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BackgroundFirst metatarsophalangeal joint (MTPJ) arthrodesis has been an effective surgical entity when indicated, but a range of severe to mild complications can occur from this procedure. Patients with diabetes mellitus have an increased risk in surgical complications, most commonly associated with soft tissue and bone healing, when compared to non-diabetic patients. The purpose of this study was to evaluate the complication rates of first MTPJ arthrodesis in diabetic patients and compare them to the existing complication rates for the procedure.MethodsA retrospective chart review was done on 76 diabetic patients, from June 2002 to August 2012. Thirty-two males and 44 females were included in the study. The authors evaluated many variables that could impact postoperative complications, including age, gender, bone graft incorporation, hemoglobin A1c, tobacco use, body mass index, peripheral neuropathy, hallux extensus, hallux interphalangeal arthritis, and rheumatoid arthritis, and compared them with the complication findings. Patient follow-up was no less than 24 months.ResultsOverall, approximately two-thirds of the patients had no complications and 35.5% of patients had at least one mild or moderate complication. Of the non-union and mal-union complications, 80 and 70% had peripheral neuropathy, respectively. One hundred percent of the patients that had mal-positions or hardware failure also had peripheral neuropathy. No severe complications were seen during follow-up. Only two of the moderate complications needed revisions, and the rest of those with moderate complications were asymptomatic.ConclusionIn conclusion, first MTPJ arthrodesis is overall an effective and beneficial procedure in patients with diabetes mellitus. Diabetic patients with peripheral neuropathy have an increased risk for mild and moderate complications.

Arthroscopy of the ankle with micro-fracture technique is one way to initially treat symptomatic talar dome lesions. Human amniotic allograft has been used in similar bone, soft tissue and cartilage defects to aid in healing of tissue using graft cells that have not differentiated into a particular cell line. Patients were taken from the primary surgeon's practice to include those who had undergone arthroscopy with micro-fracture technique for treatment of a talar dome lesion less than 2 cm 2 . 101 patient surgeries were completed arthroscopically without additional major procedures. 54 surgeries were completed with human amniotic allograft; 47 were completed without (control group). Modified ACFAS ankle scores were taken pre-operatively, 3, 12 and 24 months post-operatively. Visual analog pain scores were taken pre-operatively and 24 months post-operatively. Results comparing pre-operative modified ACFAS scores between the control and graft groups were not significantly different (p = 0.14). There was a significant improvement in both groups' scores following ankle arthroscopy with micro-fracture as expected. However, the amniotic tissue group did significantly better when comparing the post-operative scores between the control and graft group. Pain scores comparing control and amniotic patient groups were significant (p < 0.001) with amniotic allograft patients achieving a greater improvement in pain reduction than the control both early and at 24 months. There were no complications, wound dehiscence or infections recorded. Combining ankle arthroscopy/micro-fracture technique with human amniotic allograft on talar dome lesions, less than 2 cm 2 , significantly improves the patients' pain and ACFAS scores.

One of the most challenging joint conditions facing ankle surgeons today is the treatment of Osteochondritis Dissecans (OCD) of the talar dome. The use of human amniotic allograft (HAA) in various surgical procedures, has been proven to facilitate bone growth and both soft tissue and cartilage healing. The authors of this paper propose the addition of HAA to the surgical repair of talar dome lesions to improve postoperative results, specifically pain reduction. For the study, 37 patients were identified having an OCD lesion of the talus measuring no larger than 2 cm 2 . All patients were treated surgically with an arthroscopic micro-fracture repair along with the addition of HHA. Modified ACFAS ankle scores were taken pre-operatively and at 3 months, 12 months, and at 24 months postoperatively. Visual analog scores were also taken preoperative and 24 months postoperatively. The size of the talar lesions documented with pre-operative MRI's was compared with intra-operative measurements for each patient. Additional surgical repairs, comorbidities and any complications were also recorded and evaluated. All patients were treated with micro-fracture with HAA. Postoperative ACFAS scores for 3 months, 12 months and 24 months were significantly improved (p < 0.0001) compared with average preoperative scores. Additionally, VAS scores were also significantly improved when comparing the average pre-operative (4.9) and post-operative (1.1) pain scores (p < 0.0001). The size of the lesions documented by pre-operative MRI correlated to intra-operative measurements. There were no identified complications. The addition of HAA to arthroscopic micro-fracture repair of talar dome lesions measuring less than 2 cm 2 has shown to significantly improve both post-operative VAS scores, when compared to preoperative scores. This improvement in ACFAS and VAS scores speaks to the potential use of HAA in the treatment of OCD.

Background: Adult acquired flatfoot deformity is generally mediated with an Evans procedure where a wedge of bone is placed into the calcaneus to better align the foot and decrease the deformity. The purpose of this study was to assess the efficacy and safety of human amniotic allograft applied to allogeneic tri-cortical grafts in Evans calcaneal osteotomy. Methods: The medical records of patients who had Evans calcaneal osteotomy with implantation of tri-cortical iliac crest bone graft with human anmiotic allograft for surgical management of adult acquired flatfoot deformity with 2 years follow-up data were reviewed. Results: A total of 63 patients (mean age: 33.3 yr, range: 18-66 yr) were enrolled with adult acquired flatfoot deformity. Median time to weightbearing was 6 weeks. Time to wearing normal shoes was 10 weeks, and time to radiographic healing was 16 weeks. Conclusions: The use of human amniotic allograft did not diminish the long term outcome of procedure or the short term benchmarks for healing after surgery. There were no nonunion, wound dehiscence, infection, or allergic or immune reaction reported. This retrospective study demonstrated that tri-cortical iliac crest bone graft and HAA could be safely used in Evans calcaneal osteotomy with favorable results.