RESUMO
BACKGROUND: Hallux valgus (HV) is a complex deformity, with many associated risk factors. The flexor hallucis longus (FHL) tendon is a dynamic and potentially deforming force as it bowstrings laterally with HV. We hypothesized that FHL is more laterally inserted in the distal phalanx in cadavers with HV; therefore, it might be also a primary destabilizing force. We aim to compare the FHL distal insertion morphology and its relationship with osseous structures in cadavers with and without HV. METHODS: Sixteen cadaver specimens, 8 with HV and 8 without (N-HV) were dissected. We evaluated FHL distal morphology in terms of its insertional footprint location and FHL long-axis position in relation to osseous anatomy. RESULTS: Both the HV and N-HV groups displayed a laterally inserted footprint at the distal phalanx, with the HV group exhibiting median lateral translation of the footprint 6% greater than the N-HV group (P < .01). Both groups also demonstrated a laterally displaced position for the FHL long axis. The median FHL long axis for HV vs N-HV specimens 1 cm proximal to the IP joint was 9% more laterally displaced from the midaxis (P < .01), and at 1 cm proximal to the MTP joint was measured to be 15% more laterally displaced from the midaxis (P < .01). CONCLUSION: FHL demonstrated an eccentric position in terms of insertion and trajectory in both the HV and N-HV groups, with greater lateralization in specimens exhibiting HV deformity. This eccentricity potentially creates a greater deforming force vector contributing to the development of HV. CLINICAL RELEVANCE: The etiology and progression of HV deformity may include a lateralized insertion of the FHL tendon. Treatment implications remain unknown at this time.
Assuntos
Cadáver , Hallux Valgus , Tendões , Humanos , Hallux Valgus/patologia , Tendões/anatomia & histologia , Idoso , Masculino , FemininoRESUMO
Background: Ankle hemiarthroplasty is a 1-piece implant system replacing the talar side of the tibiotalar joint. Hemiarthroplasty offers limited bone resection and may provide easier revision options than joint-ablating procedures. Methods: Prospective, multicenter, noncomparative, nonrandomized clinical study with short term follow-up on patients undergoing hemiarthroplasty of the ankle. Radiologic and functional outcomes (Foot and Ankle Outcome Score FAOS, Foot and Ankle Ability Measure [FAAM], Short Form-36 Health Survey [SF-36], Short Musculoskeletal Functional Assessment [SMFA], and visual analog scale [VAS] pain scores) were obtained at 3 and 12 months and the last follow-up (mean 31.9 months). Results: Ten patients met the inclusion criteria. Three were converted to total ankle replacement at 14, 16, and 18 months. Pain VAS scores improved on average from 6.8 to 4.8 (P = .044) of the remaining 7 at a mean of 31.9 months' follow-up. For these 7 in the Survival Group, we found that SF-36 physical health component improved from 25.03 to 42.25 (P = .030), SMFA dysfunction and bother indexes improved from 46.36 to 32.28 (P = .001), and from 55.21 to 30.14 (P = .002) in the Survival Group, and FAAM sports improved from 12.5 to 34.5 (P = .023). Conclusion: Patients undergoing hemiarthroplasty of the ankle joint for talar-sided lesions had a 30% failure rate by 18 months. Those who did not have an early failure exhibited modest pain reduction, functional improvements, and better quality of life in short-term follow-up. This procedure offers a possible alternative for isolated talar ankle cartilage cases. Level of Evidence: Level IV, prospective case series.
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La patología de peroneos es compleja y frecuentemente subdiagnosticada. El conocimiento detallado de la anatomía, biomecánica y fisiopatología es fundamental para realizar un correcto diagnóstico y tratamiento. El objetivo de este artículo es revisar la información más actualizada sobre la patología de los tendones peroneos (tendinopatía, inestabilidad y rotura).
Pathology of the peroneal tendons is complex and often underdiagnosed. Knowledge of anatomy, biomechanics, and physiopathology is necessary for diagnosing and treating this condition. The objective of this article is to review the most updated information regarding peroneal tendon pathology (tendinopathy, dislocation/subluxation, and tears), which may help managing patients with lateral pain of the foot and ankle.
Assuntos
Traumatismos dos Tendões , Tendões/anatomia & histologia , Tendões/fisiopatologia , Traumatismos do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgiaRESUMO
Level of Evidence: Level V.
Assuntos
Deformidades Congênitas do Pé , Ossos do Metatarso , Metatarsalgia , Humanos , Ossos do Metatarso/cirurgia , Metatarsalgia/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , OsteotomiaRESUMO
PURPOSE: To adapt and validate the English version of the Foot and Ankle Outcome Score (FAOS) into Spanish FAOS-CL, following the WHO guidelines. METHODS: A cross-sectional study including 318 outpatients with non-traumatic conditions. Validity, acceptability and internal consistency including correlations with the Medical Outcome Study Short Form 36 are reported. RESULTS: The preliminary version resulted from the forward and back-translation and a pilot administration. Validation response rate was 99.22%. Substantial ceiling effects were observed for Symptoms and ADL and floor effect for QoL sub-scales. The FAOS-CL had excellent internal consistency (Cronbach's α = 0.98). The principal component analysis gave five factors explaining the 72.6% of the variance. The FAOS-CL items significantly correlate with their sub-scales. FAOS-CL sub-scales significantly correlated with SF-36 components and subcomponents. CONCLUSION: The first Spanish version of the FAOS was generated. Culturally adapted and validated with high reliability capable of evaluating different foot and ankle conditions.
Assuntos
Adaptação Psicológica , Articulação do Tornozelo/cirurgia , Traumatismos do Pé/cirurgia , Qualidade de Vida , Traduções , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Chile , Comparação Transcultural , Estudos Transversais , Feminino , Traumatismos do Pé/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto JovemRESUMO
Instability is a common sequela after repeated ankle sprains. When nonoperative treatment fails, open lateral ligament complex repair and reinforcement with the inferior extensor retinaculum has been the gold standard procedure. The recent advancements in arthroscopic techniques have created comparable biomechanical and functional results to open procedures. The authors' modification to the standard arthroscopic technique permits ligament approximation to the distal fibula over a larger surface area, using knotless anchors to avoid the need of an accessory portal and limit potential suture knot-related complications. Level of Evidence: Level V, expert opinion.
Assuntos
Artroscopia/métodos , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Técnicas de Sutura/instrumentação , Adolescente , Adulto , Artroscopia/instrumentação , Feminino , Humanos , Instabilidade Articular/etiologia , Ligamentos Laterais do Tornozelo/lesões , Masculino , Entorses e Distensões/complicações , Âncoras de SuturaRESUMO
BACKGROUND: Extensor hallucis longus (EHL) tendon injuries often occur in the setting of lacerations to the dorsum of the foot. End-to-end repair is advocated in acute lacerations, or in chronic cases when the tendon edges are suitable for tension free repair. Reconstruction with allograft or autograft is advocated for cases not amenable to a primary direct repair. This is often seen in cases with tendon retraction and more commonly in the chronic setting. In many countries the use of allograft is very limited or unavailable making reconstruction with autograft and tendon transfers the primary choice of treatment. Tendon diameter mismatch and diminished resistance are common issues in other previously described tendon transfers. METHODS: We present the results of a new technique for reconstruction of non-reparable EHL lacerations in three patients using a dynamic double loop transfer of the extensor digitorum longus (EDL) of the second toe that addresses these issues. RESULTS: At one-year follow up, all patients recovered active/passive hallux extension with good functional (AOFAS Score) and satisfaction results. No reruptures or other complications were reported in this group of patients. No second toe deformities or dysfunction were reported. CONCLUSIONS: Second EDL-to-EHL Double Loop Transfer for Extensor Hallucis Longus reconstruction is a safe, reproducible and low-cost technique to address EHL ruptures when primary repair is not possible. LEVEL OF EVIDENCE: IV (Case Series).
Assuntos
Hallux/lesões , Hallux/cirurgia , Músculo Esquelético/cirurgia , Ruptura/cirurgia , Traumatismos dos Tendões/cirurgia , Transferência Tendinosa/métodos , Tendões/cirurgia , Adulto , Pé , Humanos , Lacerações/cirurgia , Masculino , Pessoa de Meia-Idade , Dedos do Pé , Transplante Autólogo , Transplante Homólogo , Adulto JovemRESUMO
BACKGROUND: Locking and non-locking plates has been used for distal tibia fracture osteosynthesis. Sufficient evidence to favor one implant over the other is lacking in the current literature. Our aim is to compare them in terms of fracture healing, alignment, functional outcome, complications. METHODS: Sixty-eight patients operated on using a percutaneous plate were retrospectively reviewed. They were divided into two groups: in group 1 (28 patients) a 4.5mm narrow conventional dynamic compression plate (DCP) was used. In group 2 (40 patients) a titanium locked compression plate (LCP) was used. RESULTS: Mean time to union was 16.2 and 15.4 weeks for group 1 and 2, respectively (p=0.618). 11 patients (39.3%) in group 1 and 4 patients (10%) in group 2 showed malalignment (p=0.016). AOFAS scores at follow up were 89 and 88 in groups 1 and 2, respectively. Implant removal was necessary in 9 cases (32.1%) and 4 cases (10%) in group 1 and group 2, respectively (p=0.042). Three patients (10.7%) in group 1 and three patients (7.5%) in group 2 had an infection. CONCLUSIONS: Both plating systems have similar results in terms of time to union, infection, and AOFAS scores. The LCP seems superior with respect to alignment and the need for implant removal.
Assuntos
Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Fraturas da Tíbia/cirurgia , Adulto , Idoso , Feminino , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fraturas da Tíbia/fisiopatologia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Total ankle arthroplasty is associated with severe postoperative pain. Development of analgesic techniques such as a block with continuous infusion at the popliteal level has been shown to result in good pain control, a decrease in the use of rescue analgesia and a low rate of complications. We reviewed our experience with this method of analgesia in patients who underwent total ankle arthroplasty. METHODS: A prospective study of 30 patients undergoing total ankle arthroplasty was carried out. Twenty-two of these received and maintained a block at the popliteal level with a continuous infusion of bupivacaine, while the remaining eight received no such block. RESULTS: The visual analog scale evaluation (VAS) showed a significant improvement in pain control in the group with the popliteal block after 6, 12, 18, and 24 hours postsurgery, with pain levels peaking and being most different between 6 and 12 hours postsurgery for the two groups. The group with the popliteal block also exhibited a significantly lower consumption of morphine and a greater degree of patient satisfaction. CONCLUSION: The block with continuous infusion at the popliteal fossa was a safe technique for total ankle arthroplasty postoperative analgesia, which provided good pain control, a lower requirement of opiates and a higher level of patient satisfaction.