Talus Osteochondral Defect Treatment With Biological Scaffold.

Talus Osteochondral defects (OCDs) are challenging and there is no consensus in literature regarding which is the best method of treatment. New techniques coming from regenerative medicine are being considered good alternatives of treatment and are being used exponentially in orthopaedic surgery. Platelet-rich fibrin (PRF) is the second generation of platelet concentrates. It has a convenient method of acquisition and can be used to create a biological scaffold which is able to seal up cavitary lesions. In this article, the authors describe a talus OCD treated with a biological scaffold, reporting the technique details and its results clinical and radiological results. The case report objective is to portray the use of this kind of biological material, its advantages, and limitations.Level of Evidence: Level 5.

Ankle arthroscopy does not elevate complication rates in ankle fractures.

INTRODUCTION: Ankle fractures rank as the second most common lower limb fractures, and surgical intervention is essential for unstable ankle fractures. The use of ankle arthroscopy in such cases offers several advantages. This study aim is to assess whether arthroscopy influenced on complication rates in 171 ankle fractures treated with arthroscopic assistance. METHODS: This retrospective epidemiological analysis encompassed adult ankle fractures between December 2018 and December 2021. Initially, 173 patients were considered, but two were excluded, leaving a final sample of 171 patients. Postoperative complications were categorized as major or minor. RESULTS: The study included 171 patients with surgically treated ankle fractures assisted by arthroscopy, comprising 76 females and 95 males, with an average age of 41.9 years. Syndesmosis injuries were treated in all diagnosed cases (55.0%), and deltoid ligament injuries received attention when identified (33.7%). Arthroscopic techniques were preferred over open techniques (47.4%). Ten patients experienced complications, consisting of 2 major and 8 minor complications (5.8%). DISCUSSION: Our study's epidemiological findings align with prior literature, demonstrating that intra-articular injuries accompany 63% to 79% of ankle fractures. Arthroscopy allows for both diagnosis and treatment within the same procedure, including joint lavage to reduce inflammation. We diagnosed 57 deltoid injuries and identified a statistical relationship between chondral, syndesmotic, and deltoid ligament injuries. Infection is a common complication in ankle fracture surgery, with rates ranging from 1.44% to 16%. Our study yielded a 5.8% complication rate, comprising 1.2% major and 4.6% minor complications. Patients undergoing ORIF with arthroscopic assistance had a lower prevalence of infection. CONCLUSION: The use of arthroscopic assistance in the surgical treatment of ankle fractures does not increase the overall complication rate. LEVEL OF EVIDENCE: IV.

Mini Open Fasciotomy for Chronic Exertional Compartment Syndrome: A Prospective Case Series.

Chronic exertional compartment syndrome (CECS) is a challenging pathology that causes pain and physical limitations. Fasciotomy is the gold standard and different techniques have been described. Techniques that allow a fast return to sports and low recurrence rates are of great interest for the athletic population. This is a prospective case series presenting a mini open surgical technique and its results regarding the level of return to sports and quality of life in 13 patients. A specific CECS questionnaire was applied and analyzed concerning the distance patients were able to run before and after treatment, Tegner score, Medical Outcomes Short-Form Health Survey (SF-36), and epidemiological measures. The minimum follow-up was 12 months. The mean distance the patients were able to run per week following the surgical treatment improved from 14.1 to 38.1 km (P = .042) and the mean Tegner score improved from 3.92 to 7.08 (P = .01). Notably, 12 out of 13 patients were satisfied or very satisfied with the outcome. In this sample, the mini open technique improved patients' sports performance and quality of life and minimized pain. Chronic exertional compartment syndrome can be safely approached using a mini open technique with a good rate of satisfaction and return to sport.Levels of Evidence: IV.

Ankle fractures malreduction rate and its causes in two Brazilian tertiary training hospitals.

INTRODUCTION: Ankle fractures are one of the most frequent injuries managed by any trauma surgeon. Literature has shown that adequate reduction is of utmost importance to achieve satisfactory functional outcomes. However, malreduction rates remain high worldwide. The objective of the present study is to evaluate the quality of ankle fracture reduction in two major trauma centers in a large Brazilian city and to analyze the factors associated with malreduction METHODS: Epidemiologic data of 382 patients (189 men; 193 women) aged between 7 and 87 years who underwent osteosynthesis of the ankle in two trauma centers in a large Brazilian city. Electronic clinical records, preoperative and immediate postoperative radiographs in anteroposterior (AP), lateral and mortise views were evaluated. Pettrone's criteria were used to evaluate the quality of ankle fractures reduction. All radiographs were independently evaluated by two foot and ankle senior surgeons RESULTS: Overall, malreduction rate was 22.2%. Forty-seven (55.2%) fractures classified as malreduced had medial malleolar displacement The results showed three factors that significantly affected the quality of reduction (p<0.05), patients over 60 years, open fractures and fracture-dislocations. Patients aged over 60 years were twice more likely to have poor reduction of ankle fractures than younger ones. The risk of poor fracture reduction among those individuals with open fractures is 2.15 times greater than among patients with closed injuries. Fracture-dislocation imposed a 2.7 higher risk for malreduction DISCUSSION: We found a malreduction rate below most series previously published. Further results agree with the literature. Elderly people aged over 60 years, fracture dislocations and open fractures are associated with worse results, influencing the quality of the reduction, clinical outcomes, and the development of post-traumatic arthrosis CONCLUSION: Ankle fractures malreduction are associated with higher age, open fractures, and fracture-dislocations.

Infinity Ankle Arthroplasty Early Latin-America Experience and Patient Outcomes.

INTRODUCTION: The promising data from Ankle Arthroplasty are consequence of the evolution of instruments and implants. Recent studies have shown good results in the short and intermediate follow-up, in addition to high patient satisfaction. The aim of this study is to present the results obtained with 49 cases treated with the Infinity total ankle prosthesis in 2 South America countries. METHODS: This is a case series of 48 patients (27 women and 22 men), treated with 49 Infinity prostheses in Brazil and Colombia. They underwent surgical treatment between April 1, 2016, and January 18, 2020. We used the visual-analogue pain scale (VAS), the AOFAS score for ankle and hindfoot and the measurement of range of motion (ROM) in the pre- and post-surgical period. The radiological evaluation was performed on ankle radiographs in anteroposterior and lateral views, obtained in orthostasis, measuring the parameters suggested by Hintermann. Average follow-up was 4 years. RESULTS: VAS reduced from an average of 7.94 to 1.98; AOFAS increased from 28.02 to 83.16 and ROM increased from 11.45 to 28.08. Distal Tibial Slope is higher for higher improvements in VAS and lower for higher improvements in AOFAS and ROM. We observed 4 wound infections, 1 intra-op medial malleolus fracture. No bone cysts, tibial or talar components subsidence, polyethylene component wear or failure were observed. No salvation procedures were required in this series. DISCUSSION: This study results corroborates literature data showing great improvements in pain, functional pattern, and movement. CONCLUSION: Infinity Ankle Arthroplasty is a safe and reproducible procedure with good outcomes at a short-term follow-up. LEVEL OF EVIDENCES: 4 - Case series.

Minimally Invasive Chevron Akin: Locking The Metatarsal-Cuneiform Joint.

INTRODUCTION: Minimally Invasive Chevron Akin (MICA) can be used to treat hallux valgus (HV) associated with a hypermobility of the first metatarsal-cuneiform joint (1MTCJ). The aim of this study was to perform a radiographic analysis of the MICA, focused on evaluating the 1MTCJ. METHODS: Forty patients (50 feet) with moderate to severe HV underwent a MICA procedure. Radiographic analysis included hallux valgus angle (HVA), intermetatarsal angles between the first and second rays (IMA), the intermetatarsal angle between the proximal fragment of the osteotomy and the second ray (IAPF) and the distance between a point 3 cm distal from the base of the second metatarsal and a point located at the same height for the first metatarsal base (Dist 1-2). The IAPF was compared with the preoperative IMA, and the other parameters were compared preoperatively and postoperatively. The radiographic complications were also recorded. RESULTS: Most patients were female (92%). The mean age was 50.4 years (SD = 16.1) and the mean follow-up was 16.1 months (SD = 3.5). The average HVA improved from 32.5° to 7.3°, and the average IMA from 14.2° to 4.2°. The IAPF and Dist1-2 values showed an increase of 4.8° and 4.0 mm respectively. There were no radiographic complications. Conclusion. Minimally invasive Chevron Akin promotes a great correction of the moderate to severe HV conventional parameters and increase the transversal stability of the 1MTCJ fixing this joint as medial as possible. LEVEL OF EVIDENCE: Level IV, case series.

Percutaneous Bunionette Correction: Retrospective Case Series.

Introduction. Bunionette is a deformity of the fifth metatarsal in which there is a painful lateral bony prominence of the distal region of this bone caused by various anatomical and biomechanical changes. The aim of this study is to report on a minimally invasive technique without the use of hardware to treat these deformities. Methods. This is a case series of 18 patients, 25 feet, who underwent bunionette percutaneous surgical treatment. All patients answered the American Orthopaedic Foot and Ankle Society (AOFAS) scale and the visual analogue pain scale (VAS) preoperatively and at the last follow-up. Standard radiological evaluation included measurement of intermetatarsal (4-5 IMA) and fifth toe metatarsophalangeal (5-MTTP) angles. Time to radiographic consolidation, complications, and satisfaction rate were also documented. Results. The average follow-up was 15.9 months, the AOFAS increased from 49.6 to 92.4 and the VAS decreased from 7.7 to 1.2. It was observed that average 5-MTTP decreased from 15° to 2.7° and that 4-5-IMA decreased from 9.1° to 3.3°. These outcomes showed a statistically significant difference (P < .001). The most common observed complication was the formation of a hypertrophic bone callus in the third postoperative month in three operated feet (12%). One patient had algodystrophy, which improved after conservative treatment. There were no cases of infection, neuropraxis, or recurrences. Fifteen patients rated the result as excellent, 2 as good, and 2 as regular. Conclusion. Percutaneous osteotomy of the fifth metatarsal without the use of hardware is a safe, reproducible technique and presents good clinical and radiographic results for the treatment of bunionette.Levels of Evidence: Therapeutic studies, Level IV: Case series.

Corin ankle arthroplasty: Case-series.

BACKGROUND: Total Ankle Arthroplasty (TAA) is complex and can bring a wide variety of complications. Implant revision rates can vary from 4% to 8% in 5 years. Recent publications have shown good results in the short and intermediate follow-up and high patient satisfaction. The pre- and postoperative evaluation of these patients should include physical examination and objective radiographic measurements, which may have predictive value for implant failures and survivorship. In this paper we will present the results obtained with 29 patients treated with the Zennith (Corin Group, UK) total ankle prosthesis in Brazil. METHODS: This paper presents the results obtained with 29 patients treated with the Corin-Zennith prosthesis in three tertiary hospitals in Brazil, with an average follow-up of 5 years. The patients were submitted to clinical and radiographic evaluation. There were seventeen women and twelve men, ranging in age from 35 to 76 years, who were submitted to surgical treatment between January 16, 2013 and May 5, 2017. RESULTS: Seven patients (24%) presented cysts, being 4 (13.7%) tibial cysts and 3 (10.3%) tibial and talar cysts. Six patients (20.6%) presented talar subsidence and 3 (10.3%) presented tibial subsidence. Three patients (10.3%) presented component wear. VAS reduced and AOFAS and ROM increased in the post-operative period. The development of Cysts was associated with the theta angle and the difference in LTS (between the post and preoperative period) was associated with tibial subsidence. The complications rate was 44.8%, the revision rate was 6.9% and the survivorship rate was 93.1%. CONCLUSION: The Corin-Zennith prosthesis demonstrated to be a safe implant for improving functional parameters. Functional outcomes were not influenced for most commonly measured radiographic parameters. Further studies are needed to better understand these associations.

Planejamento pré-operatório de correção de deformidades supramaleolares através de impressão 3D / Preoperative planning of supramaleolar deformities correction through 3D printing

Planejamento pré-operatório de correção de deformidades supramaleolares através de impressão 3DRELATO DE CASOModelos impressos em 3D têm sido explorados profundamente no campo médico, destacando-se como importante ferramenta de auxílio para planejamento cirúrgico. Os autores apresentam relato de caso de um paciente, com artrose pós-traumática do tornozelo direito, submetido a osteotomia supramaleolar, em cunha de fechamento medial. Esta cirurgia foi realizada após planejamento operatório por impressão 3D, o que pode demonstrar reprodutibilidade deste método. (AU)

3D printed models have been explored deeply in the medical field, standing out as an important aid tool for surgical planning. The authors present a case report of a patient with post-traumatic arthrosis of the right ankle, who underwent supramaleolar osteotomy, using a medial closure wedge. This surgery was performed after operative planning by 3D printing, which can demonstrate the reproducibility of this method. (AU)

Fifth Metatarsal Fractures in Professional Soccer Players: Case Series.

OBJECTIVE: Fifth metatarsal fractures occur mainly in young athletes, with an estimated incidence of 1.8 per 1000 individuals per year. This study aims to evaluate the functional outcome of professional soccer players undergoing surgical treatment of fifth metatarsal base fractures. METHODS: We appraised 34 soccer players operated on from July 2001 to June 2016. All individuals were assessed by the American Orthopedic Foot and Ankle Score (AOFAS) and Visual Analog Scale (VAS) before and after surgery, with a mean 23-month follow-up. The need for grafting, fracture healing, Torg classification, and return to sports were also evaluated. RESULTS: There were 10 attackers, 7 offensive-defensive midfielders, 6 side defenders, 5 central defensive midfielders, 3 defenders, 2 goalkeepers, and 1 defensive midfielder, at an average age of 19 years. Preoperative and postoperative AOFAS averaged 42 and 99 points, respectively, whereas VAS scores were 6 and 0. The longer the time to get operated on, the greater was the need for grafting (P = .011). In our study, all fractures have consolidated. Return to sports occurred, on average, 73 days after surgical treatment, and it was not influenced by the time to get operated on, fracture healing, Torg classification, and grafting. CONCLUSION: Surgical treatment of the fifth metatarsal base fracture in professional soccer players presents good clinical results. Getting back to activities after surgery is not influenced by surgery time, fracture healing, Torg classification, and grafting.Levels of Evidence: Level IV: Therapeutic studies, Case series.

Medial and Lateral Combined Ligament Arthroscopic Repair for Multidirectional Ankle Instability.

BACKGROUND: The high prevalence of ankle sprains in the population produces a significant number of patients with lateral instability. Persistence of this condition may lead to the progressive involvement of medial structures, causing a multidirectional rotational instability. METHODS: This is a retrospective study with patients diagnosed with multidirectional instability who underwent ankle arthroscopy with medial (arthroscopic tensioning) and lateral repair (arthroscopic Bröstrom) between January 2018 and January 2020. All patients were evaluated for pain and function according to the visual analog scale (VAS) score and the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score at a mean of 14.8 months (5-27 months) in follow-up. A total of 30 ankles (29 patients) were included in the study. RESULTS: The AOFAS score increase from a 49.7 (CI 5.8) to a 91.9 (CI 2.4) mean (P = .001) and was followed by significant improvement in the mean VAS score (6.8, CI 0.37-0.95, CI 0.31). The majority of patients had associated procedures (53.3%), and a low complication rate was found (16.6%). CONCLUSION: Combined medial and lateral arthroscopic repair might be an effective and safe alternative in the treatment of multidirectional instability. Inclusion of the deltoid ligament complex and the low invasiveness of the arthroscopic technique may improve the clinical outcomes of these patients. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Is there clinical evidence to support autologous matrix-induced chondrogenesis (AMIC) for chondral defects in the talus? A systematic review and meta-analysis.

BACKGROUND: The aim of this study is to systematically review the literature on clinical outcomes of patients who have undergone autologous matrix-induced chondrogenesis (AMIC) for treatment of osteochondral lesions of the talus (OCL) and compare the studies' outcomes. METHODS: Pubmed and Embase were searched in January 2020 for articles concerning OCL surgery. Studies were included if they had a minimum 1-year follow-up and the primary measures were functional outcomes. The meta-analysis compared the Visual Analogic Score (VAS), the American Orthopedic Foot and Ankle Score (AOFAS), and the Foot Function Index (FFI) between baseline and follow-up of 1-2years, and 3-5years. A random effects model was used to evaluate outcome changes. RESULTS: The search returned 15 studies, with a total of 492 patients. The VAS improved 4.45 and 4.6 points from baseline to the 1-2year and 3-5yearfollow-up, respectively (p<0.001). AOFAS improved 31.59 and 32.47 points from baseline to the 1-2year and 3-5yearfollow-up, respectively (p<0.001). The FFI showed a significant improvement of 30.93 points from baseline to year 3-5 (p<0.001). A total of 6 patients with revision surgeries have been reported within the follow up period. It was not possible to correlate clinical features like lesion size, surgical approach, and bone marrow stimulation technique to the reported outcome. CONCLUSION: Surgical treatment of OCL via the AMIC procedure provided significant improvement in the functional outcome and pain scores when compared to the pre-operative values. Improvements were observed up to 5years post-operatively.

Diabetic foot and its serial treatment in high-risk patients: focusing on the individual.

OBJECTIVES: To assess knowledge about diabetic foot, care measures, and the importance attached to serial treatment in a group of high-risk diabetic foot patients. METHODS: This is a cross-sectional study, carried out in a tertiary hospital, with 25 patients undergoing serial treatment for diabetic foot. The tabulation of the data occurred through the use of three methodological figures: core idea, key expressions, and the collective subject discourse. RESULTS: It became evident that even among high-risk patients with diabetic foot, there is no complete knowledge about the definition of the disease. Despite this, all participants reported practicing daily care measures, including frequent inspection of the feet, food care, and attention to footwear. Regarding the importance of serial treatment, there was unanimous recognition of the relevance of this practice, which improves self-care discipline, optimizes the understanding of the disease, and helps to prevent progression. CONCLUSIONS: Authentic speeches in the context of a pathology of considerable prevalence manifested, in an unprecedented way, with conceptions about its definition, care measures, and importance of serial treatment in a high-risk group.

Diabetic foot and its serial treatment in high-risk patients: focusing on the individual

SUMMARY Objectives: To assess knowledge about diabetic foot, care measures, and the importance attached to serial treatment in a group of high-risk diabetic foot patients. METHODS: This is a cross-sectional study, carried out in a tertiary hospital, with 25 patients undergoing serial treatment for diabetic foot. The tabulation of the data occurred through the use of three methodological figures: core idea, key expressions, and the collective subject discourse. RESULTS: It became evident that even among high-risk patients with diabetic foot, there is no complete knowledge about the definition of the disease. Despite this, all participants reported practicing daily care measures, including frequent inspection of the feet, food care, and attention to footwear. Regarding the importance of serial treatment, there was unanimous recognition of the relevance of this practice, which improves self-care discipline, optimizes the understanding of the disease, and helps to prevent progression. CONCLUSIONS: Authentic speeches in the context of a pathology of considerable prevalence manifested, in an unprecedented way, with conceptions about its definition, care measures, and importance of serial treatment in a high-risk group.

RESUMO OBJETIVOS: Avaliar o conhecimento sobre o pé diabético, medidas de cuidado e importância atribuída ao tratamento seriado em um grupo de alto de risco de portadores de pé diabético. MÉTODOS: Este é um estudo transversal, realizado em um hospital terciário, com 25 pacientes submetidos ao tratamento seriado do pé diabético. A tabulação dos dados ocorreu por meio da utilização de três figuras metodológicas: ideia central, expressões-chave e o discurso sujeito coletivo. RESULTADOS: Evidenciou-se que mesmo entre pacientes de alto risco do pé diabético, não há conhecimento pleno sobre a definição da doença. Apesar disso, todos os participantes relataram praticar medidas diárias de cuidado, incluindo inspeção frequente dos pés, cuidado alimentar e atenção aos calçados. Sobre a importância do tratamento seriado, foi unânime o reconhecimento da relevância dessa prática, a qual melhora a disciplina dos autocuidados, otimiza a compreensão da doença e ajuda a prevenir a progressão. CONCLUSÕES: Discursos autênticos no âmbito de uma patologia de considerável prevalência manifestaram, de forma inédita, as concepções sobre definição, medidas de cuidado e importância do tratamento seriado em um grupo de alto risco.

Comparison of Suture-Augmented Ligamentplasty to Transarticular Screws in a Lisfranc Cadaveric Model.

BACKGROUND: Lisfranc injuries represent a spectrum of trauma from high-energy lesions, with significant instability of the midfoot, to low-energy lesions, with subtle subluxations or instability without gross displacement. Recently, treatment options that allow for physiologic fixation of this multiplanar joint are being evaluated. The purpose of this study was to analyze the stability of a cadaveric Lisfranc injury model fixed with a novel suture-augmented neoligamentplasty in comparison with a traditional transarticular screw fixation construct. METHODS: Twenty-four fresh-frozen, matched cadaveric leg and foot specimens (12 individuals younger than 65 years of age) were used for this study. Two different types of Lisfranc ligament injuries were tested: partial and complete. Two different methods of fixation were compared: transarticular screws and augmented suture ligamentplasty with FiberTape. Specimens were fixed to a rotation platform in order to stress the joints while applying 400 N of axial load and internal and external rotation. Six distances were measured and compared between the intact, injured, and fixed states with a 3D Digitizer arm, in order to evaluate the stability between them. Analysis of variance was used with P < .05 considered significant. RESULTS: Using distribution graphs and analyzing the grouped data, it was observed that there was no difference between the 2 stabilization methods, but the augmented suture ligamentplasty presented lower variability and observed distance shortenings were more likely to be around the mean. The variability of the stabilization with screws was 2.9 times higher than that with tape (P < .001). CONCLUSION: We suggest that augmented suture ligamentplasty can achieve similar stability to classic transarticular screws, with less variability. CLINICAL RELEVANCE: This cadaveric study adds new information on the debate about Lisfranc lesions treatment. Flexible fixations, such as the synthethic ligamentplasty used, can restore good stability such as conventional transarticular screws.

Biomechanical Evaluation With a Novel Cadaveric Model Using Supination and Pronation Testing of a Lisfranc Ligament Injury.

BACKGROUND: Lisfranc joint injuries can be due to direct or indirect trauma and while the precise mechanisms are unknown, twisting or axial force through the foot is a suspected contributor. Cadaveric models are a useful way to evaluate injury patterns and models of fixation, but a frequent limitation is the amount of joint displacement after injury. The purpose of this study was to test a cadaveric model that includes axial load, foot plantarflexion and pronation-supination motion, which could re-create bone diastasis similar to what is seen in subtle Lisfranc injuries. Our hypothesis was that applying pronation and supination motion to a cadaveric model would produce reliable and measurable bone displacements. METHODS: Twenty-four fresh-frozen lower leg cadaveric specimens were used. The medial (C1) and intermediate (C2) cuneiforms and the first (M1) and second (M2) metatarsal bones were marked. A complete ligament injury was performed between C1-C2 and C1-M2 in 12 specimens (group 1), and between C1-C2, C1-M2, C1-M1, and C2-M2 in 12 matched specimens (group 2). Foot pronation and supination in addition to an axial load of 400 N was applied to the specimens. A 3D digitizer was used to measure bone distances. RESULTS: After ligament injury, distances changed as follows: C1-C2 increased 3 mm (23%) with supination; C1-M2 increased 4 mm (21%) with pronation (no differences between groups). As expected, distances between C1-M1 and C2-M2 only changed in group 2, increasing 3 mm (14%) and 2 mm (16%), respectively (no differences between pronation and supination). M1-M2 and C2-M1 distances did not reach significant difference for any condition. CONCLUSIONS: Pronation or supination in addition to axial load produced measurable bone displacements in a cadaveric model of Lisfranc injury using sectioned ligaments. Distances M1-M2 and C2-M1 were not reliable to detect injury in this model. CLINICAL RELEVANCE: This new cadaveric Lisfranc model included foot pronation-supination in addition to axial load delivering measurable bone diastasis. It was a reliable Lisfranc cadaveric model that could be used to test different Lisfranc reconstructions.

Rotational biplanar Chevron osteotomy.

INTRODUCTION: The Chevron osteotomy is a reliable and popular osteotomy for treating hallux valgus worldwide. Many modifications have been described, but none of them address the rotational deformity of the first metatarsal. The objective of this study is to describe a variation of biplanar Chevron osteotomy which can address first metatarsal rotation when necessary. METHODS: The indications for the Rotational Biplanar Chevron Osteotomy (RBCO) are mild to moderate hallux valgus deformity associated with hallux pronation related to internal rotation of the first metatarsal bone. We describe a technique that uses a medial based wedge parallel to the plantar limb of the osteotomy in order to make the distal fragment free to correct rotation. RESULTS: The more recent concern about hallux valgus surgery is the very interesting concept that this deformity really occurs in three different planes, and we may have mistreated the rotation component with our current techniques. Many authors have revisited many common techniques in order to adapt them to correct metatarsal pronation. To our best knowledge, this is the first paper to describe a modification of the Chevron osteotomy to address the rotation of the first metatarsal. CONCLUSION: We can conclude that the rotational biplanar Chevron osteotomy can be an useful tool in the treatment of mild hallux valgus associated with metatarsal pronation.

Avaliação biomecânica das lesões ligamentares do complexo articular de Lisfranc: novo modelo cadavérico utilizando estresse em supinação e pronação / Biomechanical evaluation of ligament injuries of the Lisfranc joint complex: new cadaveric model using stress in supination and pronation

Introdução: as lesões no complexo articular de Lisfranc ocorrem devido a trauma direto ou indireto, no qual forças de torção ou axiais são transmitidas ao pé. Os modelos cadavéricos são úteis para avaliar padrões de lesões e modelos de fixação, mas frequentemente a quantidade de deslocamento articular após a lesão torna-se um limitador. O objetivo deste estudo foi testar um modelo cadavérico que inclui carga axial, flexão plantar do pé e movimentos de pronação-supinação, recriando diástase óssea semelhante ao observado em lesões sutis de Lisfranc na prática clínica. Nossa hipótese é de que a aplicação do movimento de pronação e supinação em um modelo cadavérico produziria deslocamentos ósseos confiáveis e mensuráveis. Métodos: foram utilizadas 24 amostras cadavéricas frescas congeladas amputadas abaixo do nível do joelho. Os ossos cuneiformes medial e intermédio, o primeiro e o segundo metatarsos, foram marcados. Uma lesão ligamentar completa foi realizada entre os cuneiformes medial e intermédio e entre o cuneiforme medial e o segundo metatarso em 12 amostras (grupo 1) e adicionou-se a lesão dos ligamentos entre o primeiro metatarso e o cuneiforme medial e entre o segundo metatarso e o cuneiforme intermédio em 12 amostras correspondentes (grupo 2). Pronação e supinação do pé, além de uma carga axial de 400 N, foram aplicadas às amostras, utilizando-se o Instrom Testing Machine. Um digitalizador tridimensional (3D) foi utilizado para medir as distâncias entre os ossos. Resultados: para o grupo de lesão parcial (grupo 1), as distâncias referentes aos ossos nos quais os ligamentos foram seccionados apresentaram aumento na condição lesionada tanto em pronação quanto em supinação, como esperado. Em relação à distância entre o cuneiforme intermédio e o primeiro metatarso e entre o primeiro e o segundo metatarsos, observou-se diminuição na condição lesionada em pronação e aumento em supinação. Para o grupo de lesão completa (grupo 2), as distâncias referentes aos locais de secção dos ligamentos apresentaram aumento na condição lesionada tanto em pronação quanto em supinação, como esperado. No tocante à distância entre o cuneiforme intermédio e o primeiro metatarso e entre o primeiro e o segundo metatarsos, verificou-se o mesmo padrão de comportamento das lesões parciais. Conclusão: o modelo biomecânico cadavérico para lesões do complexo articular de Lisfranc desenvolvido neste estudo simula o mecanismo de estresse clínico da lesão e o tipo de lesão mais comum, exibe variações de distâncias fidedignas e mensuráveis e foi desenvolvido para permitir o teste do tratamento da lesão sem interferência nos dispositivos de aferição, podendo se constituir em excelente método para a comparação de técnicas de fixação das lesões ligamentares tarsometatarsais.

Introduction: Lesions in the Lisfranc joint complex occur due to direct or indirect trauma, where a torsional or axial force is transmitted to the foot. Cadaveric models are a useful way to assess injury patterns and fixation models, but a frequent limitation is the amount of joint dislocation after injury. The aim of this study was to test a cadaveric model that includes axial load, plantar flexion of the foot and pronation-supination movement, recreating bone diastasis similar to that observed in subtle Lisfranc lesions in clinical practice. Our hypothesis is that the application of pronation and supination motion in a cadaveric model would produce reliable and measurable bone displacements. Methods: Twenty-four fresh frozen cadaveric leg samples were used. The medial (C1) and intermediate (C2) cuneiform bones, the first (M1) and second (M2) metatarsal bones were marked. A complete ligament injury was performed between C1-C2 and C1-M2 in 12 samples (Group 1) and between C1-C2, C1-M2, C1-M1 and C2-M2 in 12 corresponding samples (Group 2). Foot pronation and supination, in addition to an axial load of 400 N, were applied to the samples. A 3D scanner was used to measure the distances between the bones. Results: For the partial lesion group (Group 1), in which the ligaments between C1-C2 and C1-M2 were injured, these distances increased in the injured condition in both pronation and supination, as expected. Regarding the distance C2-M1 and M1-M2, there was a decrease in the injured condition in pronation and an increase in supination. For the complete lesion group (Group 2), in which the ligaments between C1-C2, C1-M2, C1-M1, and C2-M2 were injured, these distances increased in injured condition both in pronation and supination, as expected. Regarding the behavior of distances C2-M1 and M1-M2, the same behavior pattern was observed as in partial injuries. Conclusion: The cadaveric biomechanical model for Lisfranc joint complex injuries developed in this study simulates the mechanism of clinical stress of the lesion and the most common type of lesion, exhibits reliable and measurable distances, and allows lesion treatment without compromise, being, possibly, an excellent method for comparing tarsometatarsal ligament injury fixation methods.

Subtalar arthroscopic debridment for the treatment of sinus tarsi syndrome: case series.

OBJECTIVE: The objective of this study is to report the results of arthroscopic debridement of the subtalar joint in eight patients with Sinus Tarsi Syndrome (STS) refractory to conservative treatment. METHODS: This is a retrospective study of eight patients with STS who underwent subtalar arthroscopy for debridement of the sinus tarsi between January 2015 and January 2017 after six months of conservative treatment. All patients answered an epidemiological questionnaire and underwent functional evaluation with the Visual Analogue Pain Scale (VAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) in the preoperative and in the last evaluation (average of 12 months - 6-24 months). RESULTS: All patients showed severe synovitis in the region. Seven patients had remnants of the talocalcaneal ligaments and six of the cervical ligament. AOFAS increased by 30 points on average (51.75 in the preoperative period to 82.62 in the last follow-up) and the VAS decreased on average by 5 points (7.37 preoperatively to 2.12 in the last follow-up). These results were statistically significant with p = 0.043 and p = 0.032 respectively. Six patients described the result as excellent and two as good. No complications were reported. All patients returned to sports after six months of follow-up. CONCLUSION: The arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. More studies, with a prospective methodology, are necessary to prove the results of this technique.

Subtar arthroscopic debridment for the treatment of sinus tarsi syndrome: case series

SUMMARY OBJECTIVE: The objective of this study is to report the results of arthroscopic debridement of the subtalar joint in eight patients with Sinus Tarsi Syndrome (STS) refractory to conservative treatment. METHODS: This is a retrospective study of eight patients with STS who underwent subtalar arthroscopy for debridement of the sinus tarsi between January 2015 and January 2017 after six months of conservative treatment. All patients answered an epidemiological questionnaire and underwent functional evaluation with the Visual Analogue Pain Scale (VAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) in the preoperative and in the last evaluation (average of 12 months - 6-24 months). RESULTS: All patients showed severe synovitis in the region. Seven patients had remnants of the talocalcaneal ligaments and six of the cervical ligament. AOFAS increased by 30 points on average (51.75 in the preoperative period to 82.62 in the last follow-up) and the VAS decreased on average by 5 points (7.37 preoperatively to 2.12 in the last follow-up). These results were statistically significant with p = 0.043 and p = 0.032 respectively. Six patients described the result as excellent and two as good. No complications were reported. All patients returned to sports after six months of follow-up. CONCLUSION: The arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. More studies, with a prospective methodology, are necessary to prove the results of this technique.

RESUMO OBJETIVO: O objetivo desse estudo é relatar os resultados do desbridamento artroscópico da subtalar em oito pacientes portadores da Síndrome do Seio do Tarso (SST) refratária ao tratamento conservador. MÉTODOS: Este é um estudo retrospectivo com oito pacientes com diagnóstico de STT que foram submetidos à artroscopia subtalar para desbridamento do seio do tarso entre janeiro de 2015 e janeiro de 2017, após seis meses de tratamento conservador. Todos os pacientes responderam questionário epidemiológico e foram submetidos à avaliação funcional com a Escala Visual Analógica de dor (EVA) e o American Orthopaedic Foot and Ankle Society Score (Aofas) no pré-operatório e na última avaliação, em uma média de 12 meses (6-24 meses). RESULTADOS: Todos os pacientes exibiram intensa sinovite na região. Sete pacientes tinham resquícios de ligamentos talocalcaneanos e seis do ligamento cervical. O Aofas aumentou 30 pontos em média (51,75 no pré-operatório para 82,62 no último seguimento) e a EVA diminuiu em média 5 pontos (7,37 no pré-operatório para 2,12 no último seguimento). Esses resultados foram estatisticamente significativos com p = 0,043 e p = 0,032, respectivamente. Seis pacientes descreveram o resultado como excelente e dois como bom. Nenhuma complicação foi relatada. Todos os pacientes retornaram ao esporte após seis meses de acompanhamento. CONCLUSÃO: O desbridamento artroscópico da subtalar é uma alternativa eficaz e segura no tratamento da SST refratária ao tratamento conservador. Mais estudos, com metodologia prospectiva, são necessários para comprovar os resultados da técnica.