Objective A gold standard surgical treatment for osteochondral lesions (OCLs) of the talus still needs to be established. Still, autologous matrix-induced chondrogenesis (AMIC) is a commonly applied 1-stage procedure that has achieved good short- and mid-term results. The present cohort study aimed to assess whether the long-term, 10-year results can confirm the previous findings. Design All patients underwent an open AMIC procedure using a collagen type I/III bilayer matrix for a talar OCL. General demographic data, preoperative magnetic resonance imaging findings, intraoperative details, and German version of the Foot Function Index (FFI-D) scores preoperatively and at 1, 5, and 10 years as well as European Foot and Ankle Society (EFAS) and American Orthopedic Foot & Ankle Society (AOFAS) scores at 10 years after surgery were analyzed. The primary outcome variable was the procedure’s longitudinal effect, and several variables’ influence on the outcome was tested. Results Of 47 consecutive patients, 18 (38%) were included. Of the 18 patients, 6 (33%) were female, and 12 (67%) were male, with a mean age of 39 ± 15 (range = 15-62) and an average body mass index (BMI) of 26 ± 5 (range = 20-38) kg/m². The mean defect size was 1.4 ± 0.9 (range = 0.2-4) cm². The FFI-D total score showed a significant decrease from preoperatively to 1 year postoperatively (56 ± 19 to 34 ± 27; P = 0.001) with a further nonsignificant decrease to the 5-year (34 ± 27 to 21 ± 20; P = 0.16) and 10-year follow-up (21 ± 20 to 15 ± 13; P = 1.00). All the single items decreased significantly from preoperatively to the 5- and 10-year mark. Although not significant, most items improved from 5 to 10 years postoperatively. Age positively correlated with the preoperative, 5-year, and 10-year follow-up FFI-D total score. Conclusions AMIC, as a single-step surgical intervention, is a viable long-term treatment option. Patient selection regarding symptoms and findings is vital to achieve satisfying results.

Achillessehnenrupturen die mehr als 4–6 Wochen zurückliegen oder sich über einen längeren Zeitraum entwickelt haben, werden definitionsgemäß als chronisch bezeichnet. Die Therapie ist von zwei Herausforderungen gekennzeichnet. Zum einen müssen häufig Defektzonen von mehreren Zentimeter überbrückt werden, zum anderen führt ein längerer Funktionsverlust der Mm. gastrocnemius und soleus zu einem größtenteils irreversiblen fettigen Umbau des Muskelgewebes, sodass selbst bei Wiederherstellung der Sehne erhebliche Funktionsdefizite verbleiben können. Bestehen Zweifel an der Regenerationsfähigkeit der Wadenmuskulatur, werden unabhängig von der Defektgröße Sehnentransfers mit motorischer Ersatzplastik eingesetzt. Etabliert ist die Transposition der Sehne des M. flexor hallucis longus oder des M. peronaeus brevis. Bei intaktem Wadenmuskel können Defekte bis 2 cm mit einer direkten Naht versorgt werden. Defekte zwischen 2 und 5 cm lassen sich mithilfe einer VY-Plastik oder einer Umkehrplastik überbrücken. Bei größeren Defektzonen kommen freie Sehnentransplantate zur Anwendung. Alternativ kann aber auch hier eine Transposition der Sehne des M. flexor hallucis longus und des M. peronaeus brevis erfolgen. Ein weiterer Vorteil der Sehnentransposition ist die Verlagerung von vitalem Muskelgewebe in das Achillessehnenlager, da beide Sehnen langstreckig mit Muskelgewebe bedeckt sind. Dies bietet Vorteile bei kritischen Weichteilen oder nach Infekten. Die Nachbehandlung erfolgt analog einer akuten Achillessehnenruptur. Auch wenn die Rekonstruktion der Achillessehne die Funktion signifikant verbessert, können Defizite im Vergleich zur gesunden Seite verbleiben. Im Sport erreichen 75–80

BACKGROUND:Achilles tendon ruptures that are older than 4-6 weeks or developed over a more extended period are chronic. Two challenges characterize the treatment. First, defect zones over a length of several centimeters must frequently be bridged. Second, a prolonged loss of function of the muscles leads to an irreversible fatty degeneration of the tissue. So that even if the tendon is restored, significant functional deficits remain. If there are doubts about the ability of the calf muscles to regenerate, regardless of the size of the defect, tendon transfers are recommended to use the power of an additional muscle to support the plantar flexion of the ankle. TREATMENT:Established concepts are the transposition of the flexor hallucis longus or the peroneus brevis muscle. If the muscle is intact, defects of up to 2 cm can be treated with a direct suture. Defects between 2 and 5 cm can be bridged using a VY-plasty or a turndown flap. For larger defects, free tendon transplants can be considered. The technical alternative for larger defects is a tendon transfer of the flexor hallucis longus or the peroneus brevis muscle. Besides bridging the defect, another advantage of tendon transfer is that vital muscle tissue is placed in the bed of the Achilles tendon. Both tendons are covered with muscle tissue over nearly the full length, which offers advantages, especially in patients with critical soft tissue or after infection. FOLLOW-UP TREATMENT AND PROGNOSIS:Follow-up treatment is analogous to an acute Achilles tendon rupture. However, permanent impairments are possible; 75-80% of athletes regain their original performance level.

Despite the increasing number of revision total ankle arthroplasty (TAA), the literature on indications, surgical options, and outcomes is limited. This study reports on failure rates and patient-reported outcomes (PROM) for a cohort of 122 patients who underwent revision of TAA. A retrospective review of revision TAA between 2006 and 2020 was performed at one institution. Patient’s demographics and different surgical procedures were analyzed with particular attention to comparing polyethylene exchange with revision of both metallic components and to additional interventions for axis correction. Failure rates and the European Foot and Ankle Society (EFAS) score were collected. The average follow-up period was 70.37 ± 46.76 months. 122 patients were treated with an exchange procedure. The surgery included 69 polyethylene exchanges, 12 revisions of one metallic component, and 41 revisions of both metallic components. The overall failure rate was 14.75%. The EFAS score, completed by 94 of the 122 patients, was used to evaluate clinical outcomes. Median EFAS score was 12.51 ± 5.53, and median EFAS sports score was 2.97 ± 3.04. Revision rates after polyethylene exchange were significantly higher than after exchanging both metallic components (p value = 0.03), while the EFAS score showed slightly better results in patients treated with polyethylene exchange. Adding procedures to induce axis correction led to significantly lower revision rates (p value = 0.03), and the EFAS score was also improved but without statistical significance. The high failure rate of polyethylene exchange indicates that the intervention does not address the actual cause of failed TAA in many cases. Additional axis correction should be considered more frequently. If the underlying issues of prosthesis failure can be identified and sufficiently addressed, the results of revision surgery are likely to improve.

BACKGROUND:The number of total ankle arthroplasty (TAA) procedures increased rapidly in the last years and so have its complications. The main pillars in treating failed TAA are revision total ankle arthroplasty (RTAA), revision total ankle arthrodesis (RAA), or revision tibiotalocalcaneal fusion (RTTC). To evaluate these options, we compared clinical, radiologic, and patient-reported outcomes.METHODS:A single-center, retrospective review of 111 cases of revision procedures of failed TAA from 2006 to 2020 was performed. Patients undergoing polyethylene exchange and revision of one metallic component were excluded. Demographic data, failure, and survival rates were analyzed. The European Foot and Ankle Society (EFAS) score and radiographic changes in the subtalar joint were evaluated. The average follow-up was 67.89 ± 40.51 months.RESULTS:One hundred eleven patients underwent removal of TAA. The procedures included 40 revisions of both metallic components, 46 revision total ankle arthrodesis and 25 revision tibiotalocalcaneal fusion. The overall failure rate in the cohort was 5.41% (6/111). The failure rate after RAA was 4.35 times higher than that of RTAA, whereas RTTC did not show failures. RTAA and RTTC lead to a 1-year and 5-year survival rate of 100%. RAA resulted in a 1-year survival rate of 90% and a 5-year survival rate of 85%. The mean EFAS score in the cohort was 12.02 ± 5.83. Analysis of the EFAS score showed that RTTC provided the most reliable pain reduction, and RTAA achieved the best gait pattern. RAA resulted in poorer clinical results. Subtalar joint degeneration occurred significantly less in the RTAA group (P = .01).CONCLUSION:This retrospective study suggests lower failure rates, increased short-term survival and a better clinical outcomes of revision arthroplasty and tibiotalocalcaneal fusion than ankle arthrodesis. Revision arthroplasty is a promising solution in treating failed total ankle arthroplasty considering lower rate of subsequent adjacent joint degeneration.LEVEL OF EVIDENCE:Level III, non-randomized observational study.

BACKGROUND:There is little valid data available on managing infected total ankle arthroplasty (TAA). METHODS:A single-center, retrospective evaluation from 20 patients with PJI (periprosthetic joint infection) of the ankle compared the bacteria isolated by preoperative arthrocentesis and intraoperative cultures to the pathogens of knee PJI. Long-term failure rates of irrigation and debridement (I&D) and polyethylene exchange, revision arthroplasty, and arthrodesis were analyzed. RESULTS:The most common bacteria were Staphylococcus aureus and Coagulase-negative staphylococci. There was no significant difference when comparing the causing pathogens of PJI of the ankle with the knee. After a follow-up of 50,4 months, the long-term failure rate after I&D and polyethylene exchange was 40%, and of revision was 9%. CONCLUSIONS:We concluded that the pathogenesis of PJI of the ankle and knee seems to be comparable. Regarding treatment options, we found that standardized techniques for PJIs of the knee have their limitations regarding infected TAA.

Objectives To systematically review and evaluate the outcomes of the AMIC procedure using the Chondro-Gide membrane to treat osteochondral lesions of the ankle, Grade III/IV, and evaluate via meta-analysis the early and midterm clinical and functional improvement versus preoperative status.

Die minimal-invasive medialisierende Kalkaneusosteotomie, die Implantation eines Sinus-tarsi-Spacers sowie die Tendoskopie der Tibialis-posterior-Sehne haben sich als Therapieoptionen bei der Tibialis-posterior-Insuffizienz Grad II etabliert. Die minimal-invasive medialisierende Kalkaneusosteotomie erlaubt eine Korrektur des Rückfußvalgus analog zum offenen Vorgehen bei signifikant niedrigerem Risiko für Wundheilungsstörungen und hat in den letzten Jahren eine starke Verbreitung gefunden. Auch liegt inzwischen eine gute Evidenz zur Arthrorise vor, wobei sich der Sinus-tarsi-Spacer vor allem als Zusatz zur Kalkaneusverschiebeosteotomie etabliert hat. Die Möglichkeiten der Tendoskopie der Tibialis-posterior-Sehne sind auf Debridement und Synovektomie limitiert. Verschiedene Arbeiten berichten über minimal-invasive Alternativen zur Strayer-Prozedur bei verkürztem M. gastrocnemius. Populär ist vor allem die proximale Verlängerung des medialen Kopfes des M. gastrocnemius als weichteilschonender, wenig traumatisierender Eingriff. Berichte über eine minimal-invasive Cotton-Osteotomie finden sich bisher nicht in der Literatur.

The aim of this study was to review the patient rated outcome (PROM) of surgically treated fractures to the lateral process of the talus (LPTF) and identify factors influencing the outcome. Retrospective study with a current follow-up. Eligible were all patients treated surgically for a LPTF (n = 23) with a minimum follow-up of one year. Demographics, medical history, trauma mechanism, fracture characteristics, concomitant injuries, treatment details, complications, return to work and sports were assessed retrospectively. The current follow-up included the VAS FA, Karlsson Score, and SF-12. The primary outcome was the VAS FA. Secondary aim was the identification of parameters influencing the PROMs. 22 patients (96% follow-up) with a mean age of 32 ± 9 (18 to 49) years were included. 73% suffered a Hawkins Type 1, 23% a Type 2, and one patient a Type 3 fracture. 82% suffered concomitant injuries. 9% suffered minor surgical side infections, 50% developed symptomatic subtalar osteoarthritis. At final follow-up (44 ± 2 (12 to 97) months), the mean VAS FA Overall was 77 ± 21 (20 to 100), the Karlsson Score 72 ± 21 (34 to 97), and for the SF 12 the PCS 53 ± 8 (36 to 64) and the MCS 53 ± 7 (32 to 63). 50% of patients returned to their previous level of sports. Hawkins Type 1 fractures resulted in better VAS FA Overall score than Type 2 fractures. Posttraumatic subtalar osteoarthritis was the independent factor associated to a poor patient rated outcome (VAS FA, Karlsson Score). After a follow-up of over 3.5 years, surgically treated LPTF resulted in only moderate results. 50% suffered posttraumatic symptomatic subtalar osteoarthritis, which was the primary independent parameter for a poor outcome following LPTF. Level III.

Frakturen des Processus lateralis tali (PLT) sind selten. Mit dem Aufkommen der Trendsportart Snowboarden stieg ihre Inzidenz. Die gebräuchlichste Klassifikation ist die nach Hawkins. Ziele dieser Übersichtsarbeit sind die Sensibilisierung für diese Verletzung und die Diskussion der aktuellen Evidenz. Die Literaturrecherche ergab 8 Arbeiten mit einer Fallzahl von mindestens 7 Patienten. Sechs der 8 analysierten Arbeiten waren rein deskriptive, retrospektive Fallserien ohne definiertes Behandlungskonzept. Hier zeigten sich nur mäßige Behandlungsergebnisse. Aufgrund der jeweils geringen Fallzahl, der fehlenden schnittbildgebenden Untersuchung und der inkonsistenten Therapien lässt sich aus diesen Arbeiten kein Behandlungskonzept für Frakturen des PLT ableiten. Zwei Arbeiten validierten bestehende Behandlungsregimes. Primär wurden die operative Therapie bei dislozierten, die konservative Therapie bei nichtdislozierten Frakturen durchgeführt. Die Ergebnisse waren insgesamt zufriedenstellend. Rückschlüsse auf die konservative Behandlung von dislozierten Frakturen können nicht gezogen werden. Ein Grund für die inkonsistenten Behandlungsergebnisse könnten die beobachteten Begleitverletzungen, u. a. Luxationen der Sehnen der Mm. peronaei (46 %), kalkaneare Knorpelschäden (48 %) und Subluxationen im Subtalargelenk (7 %), sein. Basierend auf der sehr eingeschränkten Studienlage empfehlen die Autoren, bei PLT-Frakturen schnittbildgebende Verfahren zur Beurteilung der Begleitverletzungen einzusetzen, welche eine primäre Operationsindikation darstellen. Dislozierte Typ-I- und Typ-II-Frakturen (>2 mm) sollten operativ, Typ-III- sowie nichtdislozierte Typ-I- und Typ-II-Frakturen können konservativ mithilfe der Immobilisation und Teilbelastung für 6 Wochen behandelt werden.

Perkutane Korrektur einer Hallux-valgus-Fehlstellung mit und ohne Transfermetatarsalgie.

Hallux-rigidus-Therapie durch minimalinvasive Abtragung der dorsalen Osteophyten und Resektion der dorsalen Anteile des Kopfs des Metatarsale I.

Introduction. Endoprostheses of the ankle joint show higher revision rates of 3.29 revisions per 100 component years. The aims of this study were the application and modification of the consensus classification of the synovia- like interface membrane (SLIM) for periprosthetic failure of the ankle joint, the etiological clarification of periprosthetic pseudocysts and a detailed measurement of proliferative activity (Ki67) in the region of osteolysis. Material and Method. Tissue samples from 159 patients were examined according to the criteria of the standardized consensus classification. Of these, 117 cases were derived from periprosthetic membranes of the ankle. The control group included 42 tissue specimens from the hip and knee joints. Particle identification and characterization were carried out using the particle algorithm. An immunohistochemical examination with Ki67 proliferation was performed in all cases of ankle pseudocysts and 19 control cases. Results. The consensus classification of SLIM is transferrable to endoprosthetic failure of the ankle joint. Periprosthetic pseudocysts with the histopathological characteristics of the appropriate SLIM subtype were detectable in 39 cases of ankle joint endoprostheses (33.3%). The mean value of the Ki67 index was 14% and showed an increased proliferation rate in periprosthetic pseudocysts of the ankle (p-value 0.02037). C onclusion. In periprosthetic pseudocysts an above average higher detection rate of type 1 SLIM induced by abrasion (51.3%) with an increased Ki67 proliferation fraction (p-value 0.02037) was found, which can be interpreted as local destructive intraosseus synovialitis. This can be the reason for formation of pseudocystic osteolysis caused by high mechanical stress in ankle endoprostheses. A simplified diagnostic classification scoring system of dysfunctional endoprostheses of the ankle is proposed for collation of periprosthetic pseudocysts, ossifications and the Ki67 proliferation fraction.

Bandverletzungen des Sprunggelenks sind die mit Abstand häufigsten Sport- und Freizeitverletzungen. Bereits bei der Erstanamnese sollten Sie komplikationsträchtige Fälle herausfiltern. Im Folgenden geht es um Diagnostik und Therapie der akuten Distorsion und der chronischen Instabilität des oberen Sprunggelenks.

Correction: Arthroskopie 2017 https://doi.org/10.1007/s00142-017-0176-4 Aufgrund eines Übertragungsfehlers im unten stehenden Abschnitt entspricht die publizierte nicht der vom Autor eingereichten Version. Richtig ist : (…) Die feuchte Membran ist etwa 10–15 % größer als die trockene Membran (…). Der …

Äußert ein Patient den Wunsch nach einer die Beweglichkeit erhaltenden Therapie seines arthrotischen Sprunggelenks, sollten Sie als Hausarzt ihn beraten können. Mit den aktuellen, zementfrei implantierten Prothesenmodellen lassen sich heute gute mittlere Standzeiten erreichen.