Supramalleolar Lateral Opening-Wedge Osteotomy in Conjunction With Progressive Collapsing Foot Deformity Reconstruction for PCFD With Ankle Instability.

BACKGROUND: Reconstruction of progressive collapsing foot deformity (PCFD) with ankle instability (PCFD class E) remains a substantial challenge to orthopaedic surgeons. We report the outcomes of PCFD class E treated by means of a relatively standard PCFD foot reconstruction approach with the addition of a supramalleolar lateral opening-wedge osteotomy. METHODS: We conducted a retrospective study of 13 patients (15 ankles) who underwent this procedure for PCFD class E between 2010 and 2021. Mean follow-up time was 3.8 (range, 2-6.3) years. Clinical assessment was based on the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale as well as a Self-Administered Foot Evaluation Questionnaire (SAFE-Q). Radiographic assessments, including identification of the mechanical ankle joint axis point and a modified valgus Takakura-Tanaka osteoarthritis grade, were recorded. RESULTS: The mean JSSF score improved significantly from 45.2 preoperatively to 83.9 postoperatively (P < .001). SAFE-Q scores at the final follow-up were 70.1 for the pain and pain-related subscale, 75.4 for the physical functioning and daily living subscale, 83.0 for the social functioning subscale, 74.4 for the shoe-related subscale, and 78.1 for the general health and well-being subscale. Radiographic measurements showed improvement in the tibiotalar tilt angle (average improvement: 5.4 degrees); orientation of the talus joint line relative to the ground (average improvement: 14.0 degrees); anteroposterior talus-first metatarsal angle (average improvement: 11.2 degrees), talonavicular coverage angle (average improvement: 21.6 degrees), and lateral talus-first metatarsal angle (average improvement: 17.0 degrees). Postoperatively, the mechanical ankle joint axis point moved medially for all patients and into the medial half of the ankle joint for 7 patients. The modified osteoarthritis stage improved postoperatively in most cases. CONCLUSION: In this select and relatively small group of patients who had a supramalleolar lateral opening-wedge osteotomy combined with PCFD reconstruction, we measured general improvement in JSSF scores and radiographic variables. Long-term durability of the procedure remains unknown. This procedure may be an option for preserving the ankle joint in treatment of PCFD class E with osteoarthritis of the ankle. LEVEL OF EVIDENCE: Level IV, therapeutic.

Fixation of the osteochondral talar fragment yields good results regardless of lesion size or chronicity.

PURPOSE: Osteochondral talar lesions, regardless of their size and/or chronicity, are, at our hospital, now treated by fixation of the fragment if the talar dome cartilage is judged to be healthy. The retrospective study described herein was conducted to assess clinical outcomes of this treatment strategy. METHODS: The study group comprised 44 patients (18 men and 26 women) with 45 such talar lesions. In all cases, the osteochondral fragment was reduced and fixed with bone harvested from the osteotomy site and shaped into peg(s) (one to four pegs per lesion). Median follow-up was 2.1 years (1-9 years). The lesion area was measured on computed tomography arthrographs, and the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale was used to evaluate postoperative outcomes. Clinical failure was defined as a JSSF score < 80 points. RESULTS: The mean JSSF score improved significantly from 63.5 points preoperatively to 93.0 postoperatively (p < 0.001). Treatment failure occurred in only one ankle (0.02%). The mean lesion area was 51.2 mm2 (range 5-147 mm2). Correlation between lesion areas and the postoperative JSSF scores was weak (r = - 0.133). Correlation between the time of the trauma to the time of fixation surgery and the postoperative JSSF scores was also weak (r = 0.042). Radiographic outcomes were good for 28 ankles, fair for 10, and poor for 7. CONCLUSION: Fixation of the lesion fragment, regardless of size and/or chronicity, appears to be appropriate in cases of an osteochondral talar lesion. LEVEL OF EVIDENCE: IV.

Anatomical Pathology of Subtle Lisfranc Injury.

The extent and patterns of Lisfranc joint complex disruption in subtle Lisfranc injuries have not been well clarified. We reviewed the direct intraoperative findings for 87 patients, examined computed tomography images that had been obtained preoperatively for 73 of the patients, and classified the injuries according to the Kaar  et al. criteria as the transverse type (instability between the first cuneiform [C1] and the second metatarsal [M2] and between the second cuneiform [C2] and M2) or longitudinal type (instability between C1 and M2 and between C1 and C2). Our patients' injuries were classified as follows: longitudinal type (38%), transverse type (30%), transverse type and first tarsometatarsal (TMT) joint injury (20%), longitudinal type plus transverse type (7%), longitudinal type and first TMT joint injury (3%), and longitudinal type, transverse type, and first TMT joint injury (2%). In 11 patients, the longitudinal injury extended into the naviculo-first cuneiform joint. In 41 (56%) of the 73 patients for whom CT images were obtained, 1 or more fractures (not counting small avulsion fragments between C1 and M2) were found. Orthopedic surgeons should be aware of the various injury patterns possible in cases of subtle Lisfranc injury.

T1ρ mapping of articular cartilage grafts after autologous osteochondral transplantation for osteochondral lesions of the talus: A longitudinal evaluation.

BACKGROUND: Clinical results of autologous osteochondral transplantation (AOT) for treatment of osteochondral lesions of the talus have been mixed. T1ρ imaging can be used to noninvasively detect early cartilage degeneration. PURPOSE OR HYPOTHESIS: To quantitatively assess, by means of T1ρ imaging, changes over time in the biochemical health of grafted cartilage after AOT for osteochondral lesions of the talus. STUDY TYPE: Retrosepctive case series. POPULATION: The study group comprised nine patients who underwent AOT for an osteochondral lesion of the talus and in whom T1ρ mapping was performed 1 and 2 years postoperatively. FIELD STRENGTH/SEQUENCE: 3 Tesla. T1ρ-weighted turbo field echo. ASSESSMENT: The mean T1ρ value of full-thickness cartilage at the repair site and that of full-thickness cartilage elsewhere in the same image (far-field cartilage) were determined. Clinical assessment was based on the American Orthopaedic Foot & Ankle Society (AOFAS) scale. Correlation between the T1ρ ratios (grafted-to-far-field cartilage T1ρ values) and clinical outcomes was examined. STATISTICAL TESTS: Mixed effects model. Pearson correlation analysis. RESULTS: At 1 year, a significant difference existed between the mean T1ρ value of the grafted cartilage (57.0 ± 7.7 ms) and that of the far-field cartilage (41.8 ± 4.6 ms) (P < 0.001). At 2 years, the mean T1ρ value of the grafted cartilage (49.1 ± 6.4 ms) was significantly lower than that at 1 year (P = 0.011). Moderate negative correlation was found between the 1-year T1ρ ratio and 1-year AOFAS score (r = -0.60) and between the 2-year T1ρ ratio and 2-year AOFAS score (r = -0.50). DATA CONCLUSION: Our observation of substantial restoration of the proteoglycan content of the grafted cartilage approximately 2 years after AOT for osteochondral lesions of the talus indicates that the content changes gradually and that the cartilage reparation process is slower than previously believed. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2018;48:398-403.