Background: Little data exists regarding the incidence of adverse events and their associated risk factors following intra-articular corticosteroid injection of the ankle and subtalar joint. The aim of this study was to determine the complication rate associated with such injections and to identify any predictive risk factors. Methods: Adult patients who had received an intra-articular ankle or subtalar joint injection between January 2000 and April 2016 at one of 3 regional hospitals (2 level 1 trauma centers and 1 community hospital) were included. Patients with prior intra-articular injection of corticosteroid into the ankle or subtalar joint were excluded. Explanatory variables were sex, age, race, body mass index, diabetes status, tobacco use, presence of fluoroscopic guidance, location of intra-articular injection, and administering physician’s years of experience. Results: Of the 1708 patients included in the final cohort, 99 patients (5.8%) had a total of 104 adverse events within 90 days postinjection. The most prevalent types of adverse events were postinjection flare in 78 patients (4.6% of total cohort, 75% of adverse events) followed by skin reaction in 10 patients (0.6% of total cohort, 9% of adverse events). No infections were noted. Multivariable logistic regression analysis found that intra-articular injection in the subtalar ( P = .004) was independently associated with development of an adverse event. Fluoroscopic guidance was not found to be protective of an adverse event compared to nonguided injections ( P = .476). Conclusion: The adverse event rate following intra-articular ankle or subtalar joint corticosteroid injection was 5.8%, with postinjection flare being the most common complication. Infections following injection were not reported. Injection into the subtalar joint was independently associated with the development of an adverse event after intra-articular corticosteroid injection, and this was not mitigated by the use of fluoroscopic guidance. Level of Evidence: Level III, retrospective comparative study.
Background: Two common operative fixation techniques for insertional Achilles tendinopathy are the use of all-soft suture anchors vs synthetic anchors with a suture bridge. Despite increasing emphasis on early postoperative mobilization, the biomechanical profile of these repairs is not currently known. We hypothesized that the biomechanical profiles of single-row all-soft suture anchor repairs would differ when compared to double-row suture bridge repairs. Methods: Achilles tendons were detached from their calcaneal insertions on 6 matched-pair, fresh-frozen cadaver through-knee amputation specimens. Group 1 underwent a single-row repair with all-soft suture anchors. Group 2 was repaired with a double-row bridging suture bridge construct. Achilles-calcaneal displacement was tracked while specimens were cyclically loaded from 10 to 100 N for 2000 cycles and then loaded to failure. Linear mixed models were used to analyze the independent effects of age, body mass index, tendon morphology, repair construct, and footprint size on clinical and ultimate failure loads, Achilles-calcaneal displacement, and mode of failure. Results: The suture bridge group was independently associated with an approximately 50-N increase in the load to clinical failure (defined as more than 5 mm tendon displacement). There was no difference in ultimate load to failure or tendon/anchor displacement between the 2 groups. Conclusion: This cadaveric study found that a double-row synthetic bridge construct had less displacement during cyclic loading but was not able to carry more load before clinical failure when compared to a single-row suture anchor construct for the operative repair of insertional Achilles tendinopathy. Clinical Relevance: Our data suggest that double-row suture bridge constructs increase the load to clinical failure for operative repairs of insertional Achilles tendinopathy. It must be noted that these loads are well below what occurs during gait and the repair must be protected postoperatively without early mobilization. This study also identified several clinical factors that may help predict repair strength and inform further research.
Background:Postoperative pain after fixation of ankle fractures has a substantial effect on surgical outcome and patient satisfaction. Patients requiring large amounts of narcotics are at higher risk of long-term use of pain medications. Few prospective studies investigate patient pain experience in the management of ankle fractures.Methods:We prospectively evaluated the pain experience in 63 patients undergoing open reduction and internal fixation of ankle. The Short-Form McGill Pain Questionnaire was administered preoperatively and postoperatively (PP) at 3 days (3dPP) and 6 weeks (6wPP). Anticipated postoperative pain (APP) was recorded.Results:No significant differences were found between PP, APP, and 3dPP; however, 6wPP was markedly lower. Significant correlations were found between PP and APP and between preoperative and postoperative Short-Form McGill Pain Questionnaire scores. PP and APP were independent predictors of 3dPP; however, only APP was predictive of 6wPP. Sex, age, and inpatient versus outpatient status were not notable factors. No statistically significant differences were found in pain scores between fracture types.Conclusions:Both preoperative pain severity and anticipated postoperative pain are predictive of postoperative pain levels. Orthopaedic surgeons should place a greater focus on the postoperative management of patient pain and expectations after surgical procedures.
Category: Ankle Introduction/Purpose: New techniques and anchors have been developed for the surgical treatment of insertional Achilles tendinopathy and rupture to allow for earlier return to postoperative weight bearing and accelerated rehabilitation. Two recently introduced soft tissue-to-bone anchor technology have purported advantages for insertional Achilles repairs. Knotless suture anchors allow suture tension to be precisely controlled with a ratcheting mechanism. The other is a suture bridge construct fastened with biotenodesis screws, increasing the soft tissue footprint and reducing the risk of suture pullout through the tendon. However, neither technology has been studied in a biomechanical model of Achilles tendon repair. We hypothesized that there would be no difference in the biomechanical characteristics of a single-row all-suture anchor repair to a double-row repair with knotless anchors and suture tape. Methods: Six matched-pairs of fresh-frozen lower leg cadaveric specimens (12 total) were obtained. All tendons were completely detached from their calcaneal insertions and tendon thickness was measured. Calcaneal exostectomies were performed (e.g., Haglunds removal) above the Achilles insertion. Group 1 was repaired with a single-row construct with two all-soft anchors. Group 2 was repaired with a double-row suture bridge construct with two knotless anchors distally and two suture tape anchors proximally. The repaired specimens were cyclically loaded from 10N to 100N at 1 Hz for 2,000 cycles then to failure at 1mm/sec. A motion capture system measured Achilles-calcaneal displacement at the medial and lateral anchors. Paired t-tests and linear mixed models (LMMs) were used to analyze the following outcomes: clinical failure load, ultimate failure load, Achilles-calcaneal medial and lateral displacement, distance at ultimate failure load, tendon thickness, footprint, and mode of failure. A p-value of <0.05 was considered statistically significant. Results: Group 2 showed significantly less Achilles-calcaneal overall medial and lateral displacement, 19.5% and 36.9% respectively (Table 1). Group 2 showed a statistical trend toward greater clinical and ultimate failure load, 23.8% and 34.2%, respectively (Table1). LMM analyses showed that a suture bridge repair over all-soft anchor repair was independently associated with a 50.24N increase in the load to clinical failure (p=0.0011). Higher clinical failure loads were associated with higher BMI (p<0.0001), thinner tendons (p<0.0001), and smaller tendon footprints on the calcaneus (p=0.0013). Higher absolute failure loads were associated with older age (p<0.0001), higher BMI (p<0.0001), thinner tendons (p=0.0028), and larger footprints (p<0.0001). Conclusion: These data suggest a trend toward higher clinical and ultimate failure loads in a suture bridge construct compared to all-soft suture anchors for insertional Achilles repair. Loads to failure in both groups were higher than previously reported pull-out strengths for most suture anchors (150...
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