Musculoskelet Surg
· 2025 Sep · PMID 39847234
·
Full text
Post-surgical rehabilitation advice after ankle fracture surgery, particularly regarding weight-bearing, varies significantly, leading to patient frustration and inconsistent recovery outcomes. This study aimed to establ...Post-surgical rehabilitation advice after ankle fracture surgery, particularly regarding weight-bearing, varies significantly, leading to patient frustration and inconsistent recovery outcomes. This study aimed to establish a consensus for ankle fracture rehabilitation advice and identify content and implementation options for future interventions through consultation with healthcare professionals (HCPs). This study was part of the weight-bearing in ankle fractures (WAX) trial, a multicentre, randomised controlled trial. Using the behaviour change wheel (BCW) framework, three online workshops with HCPs were conducted between April 25, 2022, to May 4, 2022, to generate consensus on rehabilitation interventions. Participants completed pre-workshop tasks, and data were collected using an adapted nominal group technique (NGT). Workshop data were collated to create a survey with indicative statements about rehabilitation preferences. An online survey was subsequently disseminated to surgeons and physiotherapists between May 5, 2022, and July 13, 2022. Respondents were asked to indicate how strongly they agreed with various statements by ranking statements on a 5-point Likert scale from "strongly disagree" to "strongly agree"; 75% was used as a threshold for consensus agreement. Eight HCPs participated in the workshops, and 79 HCPs responded to the survey, representing 38 different NHS hospital trusts. Consensus was achieved on several key aspects: Patients could rest their foot on the floor while seated during non-weight-bearing periods and gradually increase weight-bearing based on comfort. It was agreed that orthotic boots are for comfort, and patients can discontinue use as early as two weeks post-operatively if weight-bearing is permitted. Guidelines for wound management, including when to get wounds wet and how to handle numbness, were also established. This study established a consensus for ankle fracture rehabilitation, emphasising patient autonomy and clear, standardised advice. The findings support the development of a tailored, patient-centred rehabilitation interventions, potentially delivered through digital platforms, to enhance recovery outcomes.
Al-Saadawi A, Tehranchi S, Chekuri R
… +2 more, Oehlen A, Sedra F
Musculoskelet Surg
· 2025 Sep · PMID 39800800
·
Full text
3D-printed (3DP) drill guides have demonstrated significant potential to accurately guide pedicle screw insertion in spinal surgery. However, their role in the upper cervical spine is not well established. This review ai...3D-printed (3DP) drill guides have demonstrated significant potential to accurately guide pedicle screw insertion in spinal surgery. However, their role in the upper cervical spine is not well established. This review aimed to compare the efficacy and safety of 3DP drill guides to the conventional fluoroscopic-guided free-hand technique for pedicle screw insertion in the upper cervical spine. A comprehensive literature search was conducted across five databases (Medline, Scopus, CENTRAL, Web of Science, and Embase). The meta-analysis compared the accuracy of pedicle screw placement, screw placement time, operative time, blood loss, fluoroscopy usage, and post-operative JOA and VAS scores between the two approaches. Seven studies were included in the review, encompassing 386 patients and 1,512 screws. The meta-analysis demonstrated that 3DP drill guides increased the rate of perfect screw insertion (OR: 4.34, P < 0.00001) and lowered the incidence of moderate (OR: 0.26, P < 0.00001) and poor (OR: 0.09, P < 0.00001) screw insertion compared to the free-hand technique. Additionally, operative time (MD: -36.07, P < 0.00001), blood loss (MD: -83.82, P < 0.00001), and fluoroscopy usage (MD: -3.47, P < 0.0001) was significantly reduced in the 3DP cohort. No significant difference was detected in screw placement time (MD: -2.65, P = 0.07), or post-operative JOA (MD: 0.17, P = 0.47), and VAS (MD: -0.09, P = 0.19) scores between the two cohorts. The review demonstrated that 3DP drill guides are a safe and effective tool to assist pedicle screw fixation in the upper cervical spine.
BACKGROUND: Isolated distal fibula fractures (DFF) are usually treated with open reduction and internal fixation (ORIF) and non-weight-bearing protocols. The study assessed the outcomes of immediate weight-bearing on DFF...BACKGROUND: Isolated distal fibula fractures (DFF) are usually treated with open reduction and internal fixation (ORIF) and non-weight-bearing protocols. The study assessed the outcomes of immediate weight-bearing on DFF healing and stability after lateral locking plating. MATERIALS AND METHODS: For this study, 49 patients affected by isolated DFF were enrolled. They underwent ORIF with a lateral polyaxial locking plate and were allowed immediate weight-bearing with crutches postoperatively. Clinical and radiographic evaluations were performed at 2, 6, and 12 weeks using the AOFAS (American Orthopedic Foot and Ankle Society) score and X-rays evaluations.. RESULTS: Immediate weight-bearing yielded positive outcomes, with a significant increase of the AOFAS score during the clinical re-evaluations. All patients tolerated early and progressive full weight-bearing without complications. Radiographic findings at 12 weeks showed complete bone healing in all cases. CONCLUSIONS: The immediate weight-bearing protocol combined with lateral locking plating resulted in favorable clinical outcomes, accelerated recovery, and successful bone healing for stable DFF cases.
PURPOSE: Poland syndrome is a congenital malformation characterized by agenesis or hypoplasia of pectoralis muscles. There is a limited literature on how the anatomic anomalies of PS may impact the movement of the should...PURPOSE: Poland syndrome is a congenital malformation characterized by agenesis or hypoplasia of pectoralis muscles. There is a limited literature on how the anatomic anomalies of PS may impact the movement of the shoulder. This study analyzes the effects of absence of the pectoralis muscles on the shoulder kinematic. METHODS: Clinical evaluation was performed analyzing range of motion (RoM), stability, cuff disease and internal rotation strength. In all patients, we used inertial sensors to analyze scapular motion in three degrees of freedom: medium-lateral rotation, posterior tilting and protraction-retraction. The same analysis was performed by dividing the patients into two groups by age to evaluate the presence of age-related alterations. RESULTS: No differences in RoM between pathological and healthy side were observed. All patients were positive for posterior instability. No significant differences in strength in internal rotation were observed with average + 6,91% (s = 2,14) on the healthy side's strength. Kinematic analysis showed higher values of scapular medium-lateral rotation and anticipation of retraction of the pathological side during flexion and abduction. Reduced scapular tilt in under 18 years old was found. CONCLUSIONS: The absence of the pectoralis muscles seems not to affect the RoM. The increased scapular rotation on the medium-lateral axis is probably due to the absence of humeral insertion of the pectoralis major and the absence of the scapular insertion of the pectoralis minor. The increased retraction in abduction it can be explained by a hypercontraction of the scapular stabilizers. The reduced tilt in under 18 years old is influenced by the lack of adaptation by the muscle groups involved.
Spontaneous osteonecrosis of the knee (SONK) was first described by Ahlbäck et al. in 1968. However, subsequent studies revealed that subchondral fractures, rather than necrosis, are the most common histopathological fin...Spontaneous osteonecrosis of the knee (SONK) was first described by Ahlbäck et al. in 1968. However, subsequent studies revealed that subchondral fractures, rather than necrosis, are the most common histopathological finding in bone samples from patients diagnosed with SONK. This has led to ongoing debate regarding the accuracy of the term "SONK." Therefore, SONK is an inappropriate definition for this condition since the absence of necrosis in most histopathological samples of patients with such diagnosis. A PRISMA-compliant scoping review was conducted using PubMed, Scopus, and Cochrane databases. All original research studies reporting histological analyses of bone samples from patients who underwent surgery following a diagnosis of SONK were considered for inclusion. Extracted data included general study characteristics, radiographic and magnetic resonance imaging (MRI) findings, time elapsed between arthroscopy and histological sampling, and the results of histological examinations of bone samples. Eight articles met the inclusion criteria, comprising 90 patients (91 knees), of which 87 bone samples were analyzed histologically. Of these, 7 showed undetermined outcomes. Among the remaining 80 samples, necrosis was identified in 35 cases and absent in 45. Subchondral insufficiency fractures (SIFs) were detected in 41 cases, with 19 of these also showing necrosis. The histopathological evidence suggests that the term "SONK" is inappropriate, as SIFs, rather than necrosis, are the predominant finding. We therefore recommend adopting "SIF" as a more accurate descriptor for this condition.
INTRODUCTION: Medial congruent (MC) systems and Posterior stabilized (PS) systems are widely utilized as implant options in total knee arthroplasties (TKAs). Nevertheless, determining which system yields superior clinica...INTRODUCTION: Medial congruent (MC) systems and Posterior stabilized (PS) systems are widely utilized as implant options in total knee arthroplasties (TKAs). Nevertheless, determining which system yields superior clinical outcomes remains unresolved. This study seeks to compare these two systems by conducting a retrospective analysis of data from a single surgeon's registry encompassing both systems. Evaluation parameters consist of range of motion (ROM) and various clinical scoring systems. METHODS: A retrospective analysis of data from a single surgeon's registry compared 45 MC with PCL resected (MC-PCLR) TKAs with 44 PS TKAs. Inclusion criteria comprised primary knee osteoarthritis with a minimum 1-year follow-up, while exclusion criteria involved secondary knee osteoarthritis and revision TKAs. Range of motion, Oxford Knee Score (OKS), Knee Society Scoring System (KS) Function Score (KS-FS), and KS Knee Score (KS-KS) were assessed preoperatively, at 3 months, and at 12 months postoperatively. Statistical analysis was performed on retrieved data. RESULTS: Both group has similar baseline demographics in terms of gender (68% vs. 73% female, p = 0.60), BMI (26.4 ± 5.7 vs. 28.3 ± 5.1 p = 0.81) and American Society for Anaesthesiology score (75% vs. 84% score of 2, p = 0.12), with the exception of age where the PS group is significantly greater (71 ± 8 vs. 66 ± 7 years, p < 0.01). There was no significant difference in range of motion (ROM), Oxford Knee Score (OKS), Knee Society Scoring System (KS) Function Score (KS-FS) and KS Knee Score (KS-KS) for all time periods except for one time stamp where preoperatively, the preoperative KS Knee Score (KS-KS) was significantly lower in the PS group. However, when comparing the change between KS-KS of pre-operation and 3 months post operation (44 ± 18 vs. 31 ± 18,p < 0.01), and pre-operation and 1 year post operation (46 ± 16 vs. 34 ± 17,p < 0.01), it is found to be significantly higher in the PS group for both time periods. All other comparisons between the three time periods were found to have similar parameters. CONCLUSIONS: PS and MC-PCLR demonstrates similar outcomes at the 1-year mark. However PS exhibits a faster rate of improvement from pre-operation to 3 months as compared to MC-PCLR.
Vittone G, Cattaneo S, Galante C
… +4 more, Domenicucci M, Saccomanno MF, Milano G, Casiraghi A
Musculoskelet Surg
· 2025 Jun · PMID 39527369
·
Full text
PURPOSE: The assessment of functional outcomes after pelvic ring fracture remains a controversial topic. The Majeed pelvic score (MPS) is the most commonly used pelvic-specific questionnaire in the literature. The aim of...PURPOSE: The assessment of functional outcomes after pelvic ring fracture remains a controversial topic. The Majeed pelvic score (MPS) is the most commonly used pelvic-specific questionnaire in the literature. The aim of this study is translation, cross-cultural adaptation and validation of the Italian version of MPS. METHODS: The study was articulated in two phases. Phase 1 consisted in translation and cross-cultural adaptation of MPS, from English into Italian. The psychometric properties were tested on 52 Italian patients (Phase 2). Construct validity was assessed by correlation with Short-Form 12 (SF-12). 33 patients repeated the questionnaire after 14 days to assess its reproducibility. All data were subsequently analyzed (descriptive statistics, multitrait analysis, reliability and construct validity assessment). RESULTS: The questionnaire was clear and easily understood (no missing data). A ceiling effect was detected for all items of the scale. Multitrait analysis showed good results for each outcome measure, except for the item "walking distance" that showed poor item discriminant validity. A significant correlation between the MPS and the physical component summary (PCS) of the SF-12 was found, while there was a weak correlation with the mental component summary (MCS). The questionnaire showed high internal consistency (Cronbach's alpha: 0.91-0.99) and very good test-retest reliability (intraclass correlation coefficients: 0.92-0.96). CONCLUSIONS: The Italian version of the MPS has demonstrated to be reliable and valid in the evaluation of patients with pelvic ring fractures. There is still however a need for an instrument capable of evaluating the mental component in these types of injuries.
Forefoot disorders are prevalent in the general population, with an incidence between 2 and 20%. Among them, lesser toe deformities (hammer, claw, and mallet toes) are frequent disorders, and their conservative managemen...Forefoot disorders are prevalent in the general population, with an incidence between 2 and 20%. Among them, lesser toe deformities (hammer, claw, and mallet toes) are frequent disorders, and their conservative management is often not adequately considered but usually attempted before surgical indication. Among conservative treatments, shoe modifications and the application of orthoses may, in most cases, alleviate symptoms. From a careful analysis of the available literature, it emerged that treatment approaches should be individualized, and patient education has to be a central aspect of therapy. Proper footwear includes rocker and cushioned soles shoes, a wide toe box, proper length, and a lowered heel, eventually combined with the placement of a felt pad. Narrowed shoes must be avoided, limiting the impaction of the distal phalanx and toenail into the ground. A custom-made silicone orthosis applied at the second digit metatarsophalangeal (MTP) joint in a hammer or claw toe seems to reduce mean peak plantar pressure in the rigid stage of deformity but not the flexible one. A metatarsal pad placed 6.5 mm proximal to the second metatarsal head was demonstrated to diminish peak pressures by 33%, and a 12.5-mm insole further reduced peak metatarsal head pressures by 23% compared with a 2.5-mm insole. The best comfort of orthoses seems to be given by treating metatarsalgia resulting from deformities such as MTP joint instability, mallet, and claw toe. Little orthotic relevance is given to deformities such as hammer toes. Although the most significant obstacle appears to be the psychological aspect of patients, who must accept the placement of compensatory orthoses, some studies show that all these management appear to be often beneficial for the treatment of these disorders. However, none of them are permanent solutions to the deformity and they can be treatment of choice just in advanced stages, in elderly and low functional demand patients.
PURPOSE: Autogenous bone grafting is a widely used technique in orthopaedic and reconstructive surgeries. The anterior superior iliac crest (AIC) and proximal tibia (PT) are common sources for bone grafts. While, AIC is...PURPOSE: Autogenous bone grafting is a widely used technique in orthopaedic and reconstructive surgeries. The anterior superior iliac crest (AIC) and proximal tibia (PT) are common sources for bone grafts. While, AIC is the gold standard, PT is popular for lower extremity procedures due to its proximity. The research investigates early complications associated with these donor sites in a tertiary orthopaedic centre in Nigeria. METHODS: This randomized controlled study was conducted from July 2020 to December 2021. It includes 66 patients randomized into AIC and PT groups. Pain score analysis and the incidence of surgical site infections were compared between both groups. RESULTS: There was no statistical difference in the incidence of surgical site infections (SSI) in both groups. The study also reveals that patients in the AIC group experienced more significant pain in the immediate postoperative period and up to two weeks after surgery, with the severity particularly pronounced on the first postoperative day. (p < 0.001). C CONCLUSIONS: The PT had less pain severity than the AIC bone graft donor sites. The authors recommend that surgeons consider PT if bone grafting is required.
BACKGROUND AND AIM: Hallux valgus is the most common forefoot disease that can cause pain and be disabling for the patient. Many surgical procedures have been described to correct this deformity; over the last years, the...BACKGROUND AND AIM: Hallux valgus is the most common forefoot disease that can cause pain and be disabling for the patient. Many surgical procedures have been described to correct this deformity; over the last years, the minimally invasive Chevron and Akin osteotomies (MICA) technique has become very popular. The aim of this review was to assess if MICA technique is a reliable procedure for treating severe hallux valgus. METHODS: A systematic review was performed according to the Preferred Reporting Items for systematic Reviews and Meta-Analysis (PRISMA) guidelines. The keywords were searched in PubMed Medline and Cochrane library. To minimise the number of missed studies, no filters were applied to the search strategy. To be considered for this review, the articles needed to comply with the following inclusion criteria: Minimally invasive Chevron and Akin osteotomy (MICA) for severe hallux valgus (HVA > 40°, IMA > 16°), patient age over 18 years and minimum follow-up of 6 months. RESULTS: Following the PRISMA flow chart 7 studies met the inclusion criteria and were taken into consideration in the review. We reached a population of 582 patients for a total of 676 feet. Males and females were 64 and 518, respectively. The mean age was 54.15 ± 8.25. The mean follow-up was 23.74 ± 9.60 months. All the studies reported an improvement in clinical results, in terms of function and quality of life. Radiological variables, mostly IMA and HVA, assessed pre- and postoperatively showed significant improvement in all studies included. CONCLUSIONS: Despite the limited number of published studies in the literature, the available evidence reveals good clinical outcomes and high levels of patient satisfaction. Percutaneous surgery for severe hallux valgus can achieve great deformity correction with reasonable rates of residual deformity. Patient satisfaction and quality of life following third-generation MICA surgery is very high.
Aprato A, Cambursano S, Artiaco S
… +4 more, Fusini F, Bevilacqua S, Catalani P, Massè A
Musculoskelet Surg
· 2025 Jun · PMID 39382615
·
Full text
BACKGROUND: This study aims to evaluate the incidence of clinically significant heterotopic ossification (HO) in primary total hip arthroplasty (THA), comparing outcomes with and without the adoption of an HO prophylacti...BACKGROUND: This study aims to evaluate the incidence of clinically significant heterotopic ossification (HO) in primary total hip arthroplasty (THA), comparing outcomes with and without the adoption of an HO prophylactic protocol in male patients under 70 years of age. METHODS: The prophylactic protocol involved the administration of 50 mg of Indomethacin twice daily for 3 weeks. HO presence was classified according to the Brooker classification system, considering "severe" clinically significant HO (Brooker grade 3 and 4). RESULTS: Two hundred and seventy-nine patients were included in our study, and an overall HO rate of 68.2% versus a rate of 61.5% was found respectively in patients not subjected and subjected to prophylactic protocol, without significant difference (PR 0.062). However, patients not subjected to the HO prophylactic protocol exhibited a severe HO rate of 22.4% compared to 7.7% in the prophylactic group, with a statistically significant difference (P = 0.008). CONCLUSIONS: Our study demonstrated that prophylactic protocol adoption is significantly associated with lower rate of severe HO in male patients under 70 years of age. Currently, there are no orthopedic guidelines for the prevention and management of HO after THA, but in the absence of contraindications, the adoption of a prophylactic protocol for HO should always be considered in high-risk patients.
With the advanced arthroscopic technique, arthroscopic-assisted reduction and internal fixation (ARIF) is gaining popularity for Glenoid fractures with and without scapular involvement. ARIF offers a complete view of the...With the advanced arthroscopic technique, arthroscopic-assisted reduction and internal fixation (ARIF) is gaining popularity for Glenoid fractures with and without scapular involvement. ARIF offers a complete view of the articular surfaces and diagnoses and treats other associated injuries. ARIF provides less soft tissue trauma than open reduction internal fixation (ORIF). The aim of this systemic review is to look at the functional outcomes and complications of ARIF. A systematic review of the PubMed, Embase, and Scopus databases was performed. The search terms included "glenoid fracture" OR "scapula fracture" AND "arthroscopic fixation" OR "arthroscopy" OR "arthroscopic-assisted reduction and internal fixation". Studies were limited to English publications with reported functional outcome measures and complications. Patient demographic characteristics, clinical outcomes including range of motion, outcome performance scores including ROWE score, visual analogue scale and American shoulder and elbow surgeons score and complications were extracted. Five studies met the inclusion criteria. The participants ranged in age from 41 to 48, and the mean length of follow-up ranged from 12 to 41 months postoperatively. The mean ROWE scores for the ARIF group were significantly better postoperatively. ARIF allows accurate diagnosis of the fracture pattern and associated injuries, in addition to representing a safe option to treat glenoid fractures with or without scapular fractures with fewer complications compared to ORIF. Level of Evidence: Level IV, Systematic review.
Platano D, Tedeschi R, Tonini G
… +5 more, Capone S, Morri M, Magli AO, Raffa D, Benedetti MG
Musculoskelet Surg
· 2025 Jun · PMID 39356384
·
Full text
Continuity of care has been linked to patient satisfaction and self-reported outcomes. Following hip fractures in the elderly, rehabilitation aims at restoring patients' mobility and independence at the pre-fracture leve...Continuity of care has been linked to patient satisfaction and self-reported outcomes. Following hip fractures in the elderly, rehabilitation aims at restoring patients' mobility and independence at the pre-fracture level and at the earliest possible time. Despite the potential role of physiotherapists' continuity on functional outcomes, this correlation has not yet been studied in an acute orthopaedic setting. Guaranteeing the presence of the same physical therapist on individual patients is challenging from an organizational point of view. An observational retrospective study was conducted on 129 aged patients (84 ± 8 years) who underwent surgery for proximal hip fracture. Indicators of outcomes were ILOA score at discharge, length of stay and achievement of rehabilitation goals as defined by the Individual Rehabilitation Project. The number of physical therapists taking care of patients was monitored during the patient's hospital stay. No correlation was found between the number of physical therapists and functional goals at discharge. The frequent change of physical therapists providing rehabilitation to elderly patients who underwent surgery for hip fragile fracture is not related to functional outcomes.
PURPOSE: The aim of this study is to report the prevalence of femoral bowing in the Egyptian arthritic knees as a representative of the middle eastern population and to study the correlation between the femoral bowing an...PURPOSE: The aim of this study is to report the prevalence of femoral bowing in the Egyptian arthritic knees as a representative of the middle eastern population and to study the correlation between the femoral bowing and the degree of arthritis, varus deformity and the distal femoral valgus cut angle (VCA). METHODS: This is a single-center observational cross-sectional study. Out of 562 knees Scheduled for TKA, 124 knees were excluded leaving 438 knees eligible for the study. The following angles were measured by two independent orthopedic surgeons: Femoral bowing angle (FBA), HKA angle, LDFA, MPTA and VCA. RESULTS: Out of 438 knees, 21knees (4.8%) had medial bowing (< - 3°), 111 (25.3%) had normal bowing (+ 3° to - 3°) and 306 (69.9%) had LFB of which 111 (25.34%) had mild LFB (+ 3 to + 5°) and 195 (44.52%) had severe LFB (> + 5°) bowing. LFB was more in older age group (p = 0.005), in females (p < 0.001), and in grade 4 OA, (p < 0.001). Also, there was a significant positive correlation between FBA and age and increasing varus HKA, and with varus orientation of the distal femur and the tibial plateau. The mean and the 95% confidence interval of the VCA for the medial bowing group was 3.43 (3.01-3.85°), for the normal bowing group was 5.42 (5.15-5.68°), for the mild lateral bowing was 6.74 (6.47-7°), and for the severe bowing group was 9.23 (8.89-9.55°). CONCLUSIONS: There is no single safe zone for the VCA to reproduce postoperative neutral coronal alignment especially in cases of severe lateral femoral bowing in TKA. However, the VCA should be analyzed in term of how much femoral bowing exists. In other words, for each subset of femoral bowing there is a safe zone for the VCA.
BACKGROUND: A persistent fracture gap following femoral nailing increases the risk of delayed and nonunion development. A forward-striking technique for reducing the gap in femoral nailing has been described, but its eff...BACKGROUND: A persistent fracture gap following femoral nailing increases the risk of delayed and nonunion development. A forward-striking technique for reducing the gap in femoral nailing has been described, but its efficacy and therapeutic consequences have not been investigated in comparative studies. We provide the results of a comparative study that investigated the forward-striking technique's efficacy in terms of remaining fracture gaps and surgical outcomes. METHODS: Between 2017 and 2022, a retrospective cohort study was undertaken on 193 skeletal mature patients obtaining reamed femoral nailing for closed femoral shaft fractures. Comparisons of residual fracture gaps, timing to union, complications and re-operation rates were made between 80 patients (41.45%) undergoing femoral nailing with the forward striking procedure and 113 patients (58.55%) undergoing traditional nailing, accompanied by minimal 1-year follow-ups. In addition, the potential difference between fracture gaps before and after applying the forward striking procedure was compared. RESULTS: Both groups had similar age, sex, presence of diabetes, smoking status, body mass index and time to surgery. However, the forward-striking group demonstrated significantly lower rates of postoperative complications, including delayed, nonunion, and the need for re-operation. Conversely, no significant differences were found in time to union (p = 0.222). The forward-striking procedure can significantly reduce residual fracture gaps from 3.99 to 1.66 mm (p < 0.001). No major complications in the forward-striking group including nonunion were observed. CONCLUSION: This study suggests that the forward-striking technique effectively reduces residual fracture gap during femoral nailing. The technique not only could be easily performed but is also reproducible. In addition, it can lower the risk of delayed union, nonunion and obviates the necessity for re-operation. LEVEL OF EVIDENCE: Level III, retrospective cohort study.
PURPOSE: Surgical treatment of chronic Achilles tendon rupture is a technically challenging procedure. We aimed to compare the clinical outcomes, range of motion, and strength of ankle plantar- and dorsiflexors between t...PURPOSE: Surgical treatment of chronic Achilles tendon rupture is a technically challenging procedure. We aimed to compare the clinical outcomes, range of motion, and strength of ankle plantar- and dorsiflexors between two techniques for fixation of flexor hallucis longus tendon to the calcaneus: interference screw and suture-external button. METHODS: Twenty-five patients participated in this retrospective comparative study. All patients underwent short harvest FHL tendon transfer for chronic AT rupture were asked for a follow-up visit, at least one year following surgery. The outcomes were evaluated by visual analog scale (VAS), AOFAS ankle-hindfoot score, and VISA-A questionnaire. Ankle ROM with possible restriction in addition to isokinetic strength of ankle plantar- and dorsiflexors was assessed. RESULTS: No statistically significant difference was observed between the groups for pain (P = 0.81), AOFAS ankle-hindfoot scale (P = 0.97), and VISA-A (P = 0.44). Notably, more decrease in ankle dorsiflexion was seen in interference screw group in comparison with suture-external button group (4.4 ± 6.6 vs. 9.5 ± 6.1 degrees, P = 0.06). The difference of active dorsiflexion between operated and non-operated side in interference screw group was statistically significant (P = 0.02). Biotenodesis screw imposed more limb asymmetry in comparison with suture-external button technique. CONCLUSIONS: Fixation of transcalcaneal FHL tendon transfer for chronic AT either by interference screw or suture-external button has encouraging postoperative clinical results. Although ROM of the ankle joint reduced in both techniques, interference screw may result in more reduction in dorsiflexion of the ankle.