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Kim J, Lee WC. Deformity Correction: Do Osteochondral Lesion of the Talus and Tibia Change After Realignment Surgery? Foot Ankle Clin 2024; 29:333-342. [PMID: 38679443 DOI: 10.1016/j.fcl.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Malalignment of the lower limb, distal tibia, foot, and hindfoot can all contribute to altered biomechanics in the ankle joint, resulting in increased focal pressure. The development of some osteochondral lesions of the ankle joint may share a similar pathophysiology, where eccentric loading to the talus or tibia within the ankle joint can lead to cartilage injury or adaptive changes. While the association between malalignment and the development of osteochondral lesions of the ankle joint may seem intuitive, the impact of realignment procedures on these lesions and patient symptoms remains a relatively underexplored topic in the literature. A comprehensive understanding of the potential role of realignment surgery in managing osteochondral lesions of the talus and tibia is crucial for advancing our knowledge of this challenging pathologic condition.
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Affiliation(s)
- Jaeyoung Kim
- Foot and Ankle Service, Hospital for Special Surgery, 532 East 72nd Street, New York, NY, USA
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, 45, Apgujeong-ro 30 gil, Gangnam-gu, Seoul 06022, Republic of Korea.
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Kim J, Rajan L, Gagne O, Kim JB, Lee WC. Realignment Surgery for Failed Osteochondral Autologous Transplantation in Osteochondral Lesions of the Talus Associated With Malalignment. Foot Ankle Spec 2024; 17:240-248. [PMID: 37021377 DOI: 10.1177/19386400231163030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND While osteochondral autologous transplantation (OAT) offers favorable results in most patients with osteochondral lesions of the talus (OLT), some patients continue to experience persistent pain following the procedure. Information regarding the etiology of this pain and outcomes of revision surgery are limited. This study aimed to report results of revision surgery with realignment procedures in patients with failed OAT who demonstrated concomitant malalignment at the distal tibia or hindfoot. METHODS Eight patients (8 ankles), who had been experiencing persistent pain for more than 1 year following OAT, underwent realignment procedures during revision surgery. All patients underwent primary OAT for the treatment of medial OLTs. Patients were divided into 2 groups based on the main location of deformity: the supramalleolar realignment group (SRG, 5 ankles) and the hindfoot realignment group (HRG, 3 ankles). No direct procedure was performed on the osteochondral lesion at the time of revision surgery. Ankle and hindfoot alignment were evaluated using 6 parameters in weightbearing radiographs. Computed tomography (CT) was used to assess for medial gutter narrowing, spur formation, and cyst volume around transplanted osteochondral plug preoperatively and postoperatively. Clinical outcomes were assessed using Foot Function Index and Visual Analogue Scale. RESULTS All patients had medial gutter narrowing or spur formation, which are early signs of ankle arthritis. The SRG had varus distal tibial alignment with a median medial distal tibial angle of 85.7 degrees (interquartile range [IQR], 3.2). The HRG had valgus hindfoot alignment and a lower medial longitudinal arch with a median hindfoot moment arm of 8.4 mm (IQR, 6.1) and a median Meary's angle of 11.8 degrees (IQR, 1.4). Spontaneous restoration of the osteochondral lesion was observed after realignment surgery, with cyst volume decreasing from 0.2592 to 0.0873 cm3 (P < .05). Clinical scores improved in all patients. CONCLUSION The current study demonstrates the effectiveness of realignment surgery in a selected patient group who experienced persistent pain and showed radiographic evidence of malalignment after primary OAT. Our study provides evidence supporting the use of realignment procedures in these cases, with results indicating improved patient-reported outcomes and spontaneous restoration of osteochondral lesions. LEVELS OF EVIDENCE Level IV: Case series.
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Affiliation(s)
- Jaeyoung Kim
- Hospital for Special Surgery, New York, New York
| | - Lavan Rajan
- Hospital for Special Surgery, New York, New York
| | - Oliver Gagne
- University of British Columbia, Vancouver, BC, Canada
| | - Ji-Beom Kim
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, Republic of Korea
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, Republic of Korea
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Kim J, Yi Y, Lee WC. Improvement in Clinical and Radiographic Outcomes After Isolated Realignment Surgery in Patients With Large Cystic Osteochondral Lesion of the Talar Shoulder and Concurrent Malalignment. Orthop J Sports Med 2024; 12:23259671241237126. [PMID: 38617889 PMCID: PMC11010760 DOI: 10.1177/23259671241237126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/07/2023] [Indexed: 04/16/2024] Open
Abstract
Background Malalignment has been suggested as a predisposing factor for the development of osteochondral lesions of the talus (OLTs). Purpose To evaluate the clinical and radiographic outcomes of realignment surgery in patients with a large cystic OLT of the talar shoulder and concurrent malalignment of the foot and ankle. Study Design Case series; Level of evidence, 4. Methods The authors reviewed consecutive patients with large cystic OLTs (diameter, >10 mm) of the talar shoulder and concurrent malalignment of the foot and ankle who underwent realignment surgery between September 2013 and April 2021. The type of realignment procedure was determined based on patient symptoms and findings on plain radiographs and weightbearing computed tomography. Clinical improvement was assessed using pre- and postoperative Foot Function Index (FFI) scores and the visual analog scale (VAS) for pain. The OLT location was categorized according to Raikin zone, and the OLT area and volume were measured and compared pre- and postoperatively. The comparative analysis was performed using the Wilcoxon signed-rank test. Results In total, 27 ankles in 27 patients (mean age, 34.4 ± 11.9 years) were included in the analysis. There were 25 patients with a medial lesion (zone 4 [n = 19], zone 7 [n = 5], and zone 1 [n = 1]), and 2 patients with a lateral lesion (zone 6). Despite OLT location, patients' symptoms varied; 15 (55.6%) patients reported both medial- and lateral-sided pain, 10 (37%) reported lateral-sided pain, and 2 (7%) reported medial-sided pain. Supramalleolar osteotomy was performed in 18 patients, while foot and hindfoot correction without supramalleolar osteotomy was performed in 9 patients. Postoperatively, both the median FFI (from 44.4 [interquartile range (IQR), 35.7-52.2] to 9.1 [IQR, 5.2-13.9]) and median VAS pain score (from 6 [IQR, 5-6] to 1 [IQR, 1-2]) improved significantly (P < .0001 for both), and the median lesion size (from 25.8 mm2 [IQR, 19.3-45.2 mm2] to 13.8 mm2 [IQR, 6.8-26.5 mm2]) and median volume (from 2226.8 mm3 [IQR, 1311-3104 mm3] to 1326.5 mm3 [IQR, 714-2100 mm3]) decreased significantly (P < .0001 for both). During the mean follow-up of 4.1 ± 2.1 years, no subsequent surgery for OLT was necessary. Conclusion The results suggest that realignment procedures can improve the symptoms and radiographic profile of OLTs in patients with large cystic OLTs of the talar shoulder and malalignment of the foot and ankle.
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Affiliation(s)
- Jaeyoung Kim
- Baylor University Medical Center, Dallas, Texas, USA
| | - Young Yi
- Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seoul, Republic of Korea
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Hantouly AT, Attia AK, Hasan K, D'Hooghe P. Is Subtle Cavovarus a Problem for Athletes? Foot Ankle Clin 2023; 28:729-741. [PMID: 37863531 DOI: 10.1016/j.fcl.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Cavovarus or high-arched foot is a common foot deformity that occurs due to the disruption of the foot-driven equilibrium between the first metatarsal, fifth metatarsal, and the heel. This imbalance leads to an increase in the foot's normal plantar concavity. Cavovarus deformity ranges from a mild and flexible malalignment to a fixed, complex, and severe deformation. Subtle cavovarus foot, the mild form of the cavus foot, was first described by Manoli and colleagues.
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Affiliation(s)
- Ashraf T Hantouly
- Department of Orthopedic Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Ahmed Khalil Attia
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Khalid Hasan
- Virginia Commonwealth University, 1200 East Broad Street, 9th Floor, Richmond, VA 23298, USA
| | - Pieter D'Hooghe
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
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Song K, Wikstrom EA. Plausible mechanisms of and techniques to assess ankle joint degeneration following lateral ankle sprains: a narrative review. PHYSICIAN SPORTSMED 2019; 47:275-283. [PMID: 30739572 DOI: 10.1080/00913847.2019.1581511] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Lateral ankle sprain (LAS) is the most common lower extremity musculoskeletal injury sustained during daily life and sport. The cascade of events that starts with ligamentous trauma leads to clinical manifestations such as recurrent sprains and giving way episodes, hallmark characteristics of chronic ankle instability (CAI). The sequelae of lateral ankle sprains and CAI appear to contribute to aberrant biomechanics. Combined, joint trauma and aberrant biomechanics appear to directly and/or indirectly play a role in talar cartilage degeneration. Up to 80% of all cases of ankle osteoarthritis (OA) are post-traumatic in nature and common etiologies for ankle post-traumatic osteoarthritis (PTOA) are histories of a single and recurrent ankle sprains. Despite known links between LAS, CAI, and PTOA and evidence demonstrating the burden of LAS and its sequelae, early pathoetiological changes of ankle PTOA and how they can be assessed are poorly understood. Therefore, the purpose of this paper is to review the plausible mechanistic links among LAS and its sequelae of CAI and PTOA as well as review non-surgical techniques that can quantify talar cartilage health. Understanding the pathway from ligamentous ankle injury to ankle PTOA is vital to developing theoretically sound therapeutic interventions aimed at slowing ankle PTOA progression. Further, directly assessing talar cartilage health non-surgically provides opportunities to quantify if current and novel intervention strategies are able to slow the progression of ankle PTOA.
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Affiliation(s)
- Kyeongtak Song
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Erik A Wikstrom
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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Abstract
In the past few decades, total ankle replacement (TAR) has become an increasingly recommended and accepted treatment in patients with end-stage ankle osteoarthritis. However, controversy still exists about the appropriate indications for TAR, specifically in ankles with coronal plane deformities. Although not explicitly proved, the long-term success of TAR seems to largely depend on the extent to which the surgeon is able to balance the ankle joint complex.
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Affiliation(s)
- Beat Hintermann
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, Liestal CH-4410, Switzerland.
| | - Roxa Ruiz
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, Liestal CH-4410, Switzerland
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Li X, Xu Y, Zhu Y, Xu X. Surgical treatment for diffused-type giant cell tumor (pigmented villonodular synovitis) about the ankle joint. BMC Musculoskelet Disord 2017; 18:450. [PMID: 29137617 PMCID: PMC5686795 DOI: 10.1186/s12891-017-1824-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/09/2017] [Indexed: 12/30/2022] Open
Abstract
Background Diffused-type giant cell tumor(Dt-GCT) is a rare, aggressive disorder of the joint synovium, bursa and tendon sheaths. Osseous erosions and subchondral cysts may develop as the result of synovium infiltration in Dt-GCT. We present a retrospective study of a series of patients who are diagnosed with Dt-GCT about the ankle joint, there clinical outcome is evaluated in this study. Material and method Fifteen patients with radiologically and histologically confirmed Dt-GCT about the ankle joint were identified in our foot and ankle department. Patients were managed with open synovectomy for the tumor tissue and bone grafting for bony erosions. X-rays and MRI scans were used for evaluation of the tumor and bony erosions pre- and post-operatively. Pre- and post-operative ankle function was assessed using the American Orthopedic Foot and Ankle Society –Ankle and Hindfoot (AOFAS-AH) score and the Muscularskeletal Tumor Society (MSTS) score. Results The mean follow-up duration was 37.4 months (range 25 to 50 months). There were 6 males and 9 females, with a mean age of 35 years old (range 18 to 65 years). All patients had talar erosion with the average size of 10.1*9.1*8.2 mm, distal tibia was affected in 5 patients with the average size of 6.2*5.6*5.8 mm. 7 patients had tendon involvement, 2 patients had recurrence and progression of ankle osteoarthritis. Both of them underwent ankle fusion. At the time of last follow-up, the mean AOFAS-AH score increased from 49 to 80 points (p < 0.05), the MSTS score increased from 12 to 22 points (p < 0.05). Conclusion For Dt-GCT with bony erosions, open synovectomy combined with bone grafting seems to be a safe and effective operation for the salvage of ankle joint. Fusion is recommended for failed and severe cartilage destruction of the ankle joint.
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Affiliation(s)
- Xingchen Li
- Orthopaedic Department, Ruijin Hospital, Ruijin Er Road No.197, Shanghai, 200025, China
| | - Yang Xu
- Orthopaedic Department, Ruijin Hospital, Ruijin Er Road No.197, Shanghai, 200025, China
| | - Yuan Zhu
- Orthopaedic Department, Ruijin Hospital, Ruijin Er Road No.197, Shanghai, 200025, China
| | - Xiangyang Xu
- Orthopaedic Department, Ruijin Hospital, Ruijin Er Road No.197, Shanghai, 200025, China.
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Li X, Zhu Y, Xu Y, Wang B, Liu J, Xu X. Osteochondral autograft transplantation with biplanar distal tibial osteotomy for patients with concomitant large osteochondral lesion of the talus and varus ankle malalignment. BMC Musculoskelet Disord 2017; 18:23. [PMID: 28103870 PMCID: PMC5244526 DOI: 10.1186/s12891-016-1367-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 12/15/2016] [Indexed: 12/04/2022] Open
Abstract
Background Osteochondral lesions of the talus (OLTs) are amongst the most common foot and ankle disorders. Varus ankle malalignment causes stress concentration on medial side of the joint, resulting in OLTs and osteoarthritis. For large symptomatic OLTs (>10 mm), Osteochondral autograft transplantation is usually recommended. This article highlights biplanar distal tibial osteotomy as an approach and management for patients with concomitant large OLTs and varus ankle malalignment. Methods From January 2012 to July 2014, 13 patients (6 male and 7 female) underwent surgery in our faculty and their average age was 55.4 (ranging from 34 to 69) years old. Oblique medial malleolar osteotomy was performed to expose the talar lesion, followed by an osteochondral autograft transplantation and distal tibial opening-wedge osteotomy. Weight-bearing X-rays were conducted and used for the measurement of radiographic parameters such as the tibial articular surface (TAS) and tibial lateral surface (TLS) angles. Ankle function of the subjects was evaluated according to the American Orthopaedic Foot and Ankle Society-Ankle and Hindfoot score (AOFAS-AH) questionnaires and Visual Analog Scale (VAS). Results 11 patients completed the follow-up over a mean period of 21.2 months. The average area of talar lesion was 135.9 mm2 while the average depth was 11.4 mm. The mean time for osseous union was 8.5 weeks. Donor site morbidity was not recorded in any of the cases. The mean AOFAS-AH and VAS improved from 53 to 90 points (p < 0.05) and 6.7 to 1.9 points (p < 0.05) respectively. The mean TAS angle improved from 83.1 to 90.3° (p < 0.05). Conclusions Biplanar distal tibial osteotomy with the combination of osteochondral autograft transplantation could be used to address patients with concomitant large OLTs and varus ankle malalignment as this technique provides excellent visualization of the talar defect, favorable biomechanical environment for the ankle joint with high rate of good and excellent results.
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Affiliation(s)
- Xingchen Li
- Orthopaedic Department, Ruijin Hospital, Ruijin Second Road No.197, Shanghai, China
| | - Yuan Zhu
- Orthopaedic Department, Ruijin Hospital, Ruijin Second Road No.197, Shanghai, China
| | - Yang Xu
- Orthopaedic Department, Ruijin Hospital, Ruijin Second Road No.197, Shanghai, China
| | - Bibo Wang
- Orthopaedic Department, Ruijin Hospital, Ruijin Second Road No.197, Shanghai, China
| | - Jinhao Liu
- Orthopaedic Department, Ruijin Hospital, Ruijin Second Road No.197, Shanghai, China
| | - Xiangyang Xu
- Orthopaedic Department, Ruijin Hospital, Ruijin Second Road No.197, Shanghai, China.
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Abstract
Within the past several years, the arthritic varus ankle has been addressed extensively in Foot and Ankle Clinics, with numerous excellent reviews by particularly knowledgeable authors. To support these outstanding contributions, this article provides a practical approach to this challenging constellation of foot and ankle abnormalities. Varus ankle arthritis exists on a continuum that prompts the treating surgeon to be familiar with a spectrum of surgical solutions, including joint-sparing realignment, arthroplasty, and arthrodesis. Each of these treatment options is addressed with several expanded case examples and supports the management approaches with the available pertinent literature.
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Affiliation(s)
- Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, 4709 Creekstone Drive, Box 2950, Durham, NC 27703, USA.
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