ABSTRACT
Introduction: Retrocalcaneal pain in late adulthood and athletes has been attributed to insertional Achilles tendinosis (IAT). Another presentation of IAT is a degenerative Achilles tear, which can be partial or complete. Symptomatic patients with failed conservative management are treated by debridement and repair of the Achilles tendon. Often, they need augmentation with a tendon transfer. The flexor hallucis longus (FHL) is the most commonly used tendon for augmentation. The Speed Bridge technique to repair the degenerated tendoachilles tear gives better pullout strength and provides a larger surface area of contact between the bone and tendon. Case Report: We included 12 patients with symptomatic degenerative Achilles tears repaired with the Speed Bridge technique and FHL augmentation. Post-operatively, all patients were allowed active ankle mobilization on day 1 and were allowed weight bearing as tolerated in an airwalker shoe. All patients went through an accelerated rehabilitation protocol. Pre-operative and post-operative American Orthopedic Foot and Ankle Hindfoot Score (AOFAS) and Visual Analog Scale (VAS) scores were compared for all the patients. Conclusion: The mean age was 58.1 (range 50-68) years. The mean follow-up period was 13.1 (range 12-15) months. The mean pre- and post-operative AOFAS score at 12 months was 59.5 (range 58-71) and 90.2 (range 87-100), respectively. The mean pre-operative VAS for pain was 6.8 (range 6-8), and the mean post-operative VAS score was 0.5 (range 0-2). The mean interval to weight bearing was 8.4 days (range 7-10) days. Our study indicates that accelerated early rehabilitation and an early return to active life are possible with the Speed Bridge technique and FHL augmentation in degenerative Achilles tears. The mean post-operative AOFAS scores were comparable to other studies, but early return to activity, minimal need for immobilization, and accelerated rehabilitation were the advantages of the Speed Bridge technique in the repair of degenerative Achilles tears.
ABSTRACT
This case report describes a rare occurrence of talar osteochondroma extending into syndesmosis, causing disruption of the interosseous membrane and the posterior inferior tibiofibular ligament (PITFL). This type of presentation for a talar osteochondroma is the first of its kind reported in the literature based on current knowledge. A detailed preoperative radiological assessment was crucial in planning the surgical approach and preparing for syndesmotic stabilization during the excision. The patient underwent successful and complete excision of the osteochondroma, and the syndesmosis was stabilized using a cortical screw along with anatomical repair of the PITFL. Apart from delayed wound healing, the patient exhibited good functional outcomes in terms of gait and ankle range of motion at the six-month follow-up. This case serves as a valuable reference for similar presentations in the future, emphasizing the importance of thorough preoperative assessment and appropriate treatment planning.
ABSTRACT
Functional outcome of first metatarsophalangeal joint (MTPJ) arthrodesis using intramedullary implant was reviewed in retrospective series of 12 patients who had MTPJ arthritis. The outcome measures were improvements seen in VAS for pain and AOFAS scores recorded pre-operatively and post-operatively at the time of achieving complete union. VAS for pain improved from mean of 7.5 pre-operative to 1.8 post-operative (p < 0.001). AOFAS Score improved from mean of 35.58 pre-operative to 80.91 post-operative (p < 0.001). The fusion rate was 100 percent and mean time needed for fusion was 9.6 weeks. Only one patient had malunion which was acceptable to patient and was not revised. The fusion using intramedullary intra-osseous Hallux Fusion implant is a promising technique with good functional outcome and low complications.
