Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

MCL insufficiency resulted from medial ankle instability and medial impingement lesions. Outcomes in the patients indicated that MCL reconstruction or resection of medial impingement lesions, performed in addition to LCL reconstruction, is effective for treating chronic combined MCL and LCL injuries of the ankle.

Study Design: This is a retrospective study. Objective: The objective of this study was to investigate the surgical outcomes of postural instability and its predictors in patients with cervical myelopathy (CM). Summary of Background Data: Although several studies have shown impaired postural stability in CM patients, there remains a paucity of literature examining its surgical outcome. Materials and Methods: Postural stability was assessed using a stabilometer preoperatively, at the early phase (3–6 months postoperatively), and 1-year postoperatively, employing 2 stabilometric parameters: sway area [SwA (cm2): the amount of sway of gravity center assessed by the outer peripheral area of the stabilogram] and sway density [SwD (/cm): the indicator of proprioceptive reflexes calculated by the locus length of the stabilogram per SwA]. Twenty-seven healthy age-matched, sex-matched, and body mass index-matched subjects were recruited as controls. To investigate the predictors of postoperative postural instability, univariate, and multivariate analyses were performed, including demographic data, preoperative neurological symptom severity, radiographic findings, and preoperative stabilometric parameters as independent variables. Results: Altogether, 54 CM patients were included in the present study. SwA was 7.89±0.84, 4.78±0.68, and 4.85±0.49, and SwD was 14.63±0.85, 20.41±1.23, and 19.36±1.40 preoperatively, at the early phase, and 1-year postoperatively, respectively, and significant improvement was found in both parameters postoperatively. However, at all timepoints, these parameters were significantly worse in CM patients than in the healthy subjects (SwA: 2.68±0.24, SwD: 24.91±1.83). Multivariate analyses showed that worse preoperative stabilometric parameters were significantly related to worse postoperative stabilometric parameters. Conclusions: Surgery significantly improved postural stability in CM patients; however, it did not reach the level observed in healthy controls, even postoperatively. A predictor of greater residual postoperative postural instability was a greater level of preoperative postural instability. In CM patients, to achieve better surgical outcome of postural stability, surgical intervention is recommended before the symptoms related to bodily imbalance deteriorate. Level of Evidence: Level III.

Background: Operative treatment is indicated for patients who have symptomatic hallux valgus (HV) with moderate to severe metatarsus adductus (MA). However, there is limited information available on the operative procedures and outcomes for the treatment of HV with MA. We aimed to investigate the average 10-year follow-up clinical and radiologic outcomes. Methods: Seventeen patients (21 feet, average age: 60.1 years) with symptomatic HV with moderate to severe MA were operatively treated. Mean postoperative follow-up duration was 114.4 (24-246) months. All feet had metatarsus adductus angle ≥20 degrees on dorsoplantar weight-bearing radiograph. The procedure included a proximal crescentic osteotomy of the first metatarsal and abduction osteotomy of the proximal third of the second and third metatarsals. Results: The mean American Orthopaedic Foot & Ankle Society scale score improved significantly postoperatively ( P < .001). The mean postoperative visual analog scale score (17 feet) was 2.0 (0-6). Preoperative metatarsalgia was severe in 2 feet, moderate in 17, and mild in 2. At the most recent follow-up evaluation, 11 feet had no pain, 9 had mild pain, and 1 had moderate pain. The mean hallux valgus angle, intermetatarsal angle, and metatarsus adductus angle significantly decreased postoperatively ( P < .001 for all). Recurrence of HV (HV angle ≥ 20 degrees) was observed in 4 feet. Conclusion: The clinical and radiologic results indicated that our novel operative treatment for HV with moderate to severe MA can achieve significant correction of HV with MA deformities and significant improvement in pain and function. Level of Evidence: Level IV, retrospective case series.

OBJECTIVES: Some forefoot shapes are ideal for pointe work in ballet. Egyptian-type, with the hallux being longest and the remaining toes decreasing in size, and Greek-type, with the second toe longer than the hallux, are considered less optimal for pointe work. Square-type, with the second toe the same length as the hallux, is considered optimal. This study compared postural stability in the bipedal stance, demi pointe, and en pointe between ballet dancers with the two toe types using a stabilometer. METHODS: This study included 25 Japanese ballet academy dancers who had received ballet lessons for at least 6 years. Toes were categorized into Egyptian-type (n=14) and square-type (n=11). Bipedal stance, demi pointe, and en pointe were tested. Center of pressure (COP) parameters were calculated from ground-reaction forces using two force plates: total trajectory length (LNG), velocities of anterior-posterior (VAP) and medial-lateral directions (VML), and maximum range displacement in the anterior-posterior (MAXAP) and medial-lateral directions (MAXML). Mann-Whitney U-tests were used to examine differences in COP parameters. RESULTS: There were no differences in parameters during bipedal stance or demi pointe. However, dancers with Egyptian-type toes had significantly greater LNG (p<0.01), VML (p=0.01), MAXML (p<0.01), and MAXAP (p=0.03) during en pointe. CONCLUSIONS: Ballet dancers with Egyptian-type toes demonstrated greater displacement in the medial-lateral and anterior-posterior directions during en pointe. Ballet dancers should be aware of toe types and sway character to optimize ballet training and balance.