Introduction: Femoral rotational osteotomies can be a treatment option for symptomatic femoral maltorsion. This study investigated the clinical and radiological results of subtrochanteric rotational osteotomy and its potential adverse effects, particularly on patellofemoral stability and geometry. Methods: Retrospective consecutive series of patients undergoing subtrochanteric rotational osteotomy with hip arthroscopy. 25 hips, 18 with decreased (⩽4°), 7 with increased (⩾28°) femoral torsion (FT), were analysed. Mean follow-up was 37 months. Subjective Hip value (SHV), WOMAC and Harris Hip Score (HHS), hip range of motion, asymmetries in foot position during gait as well as patellofemoral instability were the outcome measures. Femoral and tibial torsion as well as morphological signs of patella maltracking (TTTG, patellar tilt and lateralisation) were measured on MRI. Results: SHV improved from 52% to 72% ( p = 0.002), WOMAC from 3 to 1 ( p < 0.001) and HHS from 68 to 86 ( p < 0.001). Hips treated for reduced FT showed better internal rotation and hips treated for excessive FT less internal rotation compared to the opposite side. 1 patient demonstrated asymptomatic minor in-toeing. Objective patellofemoral instability was not found except for in 1 patient with bilateral patellofemoral apprehension. FT was normalised (mean 16° ± 9°). Tibial torsion showed normal values. Compared to the opposite side TTTG ( p > 0.08), patellar tilt ( p > 0.09) and lateralisation ( p > 0.26) did not differ. No complications occurred. Conclusions: Subtrochanteric rotational osteotomy with hip arthroscopy improves the hip subjectively without leading to objective patellofemoral instability nor changes in the patellofemoral geometry compared to contralateral side. The technique of subtrochanteric rotational osteotomy is safe and reliable.
BACKGROUND Biomechanical studies have shown a higher compressive force and higher torsional stiffness for fixation with three screws compared to two screws. However, clinical data to compare these fixation techniques is still lacking. METHODS A retrospective analysis of 113 patients was performed, who underwent isolated subtalar fusion between January 2006 and April 2018. RESULTS Revision arthrodesis was required in 8% (n=6/36) for 3-screw-fixation and 38% (n=35/77) for 2-screwfixation. For 3-screw-fixation, non-union, was observed in 14% (n=5/36) compared to 35% (n=27/77) in 2-screw fixation. Non-union (p=.025) and revision arthrodesis (p=.034) were significantly more frequent in patients with 2 screws. A body mass index 30kg/m 2 (p=.04, OR=2.6,95%CI:1.1-6.3), prior anklefusion (p=.017,OR=4.4,95%CI:1.3-14.5) and diabetes mellitus (p=.04,OR=4.9,95%CI:1.1-17.8) were associated with a higher rate of revision arthrodesis. CONCLUSIONS Our findings suggest that successful subtalar fusion is more reliably achieved with use of three screws. However, future prospective studies will be necessary to further specify this recommendation.
BackgroundSeveral risk factors for adult acquired flatfoot deformity (AAFD) have been identified in literature. To this date, little attention has been paid to the lateral ligament complex and its influence on AAFD, although its anatomic course and anatomic studies suggest a restriction to flatfoot deformity. The aim of this study was to assess the influence of the anterior talofibular ligament (ATFL) on AAFD and on radiologic outcome following common operative correction by lateral calcaneal lengthening.MethodsWe reviewed all patients that underwent lateral calcaneal lengthening for correction of AAFD between January 2008 and July 2018 at our clinic. Patients were grouped according to the preoperative MRI findings into those with an intact ATFL and those with an injured ATFL. Two independent readers assessed common radiographic flatfoot parameters on preoperative and postoperative radiographs.ResultsSixty-four flatfoot corrections in 63 patients were included, whereby the ATFL was intact in 29 cases, and in 35 cases the ligament was injured. An ATFL lesion was overall radiologically associated with increased flatfoot deformity with a statistically significant difference between the two groups for preoperative talometatarsal-angle (p = 0.002), talocalcaneal-angle (p = 0.000) and talonavicular uncoverage-angle (p = 0.005). No difference between the two groups could be observed regarding the success of operative correction or operative consistency after lateral calcaneal lengthening.ConclusionThe ATFL seems to influence the extent of AAFD. In patients undergoing lateral calcaneal lengthening, the integrity of the ligament seems not to influence the degree of correction or the consistency of the postoperative result.
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