BACKGROUND:Tarsal coalition is the congenital fusion of 2 or more tarsal bones, which can cause pain, restricted motion. Although calcaneonavicular (CN) coalitions have traditionally been reported to be the most common type of tarsal coalition in Western populations, recent East Asian studies have suggested the predominance of talocalcaneal (TC) and naviculocuneiform (NC) coalitions. We hypothesized that TC and NC coalitions are more prevalent than CN coalitions in symptomatic Japanese patients. METHODS:This multicenter retrospective study included patients diagnosed with symptomatic tarsal coalition at 4 specialized foot and ankle centers between 1997 and 2025. Demographic data, laterality, coalition type, and treatment modalities were analyzed. Coalitions were categorized as TC, NC, CN, cubonavicular, or cuneometatarsal. Treatments were classified as conservative management, coalition resection, or arthrodesis. RESULTS:A total of 127 coalitions were identified. TC coalitions were the most common type (56.7%), followed by NC (22.8%) and CN (16.5%) coalitions. Other coalitions, namely, cubonavicular (3.1%) and cuneometatarsal (0.8%), were less frequent. Among the TC coalitions, posterior facet involvement was the most frequent (73.6%), followed by combined middle-posterior involvement (22.2%), whereas isolated middle facet and panfacetal coalitions were rare. Bilateral involvement was observed in 18.9% of the patients. Conservative treatment was successful in 33.1% of the cases, whereas surgical treatment was performed in 66.9%, including coalition resection in 60.6%, and arthrodesis in 6.3%. CONCLUSION:In this symptomatic Japanese cohort, TC coalition was the most common type, followed by a relatively high proportion of NC and CN coalitions. Posterior facet involvement predominates among TC coalitions, whereas previous studies have reported a higher prevalence of middle facet involvement. Coalition resection was the most frequently performed surgical procedure in this cohort, whereas arthrodesis is rarely required. These findings highlight the importance of a computed tomography-based diagnosis for accurate characterization of coalition morphology in symptomatic tarsal coalitions. LEVEL OF EVIDENCE:Level IV, retrospective descriptive study.
BACKGROUND:Psychological distress has been associated with inferior outcomes after major joint arthroplasty, but its impact on outcomes after total ankle arthroplasty (TAA) remains unclear. The main aim of this study was to investigate whether patients reporting anxiety or depression before TAA surgery had inferior outcomes 1 year after surgery. METHODS:Retrospective analysis of prospectively collected data from a single-centre ankle arthroplasty registry. The exposure was preoperative anxiety/depression, defined from EuroQol-5 Dimensions-3 Level (EQ-5D-3L) item 5, and dichotomized, reflecting self-reported symptoms rather than a clinical diagnosis. The primary outcome was the adjusted difference between the exposure groups in the Manchester-Oxford Foot and Ankle Questionnaire (MOxFQ) score at 12 months postoperatively. Multivariable linear regression with multiple imputation of missing baseline MOxFQ was used to assess the association between preoperative anxiety/depression and 12-month MOxFQ, adjusting for baseline MOxFQ, age, sex, and diagnosis. RESULTS:Three hundred patients were included, of whom 90 (30%) reported preoperative anxiety and/or depression. These patients were younger and reported worse baseline pain and function. Although patients with preoperative anxiety/depression had worse absolute MOxFQ scores at 12 months (mean 30.2 vs 20.1; P < .001), their improvement from baseline was comparable to patients without anxiety/depression (ΔMOxFQ 41.3 vs 43.9; P = .40). In multivariable regression analyses including baseline values, preoperative anxiety/depression was not independently associated with worse 12-month MOxFQ (β = 4.3; 95% CI -0.9 to 9.5). Among patients with baseline anxiety/depression, approximately two-thirds no longer reported anxiety/depression at 12 months. CONCLUSION:Preoperative self-reported anxiety or depression was common among patients undergoing TAA and was associated with worse symptoms before surgery. However, the reporting of such symptoms did not appear to limit postoperative improvement in patient-reported outcomes at 12 months. Among patients reporting anxiety/depression preoperatively, approximately two-thirds no longer reported anxiety/depression at 12 months. LEVEL OF EVIDENCE:Level III, retrospective cohort study using prospectively collected registry data.
BACKGROUND:The prevalence of solid organ transplant (SOT) patients is rising, and orthopaedic surgeons will treat these patients in elective and traumatic settings. Ankle fractures are common orthopaedic injuries often treated with surgery. Because of organ dysfunctions and effects from immunosuppressive regimens, SOT patients may have higher complication rates postoperatively compared with non-SOT patients. However, there is minimal literature reporting on these injuries or the surgical outcomes in this population. METHODS:A retrospective case-control study was performed at a single institution to investigate postoperative outcomes of solid organ transplant (SOT) patients undergoing ankle procedures after injury. Current Procedural Terminology (CPT) codes were used to identify patients and their healthy, non-SOT matched controls. Charts were reviewed for infection, nonunion, wound dehiscence, readmission, discharge disposition, hospital length of stay (LOS), and operative time and compared between the 2groups. Generalized estimating equations (GEEs) accounted for the 3:1 matched design, analyzing continuous and categorical data via linear and logistic models, respectively. RESULTS:In this study of 132 patients (33 SOT, 99 non-SOT matched controls), there were no differences in preoperative demographics (age, body mass index, Charlson Comorbidity Index), surgical characteristics (blood loss, procedure time), or postoperative characteristics (anticoagulation, antibiotics, LOS, discharge disposition) between groups. With the numbers available, no significant differences could be detected for 90-day emergency department (ED) visit (36.4% vs 38.4%, P = .846), readmission (30.3% vs 33.3%, P = .762), deep vein thrombosis (0% vs 1.0%, P = .562), pulmonary embolism (0% vs 0%, P = 1.000), or overall complications between groups (48.5% vs 27.3%, P = .137). SOT patients had a higher frequency of nonunion/delayed union (24.2% vs 3.0%, P < .001) and were more likely to undergo external fixation prior to definitive fixation (18.2% vs 5.1%, P = .018). CONCLUSION:Patients with a history of SOT undergoing ankle procedures after injury did not show a significant difference in readmissions, ED visits, or overall complication rate after surgery compared with non-SOT patients. However, SOT patients did show a higher rate of delayed/nonunion after surgery. Close monitoring for union in SOT patients and a lower threshold for bone healing adjuvant therapies may be advantageous. LEVEL OF EVIDENCE:Level III, retrospective case-control study.
BACKGROUND:The gold standard for low bone mineral density (BMD) screening is dual-energy X-ray absorptiometry (DXA) scanning, which has declined in use in recent years for a variety of reasons. This decline warrants alternative screening mechanisms. This study aimed to determine if opportunistic foot radiographs can serve as a screening tool for predicting low BMD as measured by DXA scan. METHODS:The fifth metatarsal index (5MI), a novel measurement made using the oblique foot radiograph to evaluate cortical thickness, was calculated for patients 50 years and older who underwent a DXA scan and a foot radiograph within 1 year. T scores and BMD were documented for each patient. Receiver operating characteristic curves were generated, and areas under the curves were calculated to determine which 5MI had optimized sensitivity and specificity for identifying osteoporosis. RESULTS:A total of 89 patients were included in the study cohort. The average 5MI in patients with normal BMD, osteopenia, and osteoporosis was 52.6%, 44.6%, and 35.2%, respectively. The optimal 5MI for identifying osteoporosis based on the DXA-derived T scores was 46.8%, which correlated with an area under the curve of 0.977. This optimal cutoff for identifying osteoporosis had a sensitivity of 93.3% (95% CI, 70.2%-99.7%) and a specificity of 95.0% (95% CI, 76.4%-99.7%) (P < .001). CONCLUSION:This study describes a potential screening method using low-cost foot radiographs to identify patients with low BMD, which may support earlier detection and referral for bone health evaluation. LEVEL OF EVIDENCE:Level III, retrospective case series.
BACKGROUND:Total ankle arthroplasty (TAA) is increasingly used for end-stage ankle arthritis, with modern fixed-bearing designs demonstrating improved survivorship. The Canadian Orthopaedic Foot and Ankle Society (COFAS) classification stratifies patients by intra-articular and extra-articular deformity and adjacent joint arthritis. However, limited evidence exists on the impact of COFAS grade on mid-term TAA outcomes. This study reports the minimum 5-year outcomes of the Infinity fixed-bearing TAA and examines whether COFAS grade influences survivorship (defined as freedom from revision), complications, reoperations, revisions, radiographic findings, or patient-reported outcomes (PROMs). METHODS:A prospective, multi-center observational study included 502 ankles in 496 patients who underwent primary Infinity TAA across 11 UK centers. Patients were stratified by preoperative COFAS grade. Outcomes included implant survivorship, complications, reoperations, revisions, radiographic assessment of radiolucencies, and PROMs (the Manchester-Oxford Foot Questionnaire; the Ankle Osteoarthritis Scale [AOS]; and the EuroQol 5-dimension, 5-level index) collected preoperatively and at 2 and 5 years postoperatively. Patient-specific instrumentation (PSI) use was also recorded. RESULTS:Five-year implant survivorship was 98.2%, and reoperation without revision was 5.8%. There was no significant association between COFAS grade and revision or reoperation rates. Radiographic analysis demonstrated 5.7% linear radiolucencies >2 mm and 10.9% cystic radiolucencies >5 mm, with no correlation to COFAS grade. PROMs improved significantly across all domains from baseline to 5 years, with no differences between COFAS grades. PSI, used in 20.1% of cases, was associated with improved AOS scores at 5 years, though PSI and site effects could not be fully disentangled, and did not influence complication, revision, or radiographic outcomes. CONCLUSION:In this large multicenter cohort, higher COFAS grades were not associated with inferior outcomes in patients undergoing Infinity fixed-bearing TAA. Survivorship, complications, reoperations, radiographic outcomes, and PROMs were not statistically different across all grades. In this cohort, Infinity TAA was associated with favorable outcomes across all COFAS grades, including those with complex deformity or adjacent joint disease. LEVEL OF EVIDENCE:Level II, prospective cohort study.
BACKGROUND:Whether sesamoid subluxation relative to the metatarsal head occurs in hallux valgus (HV) remains unestablished. Deep transverse intermetatarsal ligament (DTML) attenuation, which spans the lateral sesamoid to the second metatarsal head, may increase transverse motion and facilitate medial sesamoid subluxation with the first metatarsal. This study aims to compare the average second metatarsal head to lateral sesamoid (2MTLS) distance between HV and control patients, which is a proxy of DTML length. We hypothesize that HV patients demonstrate an increased 2MTLS distance. METHODS:Sixty-eight patients were matched into 2 groups: 34 with HV and 34 without HV. Standardized preoperative weightbearing computed tomography scans were used to measure the 2MTLS distance, hallux valgus angle (HVA), intermetatarsal angle (IMA), first metatarsal pronation, and sesamoid station. The 2MTLS distance was anatomically measured from the lateral sesamoid to the second metatarsal head. RESULTS:The 2MTLS distance was significantly greater in HV patients compared with controls (20.90 mm vs 18.56 mm, P < .001). Similarly, the HVA and IMA were increased in HV patients (P < .001). First metatarsal pronation and sesamoid station were significantly greater in HV patients (P < .001). The 2MTLS distance demonstrated a moderately positive correlation with sesamoid station (r = 0.36, 95% CI 0.06-0.60), HVA (r = 0.40, 95% CI 0.12-0.65), and IMA (r = 0.43, 95% CI 0.06-0.71) but was not correlated with first metatarsal pronation (r = -0.18). Inter- and intrarater reliability for the 2MTLS measurements were ICC = 0.911 (95% CI 0.858-0.944) and 0.958 (95% CI 0.933-0.974), respectively. CONCLUSION:In HV patients, 2MTLS was significantly increased compared with controls. Additionally, as sesamoid station increased, the 2MTLS distance also increased. This challenges the long-standing view that the sesamoids remain anchored in HV and suggests the sesamoids subluxate. Clinically, this highlights the DTML's role as a restraint to first metatarsal medial deviation and suggests against sectioning the ligament during lateral release. LEVEL OF EVIDENCE:Level III, retrospective cohort study.
BACKGROUND:Morton neuroma is a common cause of forefoot pain, often refractory to conservative treatment. Corticosteroid injections provide variable and often temporary relief. Platelet-rich plasma (PRP) has emerged as a potential biologic alternative; however, comparative evidence remains limited. METHODS:This prospective unblinded randomized comparative study included 60 patients with clinically and magnetic resonance imaging (MRI)-confirmed Morton neuroma treated with either a single corticosteroid injection (n=30) or 3 leukocyte-poor PRP injections (n=30). All patients had failed ≥6 months of conservative treatment. Primary outcomes were PROMIS Physical Function (PF) and Pain Interference (PI) scores at baseline and 3, 6, and 12 months. Secondary outcomes included neuroma size on MRI at 6 months and complications. RESULTS:Baseline characteristics and PROMIS scores were comparable between groups. Both groups demonstrated significant improvement; however, PRP was associated with better outcomes at all time points. At 12 months, PROMIS PF was 61.8 ± 6.2 vs 55.2 ± 6.8 (P < .001), and PROMIS PI was 38.4 ± 6.1 vs 44.2 ± 6.8 (P = .001), favoring PRP. At 6 months, neuroma size was smaller in the PRP group (4.2 ± 1.1 vs 5.8 ± 1.4 mm; P < .001). Complication rates were low and comparable between groups. Post-injection pain rates were comparable between groups; Minor complications occurred only in the corticosteroid group, although differences did not reach statistical significance. CONCLUSION:PRP was associated with improved clinical outcomes and reduction in neuroma size at 12 months compared with corticosteroid injection. Although these findings support further investigation of PRP for symptomatic Morton neuroma, they should be interpreted cautiously and considered hypothesis generating pending confirmation in larger, methodologically rigorous studies. LEVEL OF EVIDENCE:Level II, lesser quality RCT or prospective comparative study.
BACKGROUND:Radiographic correction after hallux valgus surgery does not necessarily translate into clinically meaningful improvement. The ability of preoperative patient-reported outcome measures (PROMs) to predict clinically meaningful improvement after hallux valgus surgery remains unclear. METHODS:In this prospective cohort study, 193 patients undergoing Chevron osteotomy were included. Clinically meaningful improvement in the Manchester-Oxford Foot Questionnaire (MOxFQ) score at 1 year was defined as a ≥15-point improvement. A mixed effects model was used as the primary longitudinal analysis to assess change over time, whereas logistic regression and receiver operating characteristic (ROC) analysis evaluated clinically meaningful improvement and predictive performance. RESULTS:A total of 139 patients (72%) achieved clinically meaningful improvement. Patients with higher preoperative MOxFQ Index scores were more likely to benefit, whereas those with lower scores showed limited improvement. Preoperative MOxFQ score independently predicted responder status (odds ratio 1.06 per point; P < .001). ROC analysis demonstrated moderate discrimination (area under the curve 0.70), with a threshold of approximately 42 yielding 71% sensitivity and 65% specificity. CONCLUSION:Preoperative MOxFQ Index score predicts clinically meaningful improvement following Chevron osteotomy. Patients with a higher symptom burden benefit the most, whereas those with low baseline scores have limited potential for meaningful gain. A threshold of approximately 42 may help identify patients most likely to benefit from surgery. LEVEL OF EVIDENCE:Level IV, prospective case series.
BACKGROUND:Obesity and elevated body mass have been associated with increased rates of aseptic loosening and implant failure following total ankle arthroplasty (TAA). The purpose of this study was to investigate the role for primary stemmed or keeled tibial implants as a protective factor against aseptic loosening in this patient population. METHODS:We performed a retrospective cohort study of 699 modern primary TAAs with a minimum 2-year follow-up performed at a large academic institution between 2010 and 2023. Patients were stratified by body mass index (BMI <30 vs ≥30) and implant design (stem/keel vs low-profile). The primary outcome was mechanical failure requiring revision of metal components. Secondary outcomes included patient-reported outcomes (FAAM-ADL and VAS). Kaplan-Meier analysis and multivariable cox proportional hazards were used to assess revision risk. RESULTS:Of 699 primary TAAs, 39 (5.6%) experienced mechanical failure at a mean follow-up of 5.6 years. After adjustment for age, implant type, and subtalar fusion, BMI ≥30 was associated with a greater than 2-fold increased hazard of mechanical failure (HR 2.27, 95% CI 1.07-4.81, P = .033). Kaplan-Meier survivorship was similar for low-profile (93.7%) and stem/keel (96.1%) implants at 5 years. When stratified by both BMI and implant type, with the numbers available, no significant difference could be detected in mechanical failure, time to revision, or patient-reported outcomes were observed (P > .05). Obese patients had worse preoperative FAAM-ADL and VAS scores but achieved comparable postoperative outcomes. CONCLUSION:After adjusting for age, implant design, and subtalar fusion, BMI ≥30 was independently associated with a significantly higher hazard of mechanical failure and shorter time to revision. Despite the proposed biomechanical advantages of increased tibial fixation, the stemmed or keeled implants used in this cohort were not associated with improved survivorship or patient-reported outcomes at mid-term follow-up. LEVEL OF EVIDENCE:Level III, retrospective cohort study.
BACKGROUND:Long-leg radiographs (LLRs) are widely used to assess global lower limb alignment, and ankle alignment is frequently measured directly from the ankle region of these images in studies of knee and lower extremity realignment procedures. However, most ankle deformity assessment and treatment algorithms are based on dedicated ankle anteroposterior (AP) radiographs, which are centered on the tibiotalar joint with the beam projected parallel to the joint surface based on a protocol that differs from that used with LLR acquisition. Whether LLR-derived ankle measurements reflect the same coronal joint orientation as those obtained from dedicated ankle AP radiographs remains unclear. This study compared coronal ankle alignment measurements from dedicated ankle AP radiographs and LLRs using regional weightbearing computed tomography (WBCT) as a reference. METHODS:This retrospective study included 64 ankles in 62 patients who underwent LLRs, dedicated ankle AP radiographs, and ankle WBCT within 6 months. Coronal ankle alignment parameters, including medial distal tibial angle (MDTA) and talar tilt (TT), were measured on both LLRs and ankle AP radiographs using standardized techniques. Corresponding WBCT measurements were obtained at 25%, 50%, and 75% of the sagittal plafond dimension to represent anterior, middle, and posterior joint regions. Bland-Altman analysis was performed to compare each radiographic modality with regional WBCT measurements and to assess agreement between modalities. In addition, MDTA and TT from each radiographic modality were categorized by deformity direction to determine the proportion of ankles showing varus-valgus discordance between ankle AP radiographs and LLRs. RESULTS:LLR-derived MDTA was significantly greater than ankle AP-derived MDTA (94.6° vs 89.7°; mean difference, +4.86°; 95% CI, 3.81°-5.92°; P < .001). LLR-derived TT was also greater than ankle AP-derived TT (3.7° vs 1.4°; mean difference, +2.31°; 95% CI, 1.34°-3.28°; P < .001). Ankle AP MDTA most closely approximated the middle WBCT level (mean bias, +0.57°), whereas LLR MDTA most closely approximated the posterior WBCT level (mean bias, +2.46°). For TT, ankle AP measurements showed low mean bias relative to both the middle (+0.65°) and posterior (+0.12°) WBCT levels, whereas LLR measurements showed the smallest bias relative to the posterior level (+2.43°). Varus-valgus orientation differed between modalities in 21.9% of ankles for MDTA and 14.1% for TT. CONCLUSION:Dedicated ankle AP radiographs and LLRs are not interchangeable for coronal ankle alignment assessment. LLR-derived measurements appeared to preferentially reflect posterior plafond orientation, whereas dedicated ankle AP radiographs more closely approximated middle plafond region, particularly for MDTA. Reliance on LLRs alone may mischaracterize ankle deformity when joint-level assessment is required. LEVEL OF EVIDENCE:Level III, retrospective diagnostic.
BACKGROUND:This short report argues that the term "hallux abductus valgus" is anatomically inconsistent and should be replaced by "hallux valgus." Hallux valgus describes a lateral deviation of the great toe with a medial deviation of the first metatarsal. Although the deformity has historically been called "hallux abductus valgus," this creates confusion because the muscle contributing to the lateral deviation is the adductor hallucis, not the abductor hallucis. METHODS:The authors trace this inconsistency back to Carl Hueter's original description in the 19th century. Hueter defined the deviation of the great toe as abduction when referenced to the median plane of the whole body but as adduction when referenced to the median plane of the foot, and he preferred the former terminology. The authors argue that this was a conceptual error because movements of the toes should be described relative to the foot axis, classically defined through the second toe, rather than the body's midline. RESULTS:This terminology problem has persisted in the literature, leading some authors to misidentify the muscle released during lateral soft tissue procedures as the abductor hallucis, or to incorrectly describe the abductor hallucis as having transverse and oblique heads. CONCLUSION:Based on anatomical principles and historical analysis, the authors conclude that "Hallux Abductus Valgus" is misleading and suggest that the deformity should be called either "hallux adductus valgus" or, preferably, simply "hallux valgus."
BACKGROUND:Failed first metatarsophalangeal (MTP) joint surgery with bone loss is a challenging revision problem. This study aimed to evaluate the radiographic and clinical outcomes of iliac crest bone-block arthrodesis in this setting. METHODS:This retrospective cohort included 72 patients who underwent revision first MTP arthrodesis with tricortical iliac crest autograft between 2018 and 2022. All patients had at least 2 years of clinical and radiographic follow-up, and 83.3% had at least 3 years of follow-up. Fusion rates, complications, and changes in visual analog scale (VAS) and 36-Item Short Form Health Survey (SF-36) scores were recorded; the influence of age, comorbidities, and graft length was explored. RESULTS:The median time from the index procedure to revision was 24 months, and the median graft length 11 mm. Primary radiographic union was achieved in 67 of 72 patients (93.1%); after secondary grafting in 3 additional patients, final radiographic union was 70 of 72 (97.2%), with persistent nonunion in 2 patients (2.8%); 44.4% had at least 1 complication and 6.9% required further surgery. Median VAS improved from 8 (7.8-9.0) preoperatively to 0 (0-1.0) at 24 months, and SF-36 improved from 55 (50-62) to 88 (82-90). Exploratory analyses suggested that systemic comorbidities and longer graft length were associated with less favorable pain and functional outcomes. CONCLUSION:Iliac crest bone-block arthrodesis may be an acceptable salvage option after failed first MTP joint surgery with bone loss, achieving a high radiographic union rate and meaningful clinical improvement; however, postoperative complications were frequent, and outcomes were less favorable in patients with systemic comorbidities or larger structural defects. LEVEL OF EVIDENCE:Level IV, non-comparative retrospective cohort.
BACKGROUND:To evaluate the reduction ability of a suture button device on the syndesmosis and determine whether quadricortical or tricortical placement of the cortical button affects syndesmotic reduction; prior studies have not quantified the degree of improvement or determined whether button position or drill hole aperture accounts for the reduction benefit. METHODS:Seven cadaveric lower extremity specimens were used. Syndesmotic ligaments were sectioned. To evaluate the reduction ability, the fibula was intentionally malreduced either anterior or posterior. A 3.5-mm screw was placed followed by a TightRope (Arthrex Inc) placed quadricortical and tricortical, all placed through the same drill path and trajectory. Axial CT scans using a 3D fluoroscopic spin (Siemens Cios Spin; Simens Healthineers) were obtained after each implant: screw (S), quadricortical (Q) TightRope, and tricortical (T) TightRope. Translation and rotation were calculated. Reduction improvement from S was calculated for Q and T and analyzed using 1-sample t tests. A paired t test was used to compare the average improvement between Q and T. RESULTS:The average intentional malreduction in S was 5.10 ± 2.8 mm. The average rotational difference from baseline was 12.7° ± 4.0°, with 5 of 7 having internal rotation. In comparison, the reduction improved by 2.50 ± 1.6 mm (P = .005) in Q and 3.2 ± 1.5 mm in T (P = .001). With the numbers available, no significant difference could be detected between Q and T (P = .27). In both Q and T, 3 specimens returned to within 1 mm of baseline reduction. Q improved an average of 8.9° ± 6.1° (P = .008) and within 3.9° ± 5.2° of baseline fibular rotation. T improved by an average of 11.6° ± 4.5° (P = .0004) and within 1.3° ± 1.1° of baseline fibular rotation. With the numbers available, no significant difference in rotational improvement between Q and T could be detected (P = .227). CONCLUSION:Placement of a suture button device appears to aid in syndesmotic reduction at the time of fixation toward anatomic, with an average improvement of approximately 3 mm of translation and approximately 10° of rotation. Quadricortical and tricortical placement does not seem to play a major role in the improvement of reduction; the degree of correction appears related to the 3.7-mm drill aperture permitting suture movement rather than button position. CLINICAL RELEVANCE:Surgeons can expect a flexible suture button device to improve a suboptimal provisional syndesmotic reduction at the time of fixation by approximately 3 mm of translation and 10° of rotation. This improvement does not appear to depend on whether the construct is quadricortical or tricortical, suggesting that button position need not drive device selection for this purpose. As new flexible fixation devices enter the market, surgeons should be aware that the degree of initial corrective movement is related to the cortical drill aperture size rather than button position.
BACKGROUND:Neurologic complications are among the most frequent adverse events after ankle arthroscopy, yet their clinical course and prognostic factors remain incompletely defined. This study aimed to determine the incidence, risk factors, and natural history of postoperative neurologic complications following ankle arthroscopy. METHODS:A retrospective cohort study was conducted including 545 consecutive arthroscopic procedures of the ankle and hindfoot performed at a single referral center (October 2023-May 2025). Postoperative neurologic complications involving the superficial peroneal nerve or sural nerve were identified at routine follow-up. Patients presenting neurologic symptoms completed a structured electronic questionnaire assessing symptom onset, pain intensity, temporal evolution, neuropathic pain characteristics (DN4 and S-LANSS), and functional outcome using the Simple Ankle Value. Multivariable logistic regression analyses were performed to identify factors associated with neurologic injury and spontaneous symptom resolution. RESULTS:Neurologic complications occurred in 46 procedures (8.4%). The superficial peroneal nerve was most frequently involved (65.2%), followed by the sural nerve (23.9%). Symptoms developed within 48 hours postoperatively in 64.4% of cases. At a mean follow-up of 13 months, complete symptom resolution was observed in 44.4% of patients, while 84.4% reported progressive improvement. Smoking and surgical approach were independently associated with neurologic complications. Higher residual pain intensity and neuropathic pain features (S-LANSS ≥12) were associated with a lower likelihood of spontaneous recovery. CONCLUSION:Postoperative sensory nerve complications after ankle arthroscopy occurred in 8.4% of procedures and predominantly involved the superficial peroneal nerve. Although most patients reported progressive improvement, complete symptom resolution occurred in fewer than half at a mean follow-up of 13 months, which is a longer course than traditionally assumed. Smoking and non-anterior surgical approaches were independently associated with complications, and neuropathic pain features predicted lower rates of spontaneous recovery. These findings support individualized preoperative counseling and early recognition of neuropathic symptoms. LEVEL OF EVIDENCE:Level IV, retrospective cohort study.
BACKGROUND:Lateral ankle sprain commonly leads to chronic lateral ankle instability, often requiring ATFL reconstruction. Accurate fibular tunnel placement is essential but may be challenging when the fibular obscure tubercle (FOT) is unclear. The distal fascicle of the anterior inferior tibiofibular ligament (AITFL-df) may provide a reliable alternative landmark. METHODS:In this retrospective radiographic cohort study, we reviewed patients with chronic lateral ankle instability who underwent anatomic ATFL reconstruction between January 2020 and December 2024. Patients were allocated to 2 groups according to the landmark used intraoperatively for fibular tunnel positioning: the AITFL-df-guided group (tunnel centered 7 mm distal to the AITFL-df) and the FOT-guided group (tunnel centered at the FOT). The evaluation metric was the accuracy and consistency of the fibular tunnel position, quantified as the fibular tunnel ratio on postoperative 3-dimensional computed tomography (3D-CT). Subgroup analysis was performed according to FOT visibility on preoperative 3D-CT. RESULTS:A total of 124 patients were included (61 in the AITFL-df-guided group, 63 in the FOT-guided group). The intra- and interobserver reliability for measuring the fibular tunnel ratio was excellent (intraclass correlation coefficients > 0.87). The mean fibular tunnel ratio was comparable between the AITFL-df and FOT groups (0.45 ± 0.05 vs 0.46 ± 0.10, P = .207). However, the AITFL-df group showed significantly lower variance in tunnel position (P < .001). Subgroup analysis showed similar AITFL-df positioning irrespective of FOT visibility (P = .902 for variance), whereas FOT-guided positioning varied significantly when the FOT was unclear (P = .037 for mean, P = .022 for variance). In FOT- cases, AITFL-df-guided positioning was superior in both mean tunnel ratio and variance. CONCLUSION:The AITFL-df may serve as a reliable anatomical landmark for fibular tunnel positioning in graft-based ATFL reconstruction. Compared with the FOT, it was associated with greater positioning consistency, particularly when the FOT was unclear. LEVEL OF EVIDENCE:Level III, retrospective cohort study.
