The completely patient-reported version of the American Orthopaedic Foot and Ankle Society (AOFAS) score: A valid and reliable measurement for ankle osteoarthritis

Treatment of Distal Third Tibial Fractures with Anterior Soft Tissue Compromise through the Posterolateral Approach: Distal Third Tibial Fractures via the Posterolateral Approach

Distal third tibial fractures associated with anterior soft tissue compromise are a predictor of more complications and poor prognosis. The study aimed to introduce the treatment of such fractures through the posterolateral approach. From March 2020 and January 2022, 32 patients with distal third tibial fractures were plated through the posterolateral approach due to concurrent closed anterior soft tissue compromise. There were 30 male and 2 female patients with the mean age of 33 years (range, 20-53 years). The reduction quality of diaphyseal fractures was good (n=30) and acceptable (n=2). The reduction quality of articular fragments was anatomic (n=21), good (n=6), and fair (n=1). All anterior soft tissue injuries healed without surgical intervention. Follow-ups lasted 28 months (range, 25-34 months). The mean dorsiflexion of the injured and uninjured ankles were 17.8°±5.4° and 24.5°±6.6°, respectively (P<0.05). The mean plantar flexion of the ankles were 42°±8.8° and 46°±12.9°, respectively (P>0.05). The mean inversion of the injured and uninjured ankles were 15°±13.3° and 19°±12.4°, respectively (P<0.05). The mean eversion of the injured and uninjured ankles were 27.8°±16.9° and 32.9°±14.3°, respectively (P>0.05). The mean American Orthopaedic Foot and Ankle score was 90 (range, 68-100). Distal third tibial fractures with anterior soft tissue compromise can be plated through the posterolateral approach, resulting in good functional outcomes and minimum complications. LEVEL OF EVIDENCE: Therapeutic study, Level IV.

Transversal calcaneal anchored Achilles tendon reconstruction with free semitendinosus tendon autograft for acute rupture of Achilles tendon: clinical evaluation

Achilles tendon reconstruction is an effective method of repairing Achilles tendon rupture defects. We introduce a new approach for Achilles tendon reconstruction using transversal calcaneal anchored autogenous semitendinosus tendon graft. The study aimed to evaluate the clinical role of this new Achilles tendon reconstruction. We retrospectively enrolled patients who underwent Achilles tendon reconstruction using transversal calcaneal anchored autogenous semitendinosus tendon graft for acute Achilles tendon rupture defects from 2016 to 2021. The clinical and radiological results were assessed at the preoperative and the final postoperative follow-up with Visual Analog Score (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores and Achilles tendon Total Rupture Scores (ATRS). Besides, at the last postoperative follow-up, the difference in ankle range of motion between the two side of the patients and the incidence of postoperative complications were recorded. Results revealed patients had significantly lower VAS and higher AOFAS and ATRS (P < 0.01). Compared to the healthy ankle, the operative ankle showed significant deficits in ankle range of motion (P < 0.01). Additionally, radiological results showed no noticeable signs of tunnel enlargement in the calcaneus and no patient had re-rupture. Transversal calcaneal anchored Achilles tendon reconstruction with free semitendinosus tendon autograft is an effective treatment option for patients with acute Achilles tendon rupture with large defects and have high postoperative exercise demands.

Impact of Minimally Invasive Intra-Capsular Metatarsal Osteotomy on Plantar Pressure Decrease: A Cross-Sectional Study

Background: Metatarsalgia is a common pathology that is initially treated conservatively, but failure to do so requires surgery, such as the minimally invasive distal metatarsal osteotomy (DICMO). Methods: In this prospective study of 65 patients with primary metatarsalgia who underwent DICMO, plantar pressures, American Orthopaedic Foot and Ankle Society MetaTarsoPhalangeal-InterPhalangeal scale (AOFAS-MTP-IP) and Visual Analog Scale (VAS) were evaluated pre-operatively and post-operatively and there was a subgroup in which an inclinometer was used to observe the importance of the inclination of the osteotomy. Results: The results show a significant reduction in plantar pressures after DICMO surgery without overloading the adjacent radii, especially in the subgroup with an inclinometer to guide the osteotomy. The AOFAS-MTP-IP scale evidenced a marked improvement in metatarsal function and alignment with scores close to normal. The VAS scale showed a substantial decrease in pain after DICMO osteotomy. Conclusions: DICMO, with an inclinometer for a 45° osteotomy, proved to be a safe and effective procedure for primary metatarsalgia, although further comparative studies are needed to confirm its superiority.