Laser-Guided Intraoperative Navigation in Total Ankle Replacement Surgery.

BACKGROUND: This study aimed to evaluate the effectiveness of laser-guided intraoperative navigation compared with the conventional method in determining the accuracy of coronal alignment setting in total ankle replacement (TAR). MATERIAL AND METHODS: Sixteen cadaveric ankles were randomly divided into two groups: laser-guided and conventional. Measurements were performed following coronal alignment setting in each ankle. All parameters were collected and compared between the two groups to determine the accuracy of coronal alignment setting regarding localization of possible mechanical axis (PMA) from each method. These parameters included the distance from the most medial point of tibial surface (TS) (intra-articular part) to the marked point that was possibly close to MA (MM-PMA). RESULTS: There were no significant differences between the two groups; however, there was a trend toward more neutralization of PMA in the laser-guided group in terms of MM-PMA distance (P = 0.19). In addition, the ratio of MM-PMA to TS demonstrated that the axis closer to the actual mechanical axis (AMA) with medial deviation was only 0.6% in laser group, whereas the axis caused increased lateralization from AMA in the conventional group, which was as high as 4.4% (P = 0.15). CONCLUSION: Despite the limited sample size and insignificant differences of outcomes between the two groups, laser-guided intraoperative navigation provided higher accuracy of coronal alignment setting than the conventional method in TAR.

Minimally invasive surgery versus an arthroscopic procedure for the first metatarsophalangeal arthrodesis: A comparative study of the effectiveness and safety profile.

INTRODUCTION: First metatarsophalangeal (MTP) arthrodesis is a common procedure for treating degeneration in the MTP joint. Open arthrodesis is a conventional procedure that provides acceptable results but is more invasive than minimally invasive or arthroscopic arthrodesis. However, little is known about the different outcomes between minimally invasive surgery (MIS) and arthroscopic surgery (AS) for MTP arthrodesis. This study was performed to compare the outcomes of the first MTP joint preparation for arthrodesis regarding the effectiveness of articular surface preparation and safety between MIS and the arthroscopic procedure in cadaveric specimens. METHODS: Sixteen cadaveric feet were collected in this study from eight cadavers. The potential exclusion criteria were significantly decomposed or deformed joint. All feet were randomly allocated into two groups, eight feet for the MIS (under fluoroscopic control) group and eight feet for the arthroscopic group. One foot in the AS group was excluded because the position of an arthroscopic portal was incorrect. All feet were operated on by four fellowship-trained foot and ankle orthopedic surgeons who also had prior clinical experience with the arthroscopic and minimal invasive procedure. Following a complete procedure in each specimen, all feet were dissected and the areas of joint preparation on the metatarsal and phalangeal sides were recorded via photography and the ImageJ program. Injury to the adjacent structure was noted in each specimen. All data were analyzed via the IBM SPSS program version 22 and GraphPad to compare the outcomes between the two groups. RESULTS: The average age of the cadavers was 68.6 ± 12.3 years. The average areas of joint preparation on the metatarsal and phalangeal sides were 136.97 and 99.08 mm2, respectively. The average areas of joint preparation on the metatarsal sides were 154.26 and 117.21 mm2 in the MIS and arthroscopic groups, respectively (p value = 0.353). The average areas of joint preparation on the phalangeal sides were 82.46 and 118.08 mm2 in the MIS and arthroscopic groups, respectively (p value = 0.151). Regarding the ratio of prepared area/mean estimated fusion contact area, there was no significant difference of a ratio on metatarsal side with p value as 0.285. However, a higher level of ratio on phalangeal side was found in the arthroscopic group with p value as 0.085. For the safety profiles, the rate of adjacent injury was insignificantly higher in the MIS group (37.5%) than the arthroscopic group (0%) (p value = 0.20). All injuries were found at the extensor hallucis longus tendon. CONCLUSIONS: There were no significant differences of the effectiveness of articular surface preparation between the MIS and arthroscopic groups. However, the arthroscopic procedure seemed to provide higher rate of prepared surface area on phalangeal side and be safer to the adjacent structures than MIS for this arthrodesis.

Total talar prosthesis with and without ankle ligament reconstruction using the three-dimensional computer-aided design and computer numerical control manufacturing techniques.

Severe damage and bone loss of the talus are problematic issues because of its unique shape, function, and characteristics. This present study's objective is to propose the process of customized total talar prosthesis manufacturing, using three-dimensional (3D) Computer-Aided Design (CAD) with Computer Numerical Control (CNC) production along with evaluation of the results of total talar prosthesis replacement with or without ankle ligament reconstruction in patients with severe conditions of talus. The case series included five patients (mean age: 27.6 years) with severe talar loss or damage. The mean follow-up time was 17.8±8.4 months. Related complications were: i) mild subsidence in 1 patient (20%) and ii) periprosthetic fracture in another patient (20%). The mean clinical scores including VAS-FA and SF-36 were improved following surgeries. Customized total talar prosthesis appears to provide satisfactory outcomes for the treatment of severe talar loss or damage at a short-term follow-up.

Morphometric geometric differences between right and left human tali: A cadaveric study of fluctuating asymmetry via systematic measurement and three-dimensional scanning.

BACKGROUND: Little is known about differences in the size and morphology of the right and left human tali. The present study demonstrates differences between right and left talar morphometric geometric profiles as fluctuating asymmetry in matched pairs of cadaveric specimens. METHODS: In total, 24 tali were collected in this study. All eligible tali were systematically measured with a Vernier caliper and three-dimensional laser scanner, which provided data for further analysis regarding the talar morphometric geometric profiles. Data were calculated to demonstrate differences between the right and left talar profiles using a matched-pair method, including the general size of the talus. RESULTS: The average talar length was 53.5 mm, the average talar dome height was 31.2 mm, and the average talar body width was 41.3 mm. The average anterior trochlear width, middle trochlear width, posterior trochlear width, and trochlear length were 31.8, 31.2, 28.3, and 30.7 mm, respectively. Eleven matched pairs of intact tali were eligible for the matched-pair study. Paired t-tests showed significant differences in the talar dome height (P = 0.019), middle trochlear width (P = 0.027), and posterior trochlear width (P = 0.016) between the right and left tali. However, there were no significant differences in the surface area or volume between the right and left tali. CONCLUSION: Significant differences in the morphometric profile were found between the right and left matched pairs of tali. This basic information indicates that the profile of the contralateral talus may not be used as a single reference to reconstruct or duplicate the talus of interest in certain conditions such as talar prosthesis implantation or customized total ankle replacement.

Talar-sided osteochondral lesion of the subtalar joint following the intra-articular calcaneal fracture: study via a modified computed tomography mapping analysis.

INTRODUCTION: This study is to report the prevalence of osteochondral lesions in subtalar joint following intra-articular calcaneal fracture, including the relationship between fracture severity and lesion characteristics, using modified computed tomography (CT) mapping analysis. METHODS: Thirty patients with intra-articular calcaneal fracture who were preoperatively imaged with modified CT mapping analysis were recruited. The presence of talar-sided osteochondral lesions (OLTS) of subtalar joint was noted with lesion area defined by Akiyama's mapping classification. Lesion severity was assessed via Ferkel's classification, and fracture severity via Sanders' classification. RESULTS: Lesions were found in 28 patients (93.3%), mostly at anterior [16 (57.1%) lesions] or central [13 (46.4%) lesions] areas of posterior talar facet. Most common grade of lesion severity was grade I (mild) seen in 24 (80%) patients. Most fractures were classified as Sanders' grade III and IV with 12 (40%) and 12 (40%) patients noted, respectively. High severity of fracture denoted by Sanders' grade IV showed a trend of higher prevalence of OLTS at anterior and central sites of posterior talar facet (P = 0.181). Lesion severity was significantly higher in patients with double lesions than patients with single lesions (P = 0.005). However, OLTS were not significantly related with osteoarthritic changes in follow-up radiographs (P > 0.05). CONCLUSIONS: The prevalence of OLTS is very high following intra-articular calcaneal fractures. Most lesions occur at anterior or central area of posterior talar facet and are more likely to occur in patients with higher fracture severity. Lesion severity was significantly higher in patients with double lesions than patients with single lesions.

Peroneal Tendoscopic Debridement and Endoscopic Groove Deepening in the Prone Position.

Tendoscopy of the peroneal tendon is a promising procedure for the treatment of peroneal tendon pathology and its disorders. This procedure is minimally invasive with less physical morbidity and early functional rehabilitation. The present report demonstrates the techniques of peroneal tendoscopic debridement and endoscopic groove deepening in the prone position to treat peroneal tenosynovitis and low-lying muscle belly of peroneus brevis with a shallow and flat surface of the retro-malleolar groove. The prone position provided better ergonomics during this procedure compared with the supine position.