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Hall S, Kaplan JRM, Schipper ON, Vulcano E, Johnson AH, Jackson JB, Aiyer AA, Gonzalez TA. Minimally Invasive Approaches to Haglund's Deformity and Insertional Achilles Tendinopathy: A Contemporary Review. Foot Ankle Int 2024; 45:664-675. [PMID: 38647216 DOI: 10.1177/10711007241237529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- SarahRose Hall
- University of South Carolina, School of Medicine, Columbia, SC, USA
| | | | | | - Ettore Vulcano
- Department of Orthopaedic Surgery, Columbia University Mount Sinai Medical Center, Miami Beach, FL, USA
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Bakaes Y, Hall S, Jackson JB, Johnson AH, Schipper ON, Vulcano E, Kaplan JRM, Gonzalez TA. Percutaneous vs Open Zadek Osteotomy for Treatment of Insertional Achilles Tendinopathy and Haglund's Deformity: A Systematic Review. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241241320. [PMID: 38617581 PMCID: PMC11015789 DOI: 10.1177/24730114241241320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
Background Percutaneous Zadek osteotomy (ZO) has emerged as a surgical treatment of insertional Achilles tendinopathy (IAT) over the last decade. Existing literature is limited regarding the comparison of this approach with the more established, open ZO technique. This systematic review aims to evaluate and compare the current data on open vs percutaneous ZO approaches to help set evidence-based guidelines. Methods A systematic literature search was performed using the keywords (Zadek osteotomy) OR (Keck and Kelly osteotomy) OR (dorsal closing wedge calcaneal osteotomy) OR (Haglund Deformity) OR (Haglund Syndrome) OR (Insertional Achilles Tendinopathy) and MeSH terms Osteotomy, Calcaneus, Syndrome, Insertional, Achilles tendon, and Tendinopathy. Our search included the following databases: PubMed, Embase, and the Cochrane Library. The PRISMA protocol and the Cochrane Handbook guidelines were followed. All studies included were published from 2009 to 2024 and included the use of open or percutaneous approaches of ZO for the treatment of IAT with at least a 12-month follow-up. The MINORS score criteria were used to evaluate the strength and quality of studies. Results A total of 17 studies were reviewed, including 611 subjects and 625 ZO procedures. Of these procedures, 81 (11%) subjects had a percutaneous and 544 (89%) subjects had an open ZO. The mean follow-up time was 16.1 months for patients treated with percutaneous ZO and 36.1 months for patients treated with open ZO. Both open and percutaneous studies included in this review showed postoperative improvements in AOFAS, FFI, VISA-A, and VAS scores in patients with IAT. The reported complication rate was 5.8% among patients treated with percutaneous ZO and 10.2% among patients treated with open ZO. Conclusion Percutaneous ZO is an emerging approach with substantially fewer documented cases compared with the open ZO. Both percutaneous and open ZO appear to be relatively effective treatments for insertional Achilles tendinopathy with Haglund's deformity. The lower complication rates reported for percutaneous ZO is encouraging. Further investigation with more subjects undergoing percutaneous ZO is clearly needed.
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Affiliation(s)
- Yianni Bakaes
- School of Medicine, University of South Carolina, Columbia, SC, USA
| | - SarahRose Hall
- School of Medicine, University of South Carolina, Columbia, SC, USA
| | - J. Benjamin Jackson
- School of Medicine, University of South Carolina, Columbia, SC, USA
- Prisma Health Orthopedics, Lexington, SC, USA
| | | | | | - Ettore Vulcano
- Columbia University Division of Orthopedics at Mount Sinai Medical Center, Miami Beach, FL, USA
| | | | - Tyler A. Gonzalez
- School of Medicine, University of South Carolina, Columbia, SC, USA
- Prisma Health Orthopedics, Lexington, SC, USA
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Ehredt DJ, Razzante MC, Darji D, Miggantz SH. Endoscopic calcaneoplasty with gastrocnemius recession for Haglund's syndrome: Is it safe and effective? Results from a retrospective case series. Foot (Edinb) 2023; 57:101960. [PMID: 37898054 DOI: 10.1016/j.foot.2023.101960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Endoscopic calcaneoplasty (ECP) and gastrocnemius recession (GR) are procedures that have been described to effectively treat Haglund's deformity and insertional Achilles tendinopathy respectively. The purpose of our manuscript is to evaluate the efficacy and safety of ECP and GR with immediate weightbearing for the treatment of Haglund's deformity with mild to moderate insertional Achilles tendinopathy. METHODS We performed ECP coupled with GR on 14 patients with an average age of 52 years. All patients demonstrated < 50% tendinous degeneration on MRI. All were allowed weightbearing as tolerated in a CAM boot within the first post-operative week. AOFAS scores and plain film radiographic findings were collected pre-operatively and post-operatively. RESULTS The radiographic exam of the Fowler-Philip angle significantly improved from an average 60.1-40.7° (p < 0.001). The AOFAS ankle/hindfoot score significantly improved from an average 54.7-91.4 (p < 0.001). The average return to work was 7.5 weeks. There were two cases of temporary sural nerve paresthesia, and two cases of delayed wound healing. CONCLUSIONS This is the first mid-term study evaluating the outcomes of ECP with GR. The results of our study suggest that ECP with GR followed by immediate weightbearing is a safe and effective procedure for the treatment of Haglund's deformity and mild to moderate insertional Achilles tendinopathy.
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Affiliation(s)
- Duane J Ehredt
- Division of Foot and Ankle Surgery, Kent State University College of Podiatric Medicine, Independence, OH, USA.
| | - Mark C Razzante
- California School of Podiatric Medicine at Samuel Merritt University, Oakland, CA, USA
| | - Deepali Darji
- Podiatric Medicine and Surgery Resident, Saint Vincent Charity Medical Center, Cleveland, OH, USA
| | - Sydney H Miggantz
- Podiatric Medical Student, Kent State University College of Podiatric Medicine, Independence, OH, USA
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Desai SS, Wong TT, Crockatt WK, Tedesco LJ, Trofa DP, Popkin CA. The 'Bauer bump:' ice hockey skates as a common cause of Haglund syndrome. PHYSICIAN SPORTSMED 2023; 51:414-419. [PMID: 35583477 DOI: 10.1080/00913847.2022.2079962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
Ice hockey is a fast-paced contact sport with a high rate of injury. While many of the injuries are acute and related to high skating speeds, frequent collisions, and sharp skates, the clinician must also be aware of the chronic injuries that commonly arise from playing this sport. The "Bauer bump" is one such chronic injury, which is the onset of Haglund syndrome in ice hockey players occurring in the context of wearing ice hockey skates. With this condition, players notice a bony enlargement of their posterosuperior calcaneus with or without the accompanying symptoms of retrocalcaneal bursitis and insertional Achilles tendinopathy. It is important for clinicians to understand the nature of Haglund syndrome in hockey players so that it can be appropriately diagnosed, managed, and ultimately, prevented.
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Affiliation(s)
- Sohil S Desai
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, NY, NY, USA
| | - Tony T Wong
- Department of Musculoskeletal Radiology, Columbia University Medical Center, NY, NY, USA
| | - William K Crockatt
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, NY, NY, USA
| | - Liana J Tedesco
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, NY, NY, USA
| | - David P Trofa
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, NY, NY, USA
| | - Charles A Popkin
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, NY, NY, USA
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Tay AYW, Goh GS, Li Z, Yeo NEM, Tay KS. Two-Year Clinical and Radiologic Outcomes Following Surgical Treatment of Insertional Achilles Tendinopathy Using a Central Tendon-Splitting Approach. Foot Ankle Int 2023; 44:702-709. [PMID: 37272028 DOI: 10.1177/10711007231173679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND If conservative treatment of insertional Achilles tendinopathy (IAT) fails, surgery is often considered. Various surgical approaches have been used including the central Achilles tendon splitting approach. This study aimed to report the 2-year clinical and radiologic outcomes after surgical treatment of IAT with a central tendon-splitting approach. METHODS Seventy-five cases of IAT treated surgically via the open central tendon-splitting approach were analyzed. Clinical outcomes included the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, visual analog scale (VAS), 36-Item Short Form Health Survey (SF-36) physical (PCS) and mental (MCS) component summary scores, all measured at baseline and 6 and 24 months postoperatively. Radiologic parameters measured included the Fowler-Philip angle (FPA) and parallel pitch lines (PPL). RESULTS Three patients had clinically significant wound issues but healed completely by 3 weeks. Mean AOFAS score improved from 45.63 preoperatively to 94.71 at 24 months. Mean VAS score improved from 6.73 preoperatively to 0.55, mean SF-36 PCS from 35.98 to 48.74, and mean SF-36 MCS from 53.04 to 55.43 at 24 months. Satisfaction at 2 years was 94.3%. Mean FPA decreased from 62.0 degrees preoperatively to 34.0 degrees postoperatively. PPL was positive in 82.7% (62 of 75) of cases preoperatively, decreasing to 1.3% (1 of 75) postoperatively. Increasing age and higher preoperative VAS and SF-36 MCS scores were significantly associated with improvements in postoperative AOFAS, SF-36 PCS, and MCS scores. CONCLUSION Surgical treatment of IAT via the central tendon-splitting approach achieved substantial improvements in all patient-reported outcome measures measured. These excellent clinical outcomes continued to show improvement 2 years postoperatively. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Adriel You Wei Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Zongxian Li
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Kae Sian Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Nakajima K. Minimally invasive surgeries for insertional Achilles tendinopathy: A commentary review. World J Orthop 2023; 14:369-378. [PMID: 37377992 PMCID: PMC10292061 DOI: 10.5312/wjo.v14.i6.369] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 06/19/2023] Open
Abstract
Studies of minimally invasive surgery for insertional Achilles tendinopathy are limited. To establish this surgery, the following techniques must be minimally invasive: Exostosis resection at the Achilles tendon insertion, debridement of degenerated Achilles tendon, reattachment using anchors or augmentation using flexor hallucis longus (FHL) tendon transfer, and excision of the posterosuperior calcaneal prominence. Studies on these four perspectives were reviewed to establish minimally invasive surgery for insertional Achilles tendinopathy. Techniques for exostosis resection were demonstrated in one case study, where blunt dissection around the exostosis was performed, and the exostosis was resected using an abrasion burr under fluoroscopic guidance. Techniques for debridement of degenerated Achilles tendon were demonstrated in the same case study, where the space left after resection of the exostosis was used as an endoscopic working space, and the degenerated Achilles tendon and intra-tendinous calcification were debrided endoscopically. Achilles tendon reattachment techniques using suture anchors have been demonstrated in several studies. However, there are no studies on FHL tendon transfer techniques for Achilles tendon reattachment. In contrast, endoscopic posterosuperior calcaneal prominence resection is already established. Additionally, studies on ultrasound-guided surgeries and percutaneous dorsal wedge calcaneal osteotomy as minimally invasive surgery were reviewed.
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Affiliation(s)
- Kenichiro Nakajima
- Center for Foot and Ankle Surgery, Department of Orthopedic Surgery, YashioCentral General Hospital, Yashio-shi 340-0814, Saitama, Japan
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Yuen WLP, Tan PT, Kon KKC. Surgical Treatment of Haglund’s Deformity: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e27500. [PMID: 36060327 PMCID: PMC9424834 DOI: 10.7759/cureus.27500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 11/16/2022] Open
Abstract
Posterosuperior calcaneal prominence, also known as Haglund’s deformity, can often lead to retrocalcaneal bursitis, a significant cause of posterior heel pain. Surgery is indicated for symptomatic patients, after a period of conservative treatment including analgesia, physiotherapy, activity, and shoe wear modification has failed. Surgical options include both open and endoscopic techniques, and typically involve excision of the retrocalcaneal bursa, resection of the calcaneal prominence, and debridement of the diseased Achilles tendon. This article aims to provide an evidence-based literature review for the surgical management of Haglund’s deformity. A comprehensive evidence-based literature review of the PubMed database conducted in July 2021 identified 20 relevant articles assessing the efficacy of surgical modalities for Haglund’s deformity. The 20 studies were assigned to a level of evidence (I-IV). Individual studies were reviewed to provide a grade of recommendation (A-C, I) according to the Wright classification in support of or against the surgical modality. Qualitative and quantitative analysis was performed for the 20 studies. The results show that both open and endoscopic surgical modalities are efficacious in the treatment of Haglund’s deformity, significantly improving functional outcome scores such as American Orthopaedic Foot & Ankle Society (AOFAS) scores and patient satisfaction post-operatively. Endoscopic surgery appears to have the advantage of shorter operative times, lower complication rates, and better cosmesis. More studies are required to further validate and optimize these surgical techniques.
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Management of Insertional Achilles Tendinopathy. J Am Acad Orthop Surg 2022; 30:e751-e759. [PMID: 35286285 DOI: 10.5435/jaaos-d-21-00679] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 01/29/2022] [Indexed: 02/01/2023] Open
Abstract
Insertional Achilles tendinopathy is a common condition that can lead to chronic, debilitating heel pain in athletes and nonathletes alike. Conservative treatment options include activity and shoe wear modification, physical therapy, injections, and extracorporeal shock wave therapy. When nonsurgical treatment fails, surgical treatment is recommended. Although there are options aimed at preserving the tendon and débriding the retrocalcaneal bursa and excess bone formation, others are aimed at detaching the Achilles tendon to perform a thorough débridement and subsequent reattachment. Additional or alternate procedures may include a calcaneal closing wedge osteotomy, gastrocnemius lengthening, and flexor hallucis longus tendon transfer. Recent advances in suture anchor techniques further add to the complexity of available options. This review discusses the relevant anatomy, biomechanics, and pathophysiology as well as the recent available evidence for nonsurgical and surgical management of this condition to guide surgeons in selecting the most appropriate treatment for their patients.
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Satisfactory Functional Outcome and Significant Correlation with the Length of Haglund's Deformity after Endoscopic Calcaneoplasty: A Minimum 4-Year Follow-Up Study. Adv Orthop 2022; 2022:7889684. [PMID: 35465128 PMCID: PMC9020964 DOI: 10.1155/2022/7889684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background Haglund's syndrome is a posterosuperior calcaneal prominence with posterior heel pain causing functional disability to the patient. Operative treatment is indicated after failure of conservative measures and includes resection of the bony hump along with retrocalcaneal bursectomy. This study aimed to evaluate the functional outcome and degree of patient satisfaction after endoscopic resection of Haglund's deformity with assessment of correlation with the length of bony exostosis. Methods Seventeen patients (21 feet) with a mean age of 44.7 ± 5.1 years were included in this study. Six females and 11 males underwent endoscopic calcaneoplasty. Clinical outcome evaluation included the assessment of the visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society score (AOFAS). The preoperative and postoperative lengths of bony exostosis were measured radiologically. The paired t test and the Wilcoxon signed-rank test compared the preoperative and final postoperative means. P < 0.05 was considered statistically significant. Results The mean follow-up period was 56.4 ± 5.1 months. Statistically significant improvements in the preoperative mean of AOFAS (from 55.7 ± 9.3 to 94.3 ± 7.1) and VAS (from 8.1 ± 1.4 to 0.7 ± 1.04) at the final follow-up were noted (P < 0.0001). There was a statistically significant correlation between clinical scores (AOFAS and VAS) and the final postoperative length of the bone above parallel pitch lines (PPLs). The patients were satisfied and returned to their previous activities without reporting major morbidities except one patient who had mild pain with exertion. Conclusion Endoscopic calcaneoplasty is a safe, less invasive surgical procedure for the management of Haglund's syndrome after failure of conservative treatment. It provided a satisfactory clinical result without serious complications at a minimum 4-year follow-up.
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Resection of Haglund’s deformity using the arthroscopic method with the three-portal technique. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh210703036j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Haglund?s deformity represents a reactive enlargement of the
posterosuperior aspect of the calcaneus and often causes pain that can
significantly disturb everyday activities. If the patient?s condition did
not improve after six months of non-surgical treatment, the surgical
treatment could be taken into consideration. Although Haglund?s deformity is
successfully treated by endoscopic calcaneoplasty with two portal techniques
we decided to apply a slightly newer technique - arthroscopic surgery with
three portal techniques. Case outline. Patient with clinically and
radiographically confirmed Haglund?s deformity was operated on using
arthroscopic calcaneoplasty with three portal techniques. The postoperative
recovery went without complications and full weight-bearing was allowed
after 4 weeks. Completely return to sports activities was allowed after 4
months. Conclusion. Arthroscopic calcaneoplasty with three portal
techniques turned out to be a safe and cost-effective surgical method in the
treatment of Haglund?s deformity. There is still not enough data in the
literature regarding this type of surgical treatment, but the good
postoperative functional results are extremely encouraging since this
surgical technique enables faster recovery and fewer postoperative
complications.
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Hörterer H, Oppelt S, Böcker W, Gottschalk O, Harrasser N, Walther M, Polzer H, Baumbach SF. Patient-Reported Outcomes of Surgically Treated Insertional Achilles Tendinopathy. Foot Ankle Int 2021; 42:1565-1569. [PMID: 34154453 DOI: 10.1177/10711007211023060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to assess the patient-reported outcome measures (PROMs) in patients with insertional Achilles tendinopathy (IAT) treated surgically by debridement of all pathologies through a midline-incision trans-achillary approach (MITA). METHODS This is a retrospective cohort study with current follow-up. Patients treated surgically by a MITA, addressing all pathologies of IAT, with at least 12 months of follow-up were included. Demographics, medical history, surgical details, and complications were recorded. Patient-reported outcomes were assessed using the Foot Function Index (FFI), Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A-G), visual analog scale foot and ankle (VAS-FA), and 12-Item Short-Form Health Survey (SF-12). Longitudinal FFI data were available for 48% of the patients. RESULTS A total of 118 patients (63.4%) with a mean follow-up of 50 ± 25 months were included. The FFI improved from 53 (24) preoperatively to 2 (11) points at the final follow-up. The final VISA-A-G score was 93 (26), the VAS-FA score 93 (15), the SF-12 Physical Component Summary 56 (8), and the SF-12 Mental Component Summary 55 (12) points. There was an additional FFI improvement between 12 months and the final follow-up. Up to 47% (VISA-A-G) of patients had residual symptoms. A postoperative shoe conflict was the only parameter negatively affecting the PROMs (P < .001). CONCLUSION Addressing all pathologies of IAT by the MITA resulted in overall good postoperative PROMs after 4 years. But up to 47% of patients remained impaired. The only parameter correlating with an impaired PROM was a postoperative shoe conflict. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Hubert Hörterer
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Bavaria, Germany.,Department of General, Trauma, and Reconstructive Surgery, University Hospital Munich, Munich, Germany
| | - Sonja Oppelt
- Department of General, Trauma, and Reconstructive Surgery, University Hospital Munich, Munich, Germany
| | - Wolfgang Böcker
- Department of General, Trauma, and Reconstructive Surgery, University Hospital Munich, Munich, Germany
| | - Oliver Gottschalk
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Bavaria, Germany.,Department of General, Trauma, and Reconstructive Surgery, University Hospital Munich, Munich, Germany
| | - Norbert Harrasser
- Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Markus Walther
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Bavaria, Germany.,Department of Orthopedics and Orthopedic Surgery, Julius-Maximilians-University, Würzburg, Germany
| | - Hans Polzer
- Department of General, Trauma, and Reconstructive Surgery, University Hospital Munich, Munich, Germany
| | - Sebastian Felix Baumbach
- Department of General, Trauma, and Reconstructive Surgery, University Hospital Munich, Munich, Germany
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