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Osteochondral lesion of talus (OLT) is a foot and ankle disease characterized by ankle pain, which may impact the joint function and life quality. If managed improperly, it may lead to a further ankle arthritis, severely compromising the prognosis. The therapeutic effect of conservative treatment for OLT is still uncertain. Surgery is still the main treatment modality for OLT with various techniques. However, the optimized surgical technique is still inconclusive, furthermore, regeneration and repair of cartilage after debridement is also a great challenge for the treatment of OLT. Platelet-rich plasma (PRP) with good repair effect on cartilage injury is gradually applied in the treatment of OLT. However, there still lacks the unified understanding of the technique and specification of PRP for the treatment of OLT. Therefore, National Orthopedics Center of Shanghai Sixth People′s Hospital allied Foot Ankle Basic Research & Orthopedics Group, Chinese Association of Orthopedic Surgeons; Foot and Ankle Committee of Chinese Association of Sports Medicine Physicians; and Foot and Ankle Group of Orthopedic Specialized Branch of Shanghai Medical Association to organize related experts to formulate the Expert consensus on platelet- rich plasma treatment for osteochondral lesion of talus ( version2023). Fifteen recommendations were put forward upon PRP preparation, indications, contraindications and treatment methods of PRP for OLT, so as to standardize the PRP treatment for OLT.
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Objective To compare the effects of arthroscopic surgery plus one or more posterior small incisions and the sinus tarsi approach in the treatment of calcaneal fracture.Methods A retrospective analysis was conducted of the 85 patients with calcaneal fracture who had been treated from January 2017 to June 2017 at Department of Foot & Ankle Surgery,Guangzhou Orthopaedic Hospital.They were 43 men and 42 women,32 to 58 years of age (average,46.0 years).Arthroscopic surgery plus one or more posterior small incisions was performed in 40 of them while the sinus tarsi approach was used in the other 45 cases.The 2 groups were compared in terms of operation time,fracture healing time,incision complications and functions of the affected foot by the American Orthopedic Foot Ankle Society (AOFAS) ankle-hindfoot scores.Results There were no significant differences in the preoperative general data between the 2 groups,showing they were comparable (P ＞ 0.05).The average follow-up period for all the patients was 8 months (from 6 to 12 months).For the arthroscopic surgery group and sinus tarsi approach group,the fracture healing time was 8.6 ± 2.4 weeks and 8.9 ± 1.8 weeks,and the AOFAS ankle-hindfoot scores were 82.5 ± 5.6 and 85.1 ± 4.0,respectively,showing no significant differences between them (P ＞ O.05).The operation time in the arthroscopic surgery group (43.6 ±5.4 min) was significantly less than in the sinus tarsi approach group (56.5 ±6.4 minutes),and the rate of complications in the former[2.5％ (1/40)] significantly lower than in the latter[15.6％ (7/45)] (P ＜0.05).Conclusion Arthroscopic surgery plus one or more posterior small incisions may be a fine treatment for calcaneal fractures because postoperative incision complications can be reduced.
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Objective To investigate the clinical efficacy of arthroscopic Brostr(o)m-Gould procedure for chronic lateral ankle instability (CLAI).Methods A retrospective case series study was conducted to analyze the clinical data of 36 CLAI patients admitted to Zhejiang Provincial People's Hospital,Second Affiliated Hospital of Shenzhen University,Institute of Orthopedics of Soochow University,and Guangzhou Orthopedic Hospital from August 2016 to July 2017.There were 21 males (21 ankles) and 15 females (15 ankles),aged 18-42 years [(26.5 ± 8.6)years].The duration from injury to operation ranged from 6 to 30 months [(10.8-± 1.6) months].All patients received arthroscopic Brostr(o)m-Gould procedure (anterior talofibular ligament repair,capsular constriction,subextensor ligament reinforcement).The operation time and arthroscopic intra-articular lesions and treatment were recorded,and the wound healing and complications were recorded.The visual analogue score (VAS),front drawer test and varus stress test results,American Orthopedic Foot and Ankle Surgery Society (AOFAS) ankle-hind foot score and Karlsson-Peterson ankle function score were compared before operation,6 weeks after operation and at the last follow-up.Results All 36 patients were followed up for 18-29 months [(20.5 ±6.3) months].The operation time ranged from 45 to 115 minutes [(67.2 ± 18.6) minutes].During the operation,synovitis hyperplasia of ankle joint was found in 35 patients,scar tissue around ligament in 32,talus cartilage injury in 10,osteophyte in 19 and free body in 5,all of which were treated accordingly.All incisions were healed in the first stage after operation,without joint infection,superficial sural nerve injury or thread stimulation.The ankle varus was slightly limited in two patients after operation and improved after functional rehabilitation.No revision operation was needed at the last follow-up.Front drawer test and inverted stress test results were negative (-).The VAS score was (5.9 ± 1.6) points before operation,(1.9 ± 1.0) points at 6 weeks after operation,and (1.6 ± 0.3) points at the last follow-up,with significant difference compared with that before operation (P ＜ 0.01).The AOFAS ankle-hind foot score was (67.4 ± 7.4) points before operation,(89.2 ±4 6.8) points at 6 weeks after operation,and (91.7 ±5.3)points at the last follow-up,with significant difference compared with that before operation (P ＜ 0.01).Karlsson-Peterson ankle function score was (65.3 ± 9.6)points before operation,(88.6 ± 5.3) points at 6 weeks after operation,and (90.6 ± 3.8) points at the last follow-up,with significant difference compared with that before operation (P ＜ 0.0 1).Conclusion For CLAI,the arthroscopic Brostr(o)m-Gould procedure can treat the intra-articular lesions and reliably restore the stability of the lateral ankle.At the same time,quick motion recovery can be achieved,with satisfactory shortterm curative effect.
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Objective To evaluate the clinical efficacy and safety of all-inside arthroscopic repair of anterior talofibular ligament(ATFL) for chronic lateral ankle instability(CLAI).Methods From October 2016 to September 2017,19 patients with CLAI were treated with all-inside arthroscopic repair of ATFL at Department of Orthopaedic Surgery,Zhejiang Provincial People's Hospital and Department of Foot and Ankle Surgery,Guangzhou Orthopaedic Hospital.They were 12 men and 7 women,aged from 18 to 35 years(mean,27.3 years).Their defective ATFLs had no effective tension.After the fibular foot-print zone of ATFL was refreshed,an absorbable anchor was inserted accurately and its suture was threaded into the remnant of ATFL using the all-inside arthroscopic technique.The remnant of ATFL was fixated by the suture using Lasso-Loop method and anatomically repaired into the foot-print zone to restore the ligamentous tension.The American Orthopedic Foot and Ankle Surgery Society(AOFAS) ankle-hindfoot score,Karlsson ankle function score,Tegner activity score and visual analogue scale(VAS) were used to assess funtion of ankle before and after operation.Results All the 19 patients were followed up for a mean time of 15.6 months(from 12 to 22 months).Their ankle symptoms were all relieved after operation;their ankles recovered fine range of motion;their anterior drawer tests and varus stress tests were negative.Their preoperative AOFAS scores(64.6±11.4),Karlsson ankle function scores(63.5±11.4),Tegner activity scores(3.2±0.7) and VAS(5.8±1.7) were significantly improved at the final follow-up(92.3±3.2,91.2±4.4,5.7±0.6 and 1.4±1.0,respectively)(P<0.05).complications such as incision and articular infections,superficial peroneal nerve injury,sural nerve injury and iatrogenic fracture were not demonstrated in the cohort.By the final follow-up,no patient had been found who needed a secondary revision.Conclusions The all-inside arthroscopic repair of ATFL can be used effectively and safely for CLAI,because it leads to accurate anchor insertion,anatomic repair,limited invasion,and reliable restoration of ligamentous tension.To avoid complications,surgeons should familiarize themselves with arthroscopic procedures.
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Objective To explore the outcomes of open reduction and internal fixation ( ORIF ) with transarticular screws for Lisfranc injuries and the postoperative incidence of symptomatic tarsometatarsal os-teoarthritis ( OA ) . Methods This retrospective study involved 28 patients who had been treated surgically at our institution between January 2009 and January 2015 for Lisfranc injuries. They were 18 males and 10 females, with an average age of 36. 1 years ( from 19 to 54 years ) . According to the Quenu-Kuss classifica-tion, 5 patients had type-A injury, 10 type-B injury ( 4 cases of type-B1 and 6 ones of type-B2 ) , and 13 type-C injury ( 8 cases of type-C1 and 5 ones of type-C2 ) . The patients underwent ORIF with screws for the 1st to the 3rd tarsometatarsal joints and ORIF with Kirschner wires for the 4th to the 5th tarsometatarsal joints within 2 weeks. After the Kirschner wires were removed 8 to 10 weeks postoperatively, progressive weight-bearing began. Functional outcomes were assessed according to the American Orthopaedic Foot and Ankle Society ( AOFAS ) midfoot scores and visual analog scale ( VAS ) at final follow-ups. Results The mean duration of follow-up was 29. 9 months ( from 26 to 72 months ) . AOFAS scores revealed one excellent case, 22 good ones and 5 poor ones with an excellent to good rate of 82. 1％. The mean VAS score was 2. 8. Radiographic evidence of OA was noted in 20 patients ( 71. 4％, 20/28 ) , in 18 of whom ( 90. 0％) symp-tomatic OA was observed. There was no significant difference ( P=0. 399 ) in the incidence of symptomatic OA either between the patients with anatomic reduction ( 60. 9％, 14/23 ) and those without anatomical re-duction ( 80. 0％, 4/5 ) . Conclusions ORIF with transarticular screws can lead to good therapeutic outcomes for Lisfranc injuries. The incidence of symptomatic OA may not be related to the injury type or re-duction quality.
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Objective To compare the minimally invasive sinus tarsi approach and lateral intensive L-shaped approach in the therapeutic effects concerning medial wall reduction and calcaneal alignment for cal-caneal fractures. Methods A retrospective analysis was conducted of the 52 patients with calcaneal fracture who had been treated at Department of Foot & Ankle Surgery, Guangzhou Orthopaedic Hospital from January 2010 to December 2014. They were 39 men and 13 women, 28 to 46 years of age ( average, 40.4 years ). Of them, 26 were treated via the sinus tarsi approach ( minimally invasive group ) and the other 26 via the con-ventional lateral extensile L-shaped approach ( conventional group ) . X-ray axial films of the calcaneus were taken pre-operatively and post-operatively to evaluate the medial wall reduction and calcaneal alignment. The American Orthopedic Foot Ankle Society ( AOFAS ) ankle-hindfoot scale was adopted to assess the therapeutic effects. Results The average follow-up period for this cohort was 18 months ( from 12 to 24 months). The post-operative varus angle was 7.41°± 5.17°for the minimally invasive group and 8.01°± 5.33°for the con-ventional group; the correction of varus angle was 6.60°± 6.23°for the minimally invasive group and 8.57°± 6.64°for the conventional group; the good to excellent rate of medial wall reduction was 42.3% ( 11/26 ) for the minimally invasive group and 53.8% ( 14/26 ) for the conventional group; the AOFAS score was 89.5 ± 7.0 for the minimally invasive group and 86.2 ± 8.2 for the conventional group. There were no statistically signifi-cant differences between the 2 groups in all the above comparisons ( P ＞ 0.05 ). Conclusion The mini-mally invasive sinus tarsi approach can be a fine choice for treatment of calcaneal fractures, because it leads to no differences in medial wall reduction, postoperative varus angle and postoperative correction of varus angle, compared with the conventional lateral extensile L-shaped approach.
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Recently,wide application of MRI in clinic accelerates researches into the etiology,diagnosis,treatment and prognosis of bone bruises.MRI manifestations of bone bruises include trabecular microfracture associated with hemorrhage,oedema of subchondral bone because of direct or indirect traumatic force and focal abnormalities in subchondral bone of the knee.This condition is also known as occult injury of the knee,because it is likely to be overlooked or misdiagnosed in hospital due to its diagnostic difficulty by plain radiographs and CT.If timely intervention is not given,it will be accompanied by chronic pain which seriously affects the daily life of the patients,even resulting in early degeneration.This article discusses the current research on bone bruises of the knee.