Robotic-assisted foot and ankle surgery: a review of the present status and the future.

The surgical application of robotics has increased significantly since its first application in 1985 for a brain biopsy acquisition. Robotic-assisted surgery has been one of the viable options in various surgical areas, and also in orthopaedic surgery. Robotic-assisted orthopaedic surgery has gained popularity as a mean of improving accuracy, reducing complications and achieving better patient satisfaction. Numerous clinical research studies have demonstrated advantages of robotic-assisted orthopaedic surgery, however, most of that researches were about the total knee arthroplasty, total hip arthroplasty and spine surgery. The application of robotic technology in foot and ankle surgery is in a very nascent stage. Furthermore, there has been little research on intraoperative use of robotics in foot and ankle surgery in literature. A review of previous preclinical studies in foot and ankle robotics and clinical research studies in various fields of robot-assisted orthopaedic surgery shows that its potential application and benefits over conventional techniques, such as total ankle arthroplasty, minimally invasive surgery for foot and ankle trauma or other corrective procedure, and intraoperative biomechanical testing. More studies on practical application of robotic technology to surgical procedure in the field of foot and ankle surgery are needed to confirm its clinical usefulness and cost effectiveness.

Minimally Invasive Transverse Distal Metatarsal Osteotomy (MITO) for Hallux Valgus Correction: Early Outcomes of Mild to Moderate vs Severe Deformities.

BACKGROUND: We compared the radiological and clinical outcomes of mild to moderate and severe hallux valgus (HV) treated with minimally invasive distal metatarsal transverse osteotomy (MITO) performed by a single surgeon. METHODS: Eighty-four patients who underwent MITO between May 2018 and March 2020 were recruited and followed for at least 24 months. The severe group was defined as having a preoperative hallux valgus angle (HVA) >40 degrees or preoperative first-to-second intermetatarsal angle (1-2 IMA) >16 degrees; the mild to moderate group was defined as having an HVA <40 degrees and a 1-2 IMA <16 degrees. Pre- and postoperative measurements of the HVA, 1-2 IMA, distal metatarsal articular angle, and tibial sesamoid position were obtained. The visual analog scale for pain, the Foot and Ankle Outcome Score, and the Medical Outcomes Study Short Form Health Survey-36 physical component summary were used to assess clinical outcomes. RESULTS: A total of 116 feet were included in this study and median follow-up period of 29.0 months (range, 24-52 months). Both groups showed significant improvements in all radiologic parameters postoperatively, with the degrees of correction greater in the severe group than in the mild to moderate group. All clinical scores improved significantly from the preoperative to the last follow-up visit. Final clinical outcomes and degrees of improvement were comparable in both groups. CONCLUSION: This study showed that short-term radiographic results for patients with either mild to moderate or severe HV treated with MITO were favorable. Overall clinical outcomes were comparable to those of conventional treatments. In this series, we found MITO with screw fixation to be a satisfactory surgical option for patients with mild to severe HV deformities. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Sodium Tetradecyl Sulphate Sclerotherapy for Lateral Malleolar Bursitis of the Ankle.

Background: The aim of this study was to evaluate clinical outcomes of sodium tetradecyl sulphate (STS) sclerotherapy for conservative treatment of lateral malleolar bursitis of the ankle. Methods: We reviewed data from 20 consecutive patients (20 ankles) who underwent STS sclerotherapy between August 2018 and June 2019. After aspiration of fluid from the lateral malleolar bursal sac, 2 mL (20 mg) STS was injected into the sac. Clinical outcomes and side effects and complications were evaluated at 2 weeks, 3 months, 1 year, and 2 years after sclerotherapy. Responses to treatment were assessed according to degree of fluctuation, shrinkage of the bursal sac, and soft-tissue swelling. The 36-item short form survey (SF-36) was completed for each patient before and after therapy. Results: Complete response was observed in 17 patients (85%), and partial response was observed in 3 patients (15%) after STS sclerotherapy. SF-36 physical component scores improved from 62.2 (interquartile range, 5.2) before therapy to 70.0 (interquartile range, 7.9) at last follow-up (p < 0.05). One patient (5%) experienced transient hyperpigmentation at the injection site. No major complications occurred. Conclusions: STS sclerotherapy was an effective and safe treatment for patients with lateral malleolar bursitis of the ankle.

Long-Term Clinical Outcomes and Implant Survivorship of 151 Total Ankle Arthroplasties Using the HINTEGRA Prosthesis: A Minimum 10-Year Follow-up.

BACKGROUND: Few studies have investigated long-term clinical outcomes of a mobile-bearing total ankle arthroplasty (TAA) system. This study analyzed long-term outcomes of TAA using the HINTEGRA prosthesis at a single, non-developer center. METHODS: Primary TAAs were performed on 213 ankles in 194 patients, and 151 consecutive ankles [71%] in 136 patients with a minimum follow-up of 10 years after the primary TAA were included in this study. Clinical results were assessed using a visual analog scale (VAS) pain score, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale score, the Ankle Osteoarthritis Scale (AOS) pain and disability subscores, and ankle range of motion. Prosthesis survivorship, reoperations, and risk factors were also evaluated. RESULTS: The mean follow-up was 135.5 months (range, 120.0 to 204.0 months). All clinical scores and ankle range of motion improved significantly from preoperatively to 2 years, 4 to 6 years, and ≥10 years after TAA (p < 0.001). A total of 43 ankles (28.5%) required revision procedures, with the most common reason being periprosthetic osteolysis (32 ankles [21.2%]). The overall implant survivorship was 93.5% in Kaplan-Meier survival analysis at the mean follow-up of 11.3 years after the TAA. CONCLUSIONS: TAA using the HINTEGRA prosthesis with careful follow-up observation and appropriate adjunct procedures for the treatment of end-stage ankle arthritis produced satisfactory clinical results, which were maintained at a follow-up of ≥10 years, and resulted in 93.5% of implant survivorship. LEVEL OF EVIDENCE: Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Association between outdoor temperature and achilles tendon repair: A 14-years nationwide population-based cohort study.

The incidence of achilles tendon rupture varies by gender, age, and seasonal variation. However, there has been no study as yet linking achilles tendon rupture to daily fluctuations in outdoor temperature. The purpose of this study was to investigate the association between outdoor temperature and achilles tendon rupture using a Korea Meteorological Administration database and a Korean National Health Insurance Service-National Sample Cohort database. Between 2002 and 2015, all instances of achilles tendon repair were retrieved from the National Health Insurance Service-National Sample Cohort database to examine sociodemographic factors, specifically sex, age, residential area, and income level. Minimum age requirement was 20 years. Outdoor temperatures recorded at 16 observation points in South Korea were also acquired from the Korea Meteorological Administration data center for analysis. Overall, 850 (0.119%) of 713,456 individuals in the National Health Insurance Service-National Sample Cohort database underwent achilles tendon repair between 2002 and 2015. Yearly procedural totals increased with advancing age, peaking at ages 30-39 years (14.6 per 100,000 persons) and declining thereafter. Minimum, median, and maximum outdoor temperatures were associated with achilles tendon repair (p<0.05), as did household income. In multivariate logistic regression analysis, outdoor temperatures, sex, age, and household income emerged as factors significantly associated with achilles tendon repair. Outcomes of this study confirm an association between incidence of achilles tendon repair and outdoor temperature, the latter denoting a novel index and likely surrogate measure of vigorous physical activity afforded by warmer weather.

Concomitant coracoplasty during arthroscopic subscapularis repair does not yield better clinical outcomes and structural integrity.

PURPOSE: Few studies have examined whether concomitant coracoplasty is necessary to improve clinical and radiological outcomes after arthroscopic subscapularis repair. The purpose of this study was to compare clinical outcomes and structural integrity after arthroscopic repair of isolated subscapularis full-thickness tear, either with or without concomitant coracoplasty. METHODS: This study included 62 patients who underwent arthroscopic subscapularis repair either with coracoplasty (Group A, 35 patients) or without coracoplasty (Group B, 27 patients). Preoperative and postoperative visual analog scale pain scores, subjective shoulder values, University of California at Los Angeles shoulder scores, American Shoulder and Elbow Surgeon scores, subscapularis strength, and shoulder active range of motion (ROM) were assessed. Postoperative magnetic resonance arthrography (MRA) or computed tomographic arthrography (CTA) was performed 6 months postoperatively for structural integrity assessment. RESULTS: At 2-year follow-up, all functional scores and ROM improved significantly in both groups compared with preoperative values (p < 0.001). However, none of these values differed significantly between groups. On follow-up MRA or CTA images, although postoperative coracohumeral distance was significantly greater in Group A (8.4 mm ± 2.3 mm versus 7.0 mm ± 2.0 mm) (p = 0.018), the re-tear rates were not significantly different between groups (5/35 (14%) in Group A and 4/27 (15%) in Group B). CONCLUSIONS: For isolated subscapularis full-thickness tears, concomitant coracoplasty with arthroscopic repair did not produce better clinical outcomes or structural integrity than repair without coracoplasty. This suggests that concomitant coracoplasty may not be imperative during arthroscopic repair of isolated subscapularis full-thickness tears. LEVEL OF EVIDENCE: III.

A blocking-wire technique for removal of a broken hollow intramedullary nail.

We present a simple method to remove the distal portion of the broken nail just using the bulb-tipped guide pin and a blocking Kirschner wire. At first, we removed the proximal part of the broken nail and all interlocking screws. Next, we introduced the bulb-tipped guide wire into the distal part of the nail with fluoroscopic guidance until it passed the interlocking hole that would be used. After snugly fitting the blocking Kirschner wire into the interlocking hole of the nail, the bulb-tipped guide wire is then pulled to engage the blocking wire complex in the interlocking hole. The bulb-tipped guide wire and broken nail are removed by sequential stroke using a ram.