exclusion criteria included pregnancy, cognitive disability, concomitant bony correction, inadequate soft tissue for MB, or prior ankle surgery affecting the lateral ligament complex. Preliminary outcome measures included complication rates, ability to participate in an accelerated rehabilitation protocol, and time to return to pre- injury level of activity. Complications were identified during post-operative clinical evaluations. Conversion from accelerated to traditional rehabilitation protocol was determined by patient’s self-reported ability to participate or VAS >= 5 per the physical therapist. Patients were contacted every 2 weeks from 6 to 26 weeks post-operatively to determine return to pre-injury level of activity. Results: 119 patients with CLAI who met criteria were enrolled in the study and randomized to the MB (59 patients) or IB (60 patients) treatment arm. At six months 11 patients (18.6%) of the MB arm and 4 patients (6.7%) of the IB arm were lost to follow up. 6/48 patients in the MB group and 2/56 patients in the IB group had not returned to preinjury activity level (p =.115). The complication rate was 8.5% in the MB group versus 1.7% in the IB Group. 4 patients in the MB group failed to complete the accelerated rehabilitation protocol versus 1 in the IB group. Average time to return to pre-injury level of activity was 17.6 weeks after MB and 13.2 weeks after IB (p<0.001). Conclusion: Preliminary results from this multicenter, prospective, randomized trial suggest that IB augmentation allows for faster return to pre-injury level of activity than MB alone. IB augmentation may support successful accelerated rehabilitation. IB augmentation did not add any additional risk of post-operative complication. Further areas of investigation include longer-term follow up and patient reported outcome scores.