Level III, retrospective comparative study.

Mesenchymal stem cells (MSCs) may hold great promise for treating diabetic wounds. However, it is difficult for a clinician to use MSCs because they have not been commercialized. Meanwhile, a new commercial drug that contains adipose-derived stem cells (ASCs) has been developed. The purpose of this study was to examine the potential of allogeneic ASC sheets for treating diabetic foot ulcers. Fifty-nine patients with diabetic foot ulcers were randomized to either the ASC treatment group (n = 30) or a control group treated with polyurethane film (n = 29). Either an allogeneic ASC sheet or polyurethane film was applied on diabetic wounds weekly. These wounds were evaluated for a maximum of 12 weeks. Complete wound closure was achieved for 73% in the treatment group and 47% in the control group at week 8. Complete wound closure was achieved for 82% in the treatment group and 53% in the control group at week 12. The Kaplan-Meier median times to complete closure were 28.5 and 63.0 days for the treatment group and the control group, respectively. There were no serious adverse events related to allogeneic ASC treatment. Thus, allogeneic ASCs might be effective and safe to treat diabetic foot ulcers.

The Achilles tendon is the strongest and largest tendon in the body, but it is also the most commonly ruptured tendon. The overall incidence of Achilles tendon rupture is on the rise recently 1,2) because of the aging of the population, growing prevalence of obesity, and increased participation in sports. 3) Controversy has surrounded the optimal treatment of acute Achilles tendon rupture. 4) In the past, aggressive surgical intervention was recommended over conservative management on the basis of early studies that associated conservative treatment with high rerupture rates. [5][6][7][8] These studies provided a rationale for operative treatment of acute rupture of the Achilles tendon, despite the risk of complications from surgery such as wound infection. However, recent studies have demonstrated favorable outcomes of conservative treatment using accelerated functional rehabilitation. In such studies, functional rehabilitation was more effective in reducing rerupture rates than long-term cast immobilization, and functional improvement after nonoperative treatment was comparable to that after operative repair. [9][10][11] Currently, regardless of the treatment modality-either conservative or opera-tive-used, aggressive early rehabilitation is advocated for acute Achilles tendon ruptures to allow for an early return to activities of daily living, high patient satisfaction, and functional improvement. In this review article, we provide a comprehensive review of the literature on acute rupture of the Achilles tendon and discuss appropriate treatment options. EPIDEMIOLOGYAchilles tendon rupture accounts for 20% of all large tendon ruptures. 12) The estimated incidence ranges from 11 to 37 per 100,000 population. [13][14][15] Men are 2 to 12 times more prone to Achilles tendon rupture than women. 16) In a 2012 meta-analysis by Soroceanu et al., 10) the mean age at the time of injury among 826 patients with an acute Achilles tendon rupture was 39.8 years. The injury has a bimodal age distribution with the first peak in patients between 25 years and 40 years of age and the second peak in those over 60 years. 17,18) High-energy injuries in sports are responsible for the first peak, whereas the second peak occurring in the elderly is mostly associated with low-energy injuries, such as spontaneous rupture of the degenerated Achilles tendon or rupture in chronic Achilles tendinopathy. In young patients with acute sports injures, conservative management is usually sufficient for tendon healing. However, rupture of the degenerated tendon in the elderly requires a different treatment approach because the tendon remains vulnerable to rerupture even after operative

The observed injury pattern of the deltoid ligament was complex and frequently associated with concomitant ankle pathology. The most common tear site of the superficial deltoid ligament was the medial malleolar attachment, whereas that of the deep pTTL was near its medial talar insertion.

ObjectiveTo evaluate the prevalence of deltoid ligament and distal tibiofibular syndesmosis injury on 3T magnetic resonance imaging (MRI) in patients with chronic lateral ankle instability (CLAI).Materials and MethodsFifty patients (mean age, 35 years) who had undergone preoperative 3T MRI and surgical treatment for CLAI were enrolled. The prevalence of deltoid ligament and syndesmosis injury were assessed. The complexity of lateral collateral ligament complex (LCLC) injury was correlated with prevalence of deltoid or syndesmosis injuries. The diagnostic accuracy of ankle ligament imaging at 3T MRI was analyzed using arthroscopy as a reference standard.ResultsOn MRI, deltoid ligament injury was identified in 18 (36%) patients as follows: superficial ligament alone, 9 (50%); deep ligament alone 2 (11%); and both ligaments 7 (39%). Syndesmosis abnormality was found in 21 (42%) patients as follows: anterior inferior tibiofibular ligament (AITFL) alone, 19 (90%); and AITFL and interosseous ligament, 2 (10%). There was no correlation between LCLC injury complexity and the prevalence of an accompanying deltoid or syndesmosis injury on both MRI and arthroscopic findings. MRI sensitivity and specificity for detection of deltoid ligament injury were 84% and 93.5%, and those for detection of syndesmosis injury were 91% and 100%, respectively.ConclusionDeltoid ligament or syndesmosis injuries were common in patients undergoing surgery for CLAI, regardless of the LCLC injury complexity. 3T MRI is helpful for the detection of all types of ankle ligament injury. Therefore, careful interpretation of pre-operative MRI is essential.

The purpose of this study was to determine the area of the talus that can be reached through combined anterior and posterior arthrotomy without medial malleolar osteotomy. Five fresh-frozen cadaver foot-ankle specimens were examined using posteromedial approach and anteromedial approach. We calculated the size of the marked area beginning from the posteromedial corner of the talus in the posteromedial approach and beginning from the anteromedial corner in the anteromedial approach. From the posteromedial talus, we can access 33% of the talus' AP length and 30% of its medial to lateral length through a posteromedial approach. From the anteromedial arthrotomy, 50% of the AP length and 31% of the medial to lateral length can be reached. This leaves approximately 20% that is not accessible. If the osteochondral lesion is within the accessible area through either a posteromedial or anteromedial approach as viewed on MRI/CT, it can be safely reached without a medial malleolar osteotomy.

Background: The treatment of fifth metatarsal stress fractures can be challenging. Various operative fixation methods have been reported for fracture management. Among them, intramedullary screw fixation has become increasingly popular. However, recent reports have described failures after screw fixation in athletes. The aim of this study was to determine the rates of clinical and radiographic healing, time to return to sport, and complications of elite athletes with proximal fifth metatarsal fractures treated with plantar plating. Methods: Thirty-eight athletes with fifth metatarsal stress fractures treated using a plantar plating technique in 3 hospitals from 2013 to 2018 were evaluated retrospectively. Demographic data, radiographic evaluation, and the time until union and return to sports activities were collected and analyzed. A total of 38 patients underwent the plantar plating for a fifth metatarsal stress fracture with a mean follow-up of 23 (range, 12-49) months. Results: The mean time to the radiologic union, as determined by plain radiography, was 9.3 (range, 8-16) weeks. Although there were no nonunions or delayed unions during follow-up, 4 refractures developed (10.5%). All but 1 patient were able to return to their previous levels of sporting activity at 22.2 ± 4.5 (range, 12-40) weeks. Conclusion: With a minimum of 1-year follow-up, the described plantar plating technique could be an alternative method for the operative treatment of fifth metatarsal stress fractures without nonunion problems. Level of Evidence: Level IV, case series.

Case series with no comparison group, retrospective case series, Level IV.