ObjectiveTo summarize the current status and progress of the treatment of chronic lateral ankle instability (CLAI). MethodsThe literature about the anatomical repair of CLAI at home and abroad was reviewed and summarized. ResultsBroström and its modified operations are the most common surgical treatment of CLAI. The operations showed satisfactory clinical outcomes in the short-, medium-, and long-term follow-up and low complication rate. Suture anchor technique and arthroscopic techniques are gradually used in Broström and its modified operations with satisfactory short-term effectiveness, but long-term effectiveness needs further observation because of the limitation of the short clinical application time. ConclusionBroström and its modified operations are effective, convenient, and safe to treat CLAI. Based on the researches of biomechanics and dynamic anatomy, the more personalized design of the rehabilitation program is the further research direction.
ObjectiveTo explore the classification, diagnosis, and clinical treatment of Achilles tendinopathy.MethodsThe literature about Achilles tendinopathy at home and abroad was reviewed. The research results of classification and terms, imaging diagnosis, and clinical treatment of Achilles tendinopathy were summarized.ResultsThe classification and name of Achilles tendinopathy are not completely unified, and the concept is vague, the cause of disease is not clear. There are many treatment plans, but there is no effective evidence-based medicine research.ConclusionThe diagnosis and treatment of Achilles tendinopathy is complicated. According to the characteristics of Achilles tendon anatomy and etiology, the classification and definition of Achilles tendinopathy need to be further studied in order to guide clinical treatment more effectively and facilitate experience exchange and learning.
Objective To summarize the diagnosis and treatment of fibular fracture in ankle fracture. MethodsRelevant literature at home and abroad in recent years was widely consulted, and various types of fractures were discussed and summarized according to Danis-Weber classification. ResultsConservative treatment is not an ideal treatment for type A avulsion fracture. The operation method should be determined according to the position and size of bone mass. For simple type B fracture, both conservative treatment and surgical treatment can achieve good results. When the position of type C fracture is high and does not affect the stability of ankle joint, it can be treated conservatively, while when the position is low and affects the stability of ankle joint, it needs surgical treatment. ConclusionFirst of all, whether the fibular fracture in the ankle fracture is stable or not should be determined. Whether it is treated surgically or not, the purpose is to restore the tibiofibular syndesmosis and restore the motor function of the ankle.
ObjectiveTo study the effect of different degrees of distal tibial varus and valgus deformities on the tibiotalar joint contact, and to understand the role of fibular osteotomy. MethodsEight cadaveric lower legs were used for biomechanical study. Nine conditions were included: normal ankle joint (group A), 10° varus (group B), 5° varus (group C), 5° valgus (group D), 10° valgus (group E) with fibular preserved, and 10° varus (group F), 5° varus (group G), 5° valgus (group H), and 10° valgus (group I) after fibular osteotomy. The joint contact area, contact pressure, and peak pressure were tested; and the translation of contact force center was observed. ResultsThe joint contact area, contact pressure, and peak pressure had no significant difference between group A and groups B to E (P>0.05). After fibular osteotomy, the contact area decreased significantly in groups F and I when compared with group A (P < 0.05); the contact pressure increased significantly in groups F, H, and I when compared with group A (P < 0.05); the peak pressure increased significantly in groups F and I when compared with group A (P < 0.05). There were two main anterior-lateral and anterior-medial contact centers in normal tibiotalar joint, respectively; and the force center was in anterior-lateral part, just near the center of tibiotalar joint. While the fibula was preserved, the force center transferred laterally with increased varus angles; and the force center transferred medially with increased valgus angles. However, the force center transferred oppositely to the medial part with increased varus angles, and laterally with increased valgus angles after fibular osteotomy. ConclusionFibular osteotomy facilitates the tibiotalar contact pressure translation, and is helpful for ankle joint realignment in suitable cases.
Objective To evaluate the short-term effectiveness of talonavicular arthrodesis for Müller-Weiss disease. Methods Between May 2013 and February 2015, 13 patients with Müller-Weiss disease were treated with talonavicular arthrodesis. There were 11 females and 2 males with an average age of 59 years (range, 42-67 years). The disease duration was 8-20 years (mean, 13 years). According to Maceira stage, there were 7 cases of stage Ⅲ, 6 cases of stage Ⅳ. The foot longitudinal arch height measured on weight-bearing X-ray films was (43.1±1.8) mm; the Meary angle and talocalcaneal angle measured on lateral X-ray films were (–2.8±2.3)° and (5.8±2.4)°, respectively; the calcaneal valgus angle measured on Saltzman position X-ray films was (–2.0±0.7)°. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 43.5±12.4, and visual analogue scale (VAS) score was 7.3±1.5. Results All the patients were followed up 14-39 months (mean, 20 months). The symptoms of foot pain and intermittent claudication disappeared in all patients. All cases achieved bony union, the fusion time was 12-16 weeks (mean, 13 weeks). There was no complications such as wound infection, skin necrosis, or internal fixator broken. At last follow-up, the foot longitudinal arch height, Meary angle, talocalcaneal angle, and calcaneal valgus angle were (52.5±2.2) mm, (1.3±2.2)°, (16.5±3.7)°, and (0.4±0.7)°, respectively; the AOFAS score and VAS score were 83.8±9.1 and 1.0±0.4, respectively; all were significantly improved when compared with preoperative ones (P<0.05). Conclusion If the subtalar and calcaneocuboid joints are relatively healthy, talonavicular arthrodesis may be a reliable and effective surgical option for Müller-Weiss disease that is resistant to conservative treatment.
ObjectiveTo explore the effectiveness of modified internal fixation and fusion in treatment of type Ⅱ painful accessory navicular (PAN) in adults.MethodsBetween January 2016 and December 2017, 29 patients (37 feet) with type Ⅱ PAN were treated with modified internal fixation and fusion. There were 12 males and 17 females with an average age of 41.4 years (range, 18-50 years). The injury caused by sprain in 24 cases and no obvious inducement occurred in 5 cases. All patients received conservative treatment for more than 6 months with no significant improvement. The effectiveness was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score before operation and at last follow-up. The inclination angle of calcaneus, the first metatarsal angle of talus, the inclusion angle of talonavicular joint, and the second metatarsal angle of talus were measured on X-ray films.ResultsSuperficial infection of incision occurred in 1 case after operation, and the incision healed after enhanced dressing change. The incisons of the other patients healed by first intention. There was no deep infection or osteomyelitis. All patients were followed up 12-33 months (mean, 25.1 months). X-ray films showed that the articular surfaces healed at 2-5 months after operation, with an average of 3.4 months. No loosening or rupture of internal fixator was found during the follow-up. At last follow-up, the pain, function, alignment scores, and total score of AOFAS were significantly improved when compared with those before operation (P<0.05). The inclusion angle of talonavicular joint, the first metatarsal angle of talus, and the second metatarsal angle of talus were also significantly improved when compared with those before operation (P<0.05). But there was no significant difference in the inclination angle of calcaneus between pre- and post-operation (t=1.097, P=0.276).ConclusionModified internal fixation and fusion in treatment of type Ⅱ PAN can effectively relieve the symptoms and obtain good recovery of feet function with less complications.
Objective To investigate the effectiveness and biomechanical analysis of 3 fixation methods of screw anterior-posterior fixation (SAPF), screw posterior-anterior fixation (SPAF), and buttress plate fixation (BPF) in treatment of posterior Pilon fractures. Methods Fifteen fresh-frozen skeleto-ligamentous lower leg specimens were harvested to establish the models of posterior Pilon fracture, and then fracture was fixed with BPF (n=5), SAPF (n=5), and SPAF (n=5). Vertical force was loaded to internal fixation failure in a speed of 1 cm/minute with servohydraulic testing machine. The instantaneous loads of 1 mm and 2 mm steps and the failure modes were recorded. Between May 2008 and December 2011, 56 patients with posterior Pilon fracture were treated with SAPF (SAPF group) in 11 cases, or SPAF (SPAF group) in 26 cases, or BPF (BPF group) in 19 cases. There was no significant difference in age, gender, injury cause, side, disease duration, and complications among groups (P gt; 0.05). Clinical and radiographic examinations were used to assess the reduction and healing of fracture; the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) were used to evaluate the functional outcomes. Results No breaking or bending was observed in all specimens, fixation failure was caused by cancellous bone compression. The instantaneous loads of 1 mm and 2 mm steps were the largest in BPF group, larger in SPAF group, and smallest in SAPF group, showing significant differences among 3 groups (P lt; 0.05). A total of 47 cases were followed up 16-54 months (9 in SAPF group, 22 in SPAF group, and 16 in BPF group), with a mean time of 35.2 months. Fixation failure was found in 2 cases of SAPF group; the other cases obtain bony union within 3 to 4 months (mean, 3.2 months) with no fixation failure. The AOFAS score was significantly lower in SAPF group than in SPAF and BPF groups (P lt; 0.05), but no significant difference was found between SPAF and BPF groups (P gt; 0.05). The VAS score was significantly higher in SAPF group than in SPAF and BPF groups (P lt; 0.05), but no significant difference was found between SPAF and BPF groups (P gt; 0.05). Conclusion SAPF could not reach enough fixation strength for the posterior Pilon fracture; both SPAF and BPF could reach rigid fixation, and have good effectiveness. And from the biomechanical points, BPF could reach better fixation strength than screw fixations.
Objective To compare the functional and radiological outcomes of supramalleolar osteotomy (SMOT) between with and without fibular osteotomy for varus ankle osteoarthritis. Methods Between April 2009 and April 2014, 41 patients (41 feet) with mid-staged varus ankle osteoarthritis were treated with SMOT. Fibular osteotomy was not performed in 19 cases (group A), and fibular osteotomy was performed in 22 cases (group B). There was no significant difference in gender, age, side, body mass index, osteoarthritis stage, pathogeny, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind score, ankle osteoarthritis scale (AOS) pain and function scores, range of motion (ROM) of the ankle joint, tibial articular surface angle (TAS), talar tilt angle (TT), tibiocrural angle (TC), and tibial lateral surface angle (TLS) between 2 groups (P>0.05). The bone union was observed after operation, and functional and radiological outcomes were compared between 2 groups at last follow-up. Results All incisions healed by stage I, and no surgery related complications occurred. The mean follow-up time was 36.6 months (range, 16-55 months). Pain and limited activity were observed in 1 case of groups A and B respectively, and ankle arthrodesis was performed. All cases achieved bony union; the bone union time was (3.6±0.4) months in group A and (3.9±0.7) months in group B, showing no significant difference (t=1.61,P=0.12). At last follow-up, no significant difference was found in TAS, TLS, TT, and TC between groups (P>0.05). However, group B was significantly better than group A in improvement of TT and TC (P<0.05). The AOFAS ankle-hind score, AOS pain and function scores, ROM of the ankle joint showed no significant difference between groups (P>0.05). According to the modified Takakura stage, the improvement rates of groups A and B were 55.6% and 57.1%, respectively; no significant difference was found between 2 groups (χ2=0.01,P=0.92). Conclusion SMOT with fibular osteotomy is helpful in correction of TT and TC in patients with relative longer fibula.