PurposeThe lateral ligament complex of the ankle has been extensively studied. Recently an anatomical study described a connection between anterior taloibular ligament inferior fascicle (ATFLif) and calcaneoibular ligament (CFL). The applicability and the mechanical role of these connections have not yet been studied and need to be clariied. The purpose of this study is to evaluate the connection between ATFLif and CFL through a dynamic measurement analysis. Methods An anatomical study was performed in 13 fresh-frozen below-the-knee ankle specimens. Each specimen was dissected in a protocolized manner until the lateral ligaments were exposed. A complete injury to both ATFL's fascicles was created in the proximal third of the ligament. A displacement transducer speciically design was inserted in the CFL and in the lateral part of the calcaneus to test its lengthening. A traction of 1 kg weight (9.8 N) was applied to ATFLif while the transducer measured the lengthening that this force created in the CFL. Results A total of 13 ankle specimens were carefully dissected. One specimen with signals of a prior traumatic injury of the ATFLif was excluded. A total of 12 specimens were included, 7 females and 5 males with an average age of 74 years (52-88 years). The right ankle was dissected in 6 specimens. ATFL was identiied as a two-fascicled ligament in all cases. The ibers connecting the ATFLif and CFL were observed in all specimens. The displacement transducer showed lengthening in the CFL in all measurements with a median of 0.59 mm (SD ± 0.34). Conclusion Connecting ibers between ATFLif and CFL are robust enough to transmit tension from one structure to the other. In the case of associated proximal lesions of the ATFLif and CFL, ligaments repair with a single suture may be considered. This can be applied in surgical procedures in patients with lateral ankle instability.

Background: Both the percutaneous technique with arthroscopic assistance, also known as arthroscopic Broström (AB), and the arthroscopic all-inside ligament repair (AI) are widely used to treat chronic lateral ankle instability. The aim of this study was to compare the clinical outcomes of these 2 arthroscopic stabilizing techniques. Methods: Thirty-nine consecutive patients were arthroscopically treated for chronic ankle instability by 2 different surgeons. The AB group comprised 20 patients with a mean age of 30.2 (range, 18-42) years and a mean follow-up of 19.6 (range, 12-28) months. The AI group comprised 19 patients with a mean age of 30.9 (range, 18-46) years and mean follow-up of 20.7 (range, 13-32) months. Functional outcomes using the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog pain scale (VAS) were assessed pre- and postoperatively. Range of motion (ROM) and complications were recorded. Results: In both groups the AOFAS and VAS scores significantly improved compared with preoperative values ( P < .001) with no difference ( P > .1) between groups. In the AB group the mean AOFAS score improved from 67 (range, 44-87) to 92 (range, 76-100) and the mean VAS score from 6.4 (range, 3-10) to 1.2 (range, 0-3). In the AI group the mean AOFAS score changed from 60 (range, 32-87) to 93 (range, 76-100) and the mean VAS score from 6.1 (range, 4-10) to 0.8 (range, 0-3). At the final follow-up 8 complications (40%) were recorded in the AB group. In the AI group 1 complication (5.3%) was observed ( P < .05). Conclusion: Both the AB and AI techniques are suitable surgical options to treat chronic ankle instability providing excellent clinical results. However, the AB had a higher overall complication rate than the AI group, particularly involving a painful restriction of ankle plantarflexion and neuritis of the superficial peroneal nerve. Level of Evidence: Level III, retrospective comparative study.

No abstract

Objective: To report the clinical and radiographic results of surgical treatment of bunionette deformity with a minimally invasive technique without the use of hardware. Methods: This is a case series of 13 patients (14 feet) with a diagnosis of bunionette surgically treated with a minimally invasive osteotomy of the fifth metatarsal. All patients completed the American Orthopedic Foot and Ankle Society (AOFAS) score and a visual analog scale (VAS) for pain preoperatively and in the last follow-up visit. Radiographic measurements included the fourth-fifth intermetatarsal angle (4-5 IMA) and the fifth metatarsophalangeal (MTP-5) angle. Complications and level of patient satisfaction were also documented. Results: Mean follow-up was 12.3 months. The mean AOFAS score increased from 51.3 to 94.0, and the VAS score decrease from 7.5 to 1.1. The MTP-5 angle decreased from 11.5º to 2.3º, and the 4-5 IMA decreased from 9.8º to 3.6º. These outcomes showed a statistically significant difference (p<0.001). The only complication was hypertrophic callus formation observed in 3 feet (21.4%). There were no cases of infection, neurapraxia, wound dehiscence, nonunion, or deformity recurrence. Ten patients rated their outcome as excellent and 3 as good. Conclusion: Treatment of bunionette with percutaneous osteotomy of the fifth metatarsal without the use of hardware showed good clinical and radiographic results, with a low complication rate and a high level of patient satisfaction. Level of Evidence IV; Therapeutic Studies; Case Series.

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

No abstract

Objective: To present the clinical and radiographic results of surgical treatment of patients with moderate to severe hallux valgus (HV) by minimally invasive Chevron - Akin osteotomy (MICA). Methods: The case series comprises 25 patients (30 feet) with diagnoses of moderate to severe HV treated surgically with the MICA technique. All patients answered the American Orthopedic Foot and Ankle Score (AOFAS) and rated pain on visual analogue scale (VAS) at preoperative assessment and at the last follow-up consultation. Radiological assessment included measurement of the valgus angles of the hallux (HVA) and the 1st and 2nd ray intermetatarsal angle (IMA). Complications and satisfaction ratings were also documented. Results: Mean follow-up was 14.6 months. Mean AOFAS increased from 42.8 to 90 and VAS reduced from 8.6 to 1.7. Mean HVA reduced from 31.7o to 8.4o and IMA from 14o to 5o. All these improvements were statistically significant (p<0.001). The most common complication observed was discomfort caused by hardware, affecting five feet (16.6%). Two patients (6.6%) had transitory neurapraxia and one patient (3.3%) developed reflex sympathetic dystrophy. There were no cases of infection, relapse, pseudarthrosis, or malunion of osteotomies. Subjective satisfaction ratings classified 93.3% of results as good or excellent. Conclusion: Minimally invasive Chevron-Akin osteotomy is a safe and reproducible technique that achieves good clinical and radiographic results for treatment of moderate to severe hallux valgus. Level of Evidence IV; Therapeutic Studies; 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