Level IV, case series.

Background: The aim of the study was to evaluate the short-term clinical outcomes of arthroscopic drilling in the management of small osteochondral lesions of the talus (OLT). Methods: Thirty-two patients with small OLT (area <150 mm2 and cyst depth <7 mm as measured on CT and MRI) were treated by arthroscopic debridement and drilling. Four patients underwent simultaneous modified Broström procedures. Five patients required retrograde drilling, three because the overlying cartilage was intact and two because the lesion was posterior. Outcomes were measured using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and subjective patient satisfaction. Results: The mean age at surgery was 32±8 yr (range, 18-50 yr). There were 22 men (68.75%) and 10 women (31.25%). Four patients (12.5%) were playing sports regularly, one professionally and three recreationally. After a mean follow-up duration of 26 mo (range 12-48 mo), the mean AOFAS score improved from 71.78±11 (range 51-87) preoperatively to 91±7 (range 80-100). The results were excellent in 15 patients (46.9%), good in 12 (37.5%), fair in five(15.6%). According to the Saxena criteria 16 patients (50%) were very satisfied, nine patients (28.1%) were satisfied, six patients (18.8%) were satisfied with reservations and one patient (3.1%) was unsatisfied. Conclusions: Arthroscopic drilling for small OLT is safe and easy with results comparable to microfracture but with the advantages of deeper penetration and the ability to drill retrograde into posterior lesions or lesions with intact cartilage.

Background: Calcaneal malunion is a common complication of nonoperative management of calcaneal fracture, which leads to a disruption of the biomechanics of the lower extremity, pain, and permanent disability. Our aim was to evaluate pain, function, and gait after combined subtalar joint fusion, calcaneal osteotomy, and lateral wall exostectomy for patients with neglected calcaneal fractures with malunion. Methods: Eighteen patients with malunited calcaneal fractures, varus deformity, and subtalar arthritis were operated upon and then followed up for 18 months. All cases were assessed clinically using the American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS); radiologically by measuring the talar inclination, talocalcaneal and talus-first metatarsal angles, and talocalcaneal height; and biomechanically by measuring the stride duration, step width, comfortable speed, and ground reaction forces in relation to the body weight. Results: A significant improvement in AOFAS (59.8 preoperatively to 80.2 after 18 months) and VAS (61.1 preoperatively to 29.4) was found. Also, our study revealed a significant improvement in the radiographic measurements including the valgus angle, the talocalcaneal angle, the talocalcaneal height, and the talar inclination angle. The gait analysis found that the maximum loading force in the push-off phase and comfortable speed yielded a significant improvement postoperatively. However, no significant differences between the preoperative data and the final follow-up in terms of the step width, stride duration, maximum peak force during loading phase, and minimum peak force during midstance phase were found. Conclusion: The combination of valgus calcaneal osteotomy, lateral wall exostectomy, and subtalar fusion resulted in pain reduction, improved function, and better gait. However, the limited bone stock for the graft used in the subtalar fusion made use of this technique in severely reduced height unadvisable. Level of Evidence: Level IV, case series.

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