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El-Sharkasy MH, El-Singergy AA, Mansour AMR, Badawy MA, Khedr A. Union in Lateral Column Lengthening by Plate Fixation Without Bone Graft in Flexible Flatfoot: A Case Series. Indian J Orthop 2023; 57:1283-1289. [PMID: 37525734 PMCID: PMC10387035 DOI: 10.1007/s43465-023-00945-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/22/2023] [Indexed: 08/02/2023]
Abstract
Purpose This study's goal was to evaluate the outcomes of lateral column lengthening by plate fixation without bone graft in the management of symptomatic flexible flatfoot. Methods A prospective randomized trial study included 30 feet (27 patients) and was performed from March 2017 to December 2019. Functional and radiological evaluations were done pre-operative and at the final post-operative follow-up. The functional assessment was done using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Results The mean follow-up was 16.5 ± 3.027 months. The mean age of patients was 22.6 ± 6.29 years. All cases showed union ranging from 8 to 12 weeks, with a mean of 10 ± 1.88 weeks. The mean AOFAS score improved from 51.6 ± 6.75 to 92.2 ± 6.21. The mean anteroposterior (AP) talo-first metatarsal angle improved from 25.3° ± 8.31° to 3.4° ± 5.10°. The mean anteroposterior (AP) talo-navicular coverage improved from 22.10° ± 4.28° to 2.3° ± 3.46°. The mean Lateral talo-first metatarsal angle improved from 18.6° ± 4.79° to 3.3° ± 3.16°. The calcaneal pitch angle improved from 9.6° ± 4.14° to 15.1° ± 4.43°. The mean lateral talo-calcaneal angle improved from 45.7° ± 3.77° to 37.5° ± 3.47°. Conclusion Using an interposition wedge plate for LCL without bone graft leads to a high union rate, maintains the correction, and avoids possible complications of autografts and allografts.
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Affiliation(s)
- Mohamed Hegazy El-Sharkasy
- Orthopedic Surgery Department, Shoubra General Hospital, Cairo, Egypt
- Orthopedic Surgery Department, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
| | | | - Ali M. Reda Mansour
- Orthopedic Surgery Department, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
| | | | - Ahmed Khedr
- Orthopedic Surgery Department, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
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Stamatos NJ, Murasko MJ, Richardson K, O’Connor C, Anoushiravani AA, Adams C, Rosenbaum A. Radiographic Outcomes of Titanium Augment vs Bone Graft in Lateral Column Lengthening for Adult-Acquired Flatfoot Deformity. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231176554. [PMID: 37325693 PMCID: PMC10262613 DOI: 10.1177/24730114231176554] [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: 06/17/2023] Open
Abstract
Background Lateral column lengthening (LCL) is a surgical procedure used to manage forefoot abduction and, in theory, also increases the longitudinal arch by plantarflexion of the first ray through tensioning the peroneus longus for patients with stage IIB adult acquired flatfoot deformity (AAFD). This procedure utilizes an opening wedge osteotomy of the calcaneus, which is then filled with autograft, allograft, or a porous metal wedge. The primary aim of this study was to compare the radiographic outcomes of these different bone substitutes following LCL for stage IIB AAFD. Methods We conducted a retrospective review of all patients who underwent LCL from October 2008 until October 2018. Preoperative weightbearing radiographs, initial postoperative radiographs, and 1-year weightbearing radiographs were reviewed. The following radiographic measurements were recorded: incongruency angle, talonavicular coverage angle (TNCA), talar-first metatarsal angle (T-1MT), and calcaneal pitch. Results A total of 44 patients were included in our study. The mean age of the cohort was 54 (range, 18-74). The study cohort was divided into 2 groups. There were 17 (38.7%) patients who received a titanium metal wedge and 27 (61.5%) that received autograft or allograft. Patients that underwent LCL with the autograft/allograft group were significantly older (59 vs 47 years old, P = .006). Patients who underwent LCL with a titanium wedge had a significantly higher preoperative talonavicular angle (32 vs 27 degrees, P = .013). There were no significant differences in postoperative TNCA, incongruency angle, or calcaneal pitch at 6 months or 1 year. Conclusion At 6 months and 1 year, no radiographic differences were found between autograft/allograft bone substitutes vs titanium wedge in LCL. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
| | - Marlon J. Murasko
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Kyle Richardson
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Casey O’Connor
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | | | - Curtis Adams
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | - Andrew Rosenbaum
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
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Wu J, Liu H, Xu C. The optimal procedure for lateral column lengthening calcaneal osteotomy according to anatomical patterns of the subtalar joint: an anatomical study in the Chinese population. BMC Musculoskelet Disord 2022; 23:751. [PMID: 35927661 PMCID: PMC9354284 DOI: 10.1186/s12891-022-05715-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 07/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background Lateral column lengthening calcaneal osteotomy is a powerful procedure for correcting forefoot abduction in flatfoot deformity. However, it involves the risk of damaging articular facets of the subtalar joint. The optimal method to avoid violating the subtalar joint during lateral column lengthening remained controversial in published reports, implying that the subtalar joint might present anatomical variations among different nationalities. Therefore, the objective of this study was to perform an anatomical study by targeting the healthy Chinese population for the purpose of identifying the optimal procedure for lateral column lengthening calcaneal osteotomy according to anatomical patterns of the subtalar joint. Methods A total of 72 ft from 70 fresh frozen cadavers were obtained from the Department of Anatomy of Central South University. For each foot, soft tissues were surgically removed from the bones, and the calcaneus was completely separated from other bones to recognize the anatomical features of the calcaneus. The distance between the calcaneocuboid joint and the articular facet of the subtalar joint was measured by digital calipers for further analysis. Results Out of the 72 ft, 36.1% had separated anterior and middle facets in the calcaneus, and 63.8% had partly or completely fused anterior and middle facets. In the calcanei with discrete facets, the mean distance from the calcaneocuboid joint to the proximal margin of the anterior facet was 12.75 ± 2.10 mm, and the mean width of the separation between the anterior and middle facets was 2.43 ± 1.41 mm. In the calcanei with partly or completely fused anterior and middle facets, the mean width of the narrowest part of the tarsal sinus was 5.81 ± 0.62 mm and 6.25 ± 0.35 mm, respectively. Conclusions The anatomy of the subtalar joint presents significant individual variations in the Chinese population. Calcanei with partly or completely fused anterior and middle facets were observed in nearly two thirds of individuals. Since the modified Evans procedure might potentially incur damage to the subtalar joint facets, the Hintermann procedure or other modified extra-articular lateral column lengthening procedures may be more applicable to the Chinese population.
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Affiliation(s)
- Jiajun Wu
- Department of Orthopaedics Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, China
| | - Hua Liu
- Department of Orthopaedics Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, China
| | - Can Xu
- Department of Orthopaedics Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, China.
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Davies JP, Ma X, Garfinkel J, Roberts M, Drakos M, Deland J, Ellis S. Subtalar Fusion for Correction of Forefoot Abduction in Stage II Adult-Acquired Flatfoot Deformity. Foot Ankle Spec 2022; 15:221-235. [PMID: 32830562 DOI: 10.1177/1938640020951050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Correction of talonavicular uncoverage (TNU) in adult-acquired flatfoot deformities (AAFD) can be a challenge. Lateral column lengthening (LCL) traditionally is utilized to address this. The primary study objective is examining stage II AAFD patients and determining if correction can be achieved with subtalar fusion (STF) comparable to LCL. METHODS Following institutional review board approval, retrospective chart review performed identifying patients meeting criteria for stage IIB AAFD who underwent either STF with concomitant flatfoot procedures (but not LCL) to correct TNU, or who underwent LCL as part of their flatfoot reconstruction. Patients indicated for STF had one or more of the following: higher body mass index (BMI), were older, had greater deformity, lateral impingement pain, intraoperative spring ligament hyperlaxity. Patients without 1-year follow-up or compete records were excluded. All other patients were included. A total of 27 isolated STFs identified, along with 143 who underwent LCL. Pre-/postoperative radiographic parameters obtained as well as PROMIS (Patient-Reported Outcomes Measurement Information System) and FAOS (Foot and Ankle Outcome Score) scores. Radiographic and patient reported outcomes both preoperatively and at 1-year follow-up evaluated for both groups. RESULTS STF patients were older (P < .05), with higher BMIs (P < .004). STF had significantly worse TNU (P < .001) than LCL patients, and average change in STF TNU was larger than LCL change postoperatively (P = .006), after adjusting for age, BMI, gender. PROMIS STF improvement reached statistical significance in Physical Function (P 0.011), for FAOS Pain (P 0.025) and Function (P = 0.04). CONCLUSIONS STF can be used in appropriately indicated patients to correct flatfoot deformity without compromising radiographic or clinical, correcting not only hindfoot valgus, but also talonavicular uncoverage (TNU) and corresponding medial arch collapse. LEVELS OF EVIDENCE Level III: Retrospective chart review comparison study (case control).
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Affiliation(s)
- James P Davies
- Premier Orthopedic Specialists of Tulsa, Tulsa, Oklahoma
| | - Xiaoyue Ma
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York
| | - Jonathan Garfinkel
- Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Matthew Roberts
- Department of Orthopaedic Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York
| | - Mark Drakos
- Department of Orthopaedic Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York
| | - Jonathan Deland
- Department of Orthopaedic Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York
| | - Scott Ellis
- Department of Orthopaedic Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York
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Modha RK, Kilmartin TE. Lateral Column Lengthening For Flexible Adult Acquired Flatfoot: Systematic Review and Meta-Analysis. J Foot Ankle Surg 2021; 60:1254-1269. [PMID: 34253434 DOI: 10.1053/j.jfas.2021.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/30/2021] [Accepted: 02/21/2021] [Indexed: 02/03/2023]
Abstract
Flexible Adult Acquired Flatfoot is known to have multiplanar components and can often be a challenge to manage in the clinical setting, with resistance to non-surgical intervention. Lateral Column Lengthening is a favorable option for surgical management, although there are several methods in achieving this, an opening wedge osteotomy of the anterior calcaneus or distraction arthrodesis of the calcaneocuboid joint appear to be the 2 most widespread. In this review we conducted in systematic fashion, analysis of the available literature utilizing the following electronic bibliographic databases, in line with the PRISMA-P checklist: MEDLINE, CINHAL, EMBASE, and the Cochrane library without date restriction up to November 1, 2019. Results identified 21 studies which were assessed for quality using the Coleman methodology score and later evaluated using the PICO analysis system. From 172 participants, we found a higher rate of graft failure with the use of allograft versus autograft, although from a total 355 cases union rates were reported as similar. From the 355, fewer complications with arthrodesis in comparison to osteotomy were reported, including that of post-operative lateral column pain. Surgical intervention using either lateral column procedure yields excellent clinical and radiological results, the literature findings marginally favor the arthrodesis procedure and autograft over allograft. Keeping graft size under 8 mm was found to be clinically important to mitigate overlengthening of the lateral column and biomechanical testing exhibited triangular graft superiority. Where significant correction is required the addition of a medial column stabilization procedure will mitigate post-operative intractable lateral column pain.
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Affiliation(s)
- Ravi Krishān Modha
- Podiatric Surgeon, Department of Podiatric Surgery, West Middlesex University Hospital, London, United Kingdom.
| | - Timothy E Kilmartin
- Consultant Podiatric Surgeon, Department of Podiatric Surgery, Ilkeston Hospital, Ilkeston, United Kingdom
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6
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Crawford AW, Haleem AM. I am Afraid of Lateral Column Lengthening. Should I Be? Foot Ankle Clin 2021; 26:523-538. [PMID: 34332733 DOI: 10.1016/j.fcl.2021.06.003] [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: 02/02/2023]
Abstract
Lateral column lengthening has long been used in conjunction with other soft tissue and bony procedures to correct the midforefoot abduction seen in class B progressive collapsing foot deformity. The effectiveness of this osteotomy to restore the physiologic shape of the foot has been used by foot and ankle surgeons around the world to provide functional improvement for patients suffering from this disease. The overall low complication rates, low nonunion rates, and improved radiographic and functional outcomes provided by lateral column lengthening make this a valuable option for the treatment of class B progressive collapsing foot deformity.
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Affiliation(s)
- Alexander W Crawford
- Department of Orthopedic Surgery, Oklahoma University Health Sciences Center, University of Oklahoma College of Medicine, 800 Stanton L Young Boulevard, Suite 3400, Oklahoma City, OK 73104, USA
| | - Amgad M Haleem
- Department of Orthopedic Surgery, Oklahoma University Health Sciences Center, University of Oklahoma College of Medicine, 800 Stanton L Young Boulevard, Suite 3400, Oklahoma City, OK 73104, USA; Department of Orthopedic Surgery, Kasr Al-Ainy Hospitals, College of Medicine, Cairo University, Cairo, Egypt.
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7
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Silva MGAN, Koh DTS, Tay KS, Koo KOT, Singh IR. Lateral column osteotomy versus subtalar arthroereisis in the correction of Grade IIB adult acquired flatfoot deformity: A clinical and radiological follow-up at 24 months. Foot Ankle Surg 2021; 27:559-566. [PMID: 32811742 DOI: 10.1016/j.fas.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/02/2020] [Accepted: 07/25/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adult acquired flat foot deformity (AAFD) is a spectrum of conditions which can be progressive if untreated. Surgical correction and restoration of anatomical relationship are often required in the treatment of symptomatic Grade II AAFD after a failed course of conservative treatment. There is a paucity of literature recommending best practice-especially in the adult population. The authors aim to compare radiological and clinical outcomes of two widely employed surgical techniques in the treatment of symptomatic AAFD. METHODS A retrospective study of 76 patients with Grade IIB AAFD and had undergone either lateral column lengthening (LCL) or subtalar arthroereisis (STA) surgical correction of their symptomatic AAFD. Each technique was augmented with both bony osteotomy and soft tissue transfer as determined by on table assessment. Clinical and radiological outcomes were reviewed 24 months after surgery. RESULTS LCL and STA groups had comparable radiological outcomes at 24 months after surgery. However, LCL group demonstrated superior American Orthopaedic Foot and Ankle Society (AOFAS) midfoot (90.3 ± 12.6 vs 81.1 ± 20.6, p < 0.001) as well as Visual Analogue Scale (VAS) midfoot scores (0.5 ± 1.6 vs 1.3 ± 2.4, p < 0.001) at 24 months compared to the STA group. STA had a higher complication rate (20.6% vs 4.4%), with all cases complaining of sinus tarsi pain requiring subsequent removal of implant. CONCLUSION There is a role for either techniques in the treatment of symptomatic AAFD. LCL whilst more invasive has demonstrated superior outcome scores and lower complication rates at 24 months compared to STA. Patients need to be counselled appropriately to appreciate the benefits of each technique.
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Affiliation(s)
- M G A N Silva
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Don T S Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
| | - Kae Sian Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Kevin O T Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Inderjeet R Singh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Thordarson DB, Schon LC, de Cesar Netto C, Deland JT, Ellis SJ, Johnson JE, Myerson MS, Sangeorzan BJ, Hintermann B. Consensus for the Indication of Lateral Column Lengthening in the Treatment of Progressive Collapsing Foot Deformity. Foot Ankle Int 2020; 41:1286-1288. [PMID: 32851858 DOI: 10.1177/1071100720950732] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
RECOMMENDATION Progressive collapsing foot deformity (PCFD) is a complex 3D deformity with varying degrees of hindfoot valgus, forefoot abduction, and midfoot supination. Although a medial displacement calcaneal osteotomy can correct heel valgus, it has far less ability to correct forefoot abduction. More severe forefoot abduction, most frequently measured preoperatively by assessing talonavicular coverage on an anteroposterior (AP) weightbearing conventional radiographic view of the foot, can be more effectively corrected with a lateral column lengthening procedure than by other osteotomies in the foot. Care must be taken intraoperatively to not overcorrect the deformity by restricting passive eversion of the subtalar joint or causing adduction at the talonavicular joint on simulated AP weightbearing fluoroscopic imaging. Overcorrection can lead to lateral column overload with persistent lateral midfoot pain. The typical amount of lengthening of the lateral column is between 5 and 10 mm. LEVEL OF EVIDENCE Level V, consensus, expert opinion. CONSENSUS STATEMENT ONE Lateral column lengthening (LCL) procedure is recommended when the amount of talonavicular joint uncoverage is above 40%. The amount of lengthening needed in the lateral column should be judged intraoperatively by the amount of correction of the uncoverage and by adequate residual passive eversion range of motion of the subtalar joint.Delegate vote: agree, 78% (7/9); disagree, 11% (1/9); abstain, 11% (1/9).(Strong consensus). CONSENSUS STATEMENT TWO When titrating the amount of correction of abduction deformity intraoperatively, the presence of adduction at the talonavicular joint on simulated weightbearing fluoroscopic imaging is an important sign of hypercorrection and higher risk for lateral column overload.Delegate vote: agree, 100% (9/9); disagree, 0%; abstain, 0%.(Unanimous, strongest consensus). CONSENSUS STATEMENT THREE The typical range for performing a lateral column lengthening is between 5 and 10 mm to achieve an adequate amount of talonavicular coverage.Delegate vote: agree, 100% (9/9); disagree, 0%; abstain, 0%.(Unanimous, strongest consensus).
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Affiliation(s)
| | - Lew C Schon
- Mercy Medical Center, Baltimore, MD, USA.,New York University Grossman School of Medicine, New York, NY, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA.,Georgetown School of Medicine, Washington, DC, USA
| | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | | | | | | | - Mark S Myerson
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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Conti MS, Garfinkel JH, Ellis SJ. Outcomes of Reconstruction of the Flexible Adult-acquired Flatfoot Deformity. Orthop Clin North Am 2020; 51:109-120. [PMID: 31739874 DOI: 10.1016/j.ocl.2019.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Reconstruction of the flexible adult-acquired flatfoot deformity (AAFD) is controversial, and numerous procedures are frequently used in combination, including flexor digitorum longus transfer, medializing calcaneal osteotomy (MCO), heel cord lengthening/gastrocnemius recession, lateral column lengthening (LCL), Cotton osteotomy or first tarsometatarsal fusion, and spring ligament reconstruction. This article summarizes recent studies demonstrating that patients have significant improvements after operative treatment of flexible AAFD. It reviews current literature on clinical and radiographic outcomes of the MCO, LCL, and Cotton osteotomies. The authors describe how this information can be used in surgical decision making in order to tailor operative treatment to an individual patient's deformity.
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Affiliation(s)
- Matthew S Conti
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Jonathan H Garfinkel
- Cedars-Sinai Medical Center, 444 S. San Vicente Boulevard, Suite 603, Los Angeles, CA 90048, USA
| | - Scott J Ellis
- Department of Orthopaedic Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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10
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Abstract
Use of orthobiologics in sports medicine and musculoskeletal surgery has gained significant interest. However, many of the commercially available and advertised products are lacking in clinical evidence. Widespread use of products before fully understanding their true indications may result in unknown adverse outcomes and may also lead to increased health care costs. As more products become available, it is important to remain judicial in use and to practice evidence-based medicine. Likewise, it is important to continue advances in research in hopes to improve surgical outcomes. This article reviews clinical evidence behind common orthobiologics in the treatment of foot and ankle pathology.
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Tsai J, McDonald E, Sutton R, Raikin SM. Severe Flexible Pes Planovalgus Deformity Correction Using Trabecular Metallic Wedges. Foot Ankle Int 2019; 40:402-407. [PMID: 30565478 DOI: 10.1177/1071100718816054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: Lateral column lengthening and plantarflexion dorsal opening wedge osteotomy of the medial cuneiform are 2 commonly used procedures to address the deformity seen in severe flexible pes planovalgus deformity. Traditionally, iliac crest allograft or autograft has been used to fill the osteotomy sites. Porous metallic wedges can be used as an alternative to avoid the concerns associated with both autograft and allograft. METHODS: We performed a retrospective review of patients who had corrective osteotomies utilizing metallic wedges to address flexible pes planovalgus with at least 2 years of follow-up data. Preoperative radiographic measurements (anteroposterior [AP] and talo-first metatarsal angle, calcaneal pitch, talocalcaneal angle, and talonavicular uncoverage angle) and functional scores (visual analog scale [VAS] pain, Foot and Ankle Ability Measure [FAAM] Activities of Daily Living [ADL], FAAM Sports) were compared to postoperative radiographic measurements and functional scores. RESULTS: There were statistically significant improvements in all radiographic parameters and functional scores. Two nonunions were seen, one of which healed with revision surgery while the other was asymptomatic. At the time of last radiographic follow-up, there were no recurrences of deformity or collapse. CONCLUSION: Porous metallic wedges offer an attractive alternative to autograft and/or allograft in the setting of corrective osteotomies for severe flexible pes planovalgus. Patients who underwent corrective osteotomies using these wedges demonstrated reliable, effective, and stable radiographic correction as well as significant improvements in function and pain. LEVEL OF EVIDENCE: Level IV, case series.
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Affiliation(s)
- Justin Tsai
- 1 Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Elizabeth McDonald
- 1 Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ryan Sutton
- 2 Sidney Kimmel Medical College, Ivyland, PA, USA
| | - Steven M Raikin
- 1 Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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12
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Abstract
There are several reconstructive procedures in foot and ankle surgery wherein structural grafts are needed to fill defects, restore height, and maintain correction while providing an osteoconductive environment until fusion occurs. Traditionally used autografts and allografts have their disadvantages and limitations. Porous tantalum, with stiffness similar to bone and its biocompatibility, can be a viable option in foot and ankle reconstructive procedures.
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13
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Moore SH, Carstensen SE, Burrus MT, Cooper T, Park JS, Perumal V. Porous Titanium Wedges in Lateral Column Lengthening for Adult-Acquired Flatfoot Deformity. Foot Ankle Spec 2018; 11:347-356. [PMID: 29073794 DOI: 10.1177/1938640017735890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
UNLABELLED Lateral column lengthening (LCL) is a common procedure for reconstruction of stage II flexible adult-acquired flatfoot deformity (AAFD). The recent development of porous titanium wedges for this procedure provides an alternative to allograft and autograft. The purpose of this study was to report radiographic and clinical outcomes achieved with porous titanium wedges in LCL. A retrospective analysis of 34 feet in 30 patients with AAFD that received porous titanium wedges for LCL from January 2011 to October 2014. Deformity correction was assessed using both radiographic and clinical parameters. Radiographic correction was assessed using the lateral talo-first metatarsal angle, the talonavicular uncoverage percentage, and the first metatarsocuneiform height. The hindfoot valgus angle was measured. Patients were followed from a minimum of 6 months up to 4 years (mean 16.1 months). Postoperative radiographs demonstrated significant correction in all 3 radiographic criteria and the hindfoot valgus angle. We had no cases of nonunion, no wedge migration, and no wedges have been removed to date. The most common complication was calcaneocuboid joint pain (14.7%). Porous titanium wedges in LCL can achieve good radiographic and clinical correction of AAFD with a low rate of nonunion and other complications. LEVELS OF EVIDENCE Level IV: Case series.
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Affiliation(s)
- Spencer H Moore
- University of Virginia Medical Center, Charlottesville, Virginia
| | | | - M Tyrrell Burrus
- University of Virginia Medical Center, Charlottesville, Virginia
| | - Truitt Cooper
- University of Virginia Medical Center, Charlottesville, Virginia
| | - Joseph S Park
- University of Virginia Medical Center, Charlottesville, Virginia
| | - Venkat Perumal
- University of Virginia Medical Center, Charlottesville, Virginia
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14
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Bernasconi A, Sadile F, Welck M, Mehdi N, Laborde J, Lintz F. Role of Tendoscopy in Treating Stage II Posterior Tibial Tendon Dysfunction. Foot Ankle Int 2018; 39:433-442. [PMID: 29451811 DOI: 10.1177/1071100717746192] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stage II tibialis posterior tendon dysfunction (PTTD) resistant to conservative therapies is usually treated with invasive surgery. Posterior tibial tendoscopy is a novel technique being used in the assessment and treatment of posterior tibial pathology. The aims of this study were (1) to clarify the role of posterior tibial tendon tendoscopy in treating stage II PTTD, (2) to arthroscopically classify spring ligament lesions, and (3) to compare the arthroscopic assessment of spring ligament lesions with magnetic resonance imaging (MRI) and ultrasonographic (US) data. METHODS We reviewed prospectively collected data on 16 patients affected by stage II PTTD and treated by tendoscopy. We report the reoperation rate and functional outcomes evaluated by comparing pre- and postoperative visual analogic scale for pain (VAS-pain) and the Short-Form Health Survey (SF-36; with its physical [PCS] and mental [MCS] components). Postoperative satisfaction was assessed using a VAS-satisfaction scale. One patient was lost to follow-up. Spring ligament lesions were arthroscopically classified in 3 stages. Discrepancies between preoperative imaging and intraoperative findings were evaluated. RESULTS At a mean of 25.6 months' follow-up, VAS-pain ( P < .001), SF-36 PCS ( P = .039), and SF-36 MCS ( P < .001) significantly improved. The mean VAS-satisfaction score was 75.3/100. Patients were relieved from symptoms in 80% of cases, while 3 patients required further surgery. MRI and US were in agreement with intraoperative data in 92% and 67%, respectively, for the tendon assessment and in 78% and 42%, respectively, for the spring ligament. CONCLUSIONS Tendoscopy may be considered a valid therapeutic tool in the treatment of stage II PTTD resistant to conservative treatment. It provided objective and subjective encouraging results that could allow continued conservative therapy while avoiding more invasive surgery in most cases. MRI and US were proven more useful in detecting PT lesions than spring ligament tears. Further studies on PT could use this tendoscopic classification to standardize its description. LEVEL OF EVIDENCE Level IV, therapeutic study, case series.
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Affiliation(s)
- Alessio Bernasconi
- 1 Department of Public Health, "Federico II" Naples University School of Medicine and Surgery, Trauma and Orthopaedic Unit, Napoli, Italy
| | - Francesco Sadile
- 1 Department of Public Health, "Federico II" Naples University School of Medicine and Surgery, Trauma and Orthopaedic Unit, Napoli, Italy
| | - Matthew Welck
- 2 Foot & Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, UK
| | - Nazim Mehdi
- 3 Clinique de l'Union, Ankle and Foot Surgery Center, Saint-Jean, France
| | - Julien Laborde
- 3 Clinique de l'Union, Ankle and Foot Surgery Center, Saint-Jean, France
| | - François Lintz
- 3 Clinique de l'Union, Ankle and Foot Surgery Center, Saint-Jean, France
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15
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Saunders SM, Ellis SJ, Demetracopoulos CA, Marinescu A, Burkett J, Deland JT. Comparative Outcomes Between Step-Cut Lengthening Calcaneal Osteotomy vs Traditional Evans Osteotomy for Stage IIB Adult-Acquired Flatfoot Deformity. Foot Ankle Int 2018; 39:18-27. [PMID: 28985691 DOI: 10.1177/1071100717732723] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The forefoot abduction component of the flexible adult-acquired flatfoot can be addressed with lengthening of the anterior process of the calcaneus. We hypothesized that the step-cut lengthening calcaneal osteotomy (SLCO) would decrease the incidence of nonunion, lead to improvement in clinical outcome scores, and have a faster time to healing compared with the traditional Evans osteotomy. METHODS We retrospectively reviewed 111 patients (143 total feet: 65 Evans, 78 SLCO) undergoing stage IIB reconstruction followed clinically for at least 2 years. Preoperative and postoperative radiographs were analyzed for the amount of deformity correction. Computed tomography (CT) was used to analyze osteotomy healing. The Foot and Ankle Outcome Scores (FAOS) and lateral pain surveys were used to assess clinical outcomes. Mann-Whitney U tests were used to assess nonnormally distributed data while χ2 and Fisher exact tests were used to analyze categorical variables (α = 0.05 significant). RESULTS The Evans group used a larger graft size ( P < .001) and returned more often for hardware removal ( P = .038) than the SLCO group. SLCO union occurred at a mean of 8.77 weeks ( P < .001), which was significantly lower compared with the Evans group ( P = .02). The SLCO group also had fewer nonunions ( P = .016). FAOS scores improved equivalently between the 2 groups. Lateral column pain, ability to exercise, and ambulation distance were similar between groups. CONCLUSION Following SLCO, patients had faster healing times and fewer nonunions, similar outcomes scores, and equivalent correction of deformity. SLCO is a viable technique for lateral column lengthening. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Stuart M Saunders
- 1 Novant Health Orthopedics and Sports Medicine, Winston Salem, NC, USA
| | - Scott J Ellis
- 2 Department of Orthopedics, Foot and Ankle Division, Hospital for Special Surgery, New York, NY, USA
| | | | - Anca Marinescu
- 2 Department of Orthopedics, Foot and Ankle Division, Hospital for Special Surgery, New York, NY, USA
| | - Jayme Burkett
- 3 Department of Biostatistics, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan T Deland
- 2 Department of Orthopedics, Foot and Ankle Division, Hospital for Special Surgery, New York, NY, USA
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16
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Stage IIB Flatfoot Reconstruction Using Literature-based Equations for Heel Slide and Lateral Column Lengthening. TECHNIQUES IN FOOT AND ANKLE SURGERY 2017. [DOI: 10.1097/btf.0000000000000164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Foster JR, McAlister JE, Peterson KS, Hyer CF. Union Rates and Complications of Lateral Column Lengthening Using the Interposition Plating Technique: A Radiographic and Medical Record Review. J Foot Ankle Surg 2017; 56:247-251. [PMID: 28231960 DOI: 10.1053/j.jfas.2016.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Indexed: 02/03/2023]
Abstract
Lateral column lengthening is a common procedure for correction of pes planovalgus. A tricortical bone graft has been a standard among foot and ankle surgeons. The purpose of the present study was to compare the union rates and complications between the 2 forms of fixation for lateral column lengthening. The present study was a retrospective medical record and radiograph review of 52 patients divided into 2 equal groups, allograft (group A) and opening wedge plate (group B). The radiographic analyses compared the preoperative, postoperative and long-term measurements of cuboid abduction and talonavicular angles. The outcome measures included nonunion, hardware removal, and infection. The median follow-up duration for each group was 34.5 (range 6.3 to 89.5) months and 12.6 (range 6.5 to 56.8) months for groups A and B, respectively. Group A had 4 nonunions (15.4%) and group B had 2 nonunions (7.7%). The mean radiographic measurements of cuboid abduction and talonavicular articulation for each group improved significantly. The incidence of hardware removal was greater for group A than for group B (30.8% versus 15.4%), although the difference was not statistically significant. The median time to osseous healing for group A was 12.0 (range 8.0 to 80.0) weeks and for group B was 10.0 (range 6.0 to 36.0) weeks. The interposition plating techniques for lateral column lengthening procedures had a lower nonunion rate and incidence of hardware removal compared with the traditional use of tricortical bone grafting. The findings from the present study will aid surgeons in alternative fixation for lateral column lengthening procedures.
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Affiliation(s)
| | | | - Kyle S Peterson
- Fellowship-Trained Foot and Ankle Surgeon, Suburban Orthopaedics, Bartlett, IL
| | - Christopher F Hyer
- Fellowship Co-Director, Orthopedic Foot and Ankle Center, Westerville, OH.
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18
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Müller SA, Barg A, Vavken P, Valderrabano V, Müller AM. Autograft versus sterilized allograft for lateral calcaneal lengthening osteotomies: Comparison of 50 patients. Medicine (Baltimore) 2016; 95:e4343. [PMID: 27472719 PMCID: PMC5265856 DOI: 10.1097/md.0000000000004343] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 06/10/2016] [Accepted: 06/30/2016] [Indexed: 11/29/2022] Open
Abstract
Sterilized allografts may be less resistant to collapse and prone to nonunion leading to loss of correction in open wedge osteotomies. These adverse events usually occur at early time points (i.e., < 9 months postoperatively). The goal of this study was to compare sterilized allografts to autologous grafts in respect to secondary loss of hindfoot alignment and graft incorporation after lateral calcaneal lengthening osteotomies.Fifty patients (22 F/ 28 M, age: 16-69 years) who had undergone 50 lateral calcaneal lengthening osteotomies for adult flatfoot deformity were included in this retrospective study. Cortical sterilized allografts were used in 25 patients, autologous grafts in the remaining 25. Patients' preoperative, 6 and 12 weeks, and 6 to 9 months follow-up weight-bearing radiographs of the affected foot were analyzed by 2 blinded radiologists: on each radiograph, graft incorporation, the talo-first metatarsal angle (TFMA), the talo-navicular coverage angle (TNCA), and the calcaneal pitch angle (CPA) were assessed. Loss of hindfoot alignment was defined as an increase of the TFMA or the TNCA or a decrease of the CPA, each by 5°.Inter- and intraclass correlation coefficients for TFMA, TNCA, and CPA measurements ranged from 0.93 to 0.99. At all follow-up visits, the ratio of patients with loss of hindfoot alignment and graft incorporation was not significantly different between the allograft and autograft group. However, loss of correction was associated with failure of graft incorporation.Compared with autografts, sterilized allografts do not increase the risk for loss of hindfoot alignment in lateral column lengthening of the calcaneus. With respect to mechanical resistance, allografts thus mean an equal and valid alternative without risk of donor site morbidities.
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Affiliation(s)
- Sebastian A. Müller
- Department of Orthopedic Surgery, University Hospital Basel, Basel, Switzerland
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19
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Gross CE, Huh J, Gray J, Demetracopoulos C, Nunley JA. Radiographic Outcomes Following Lateral Column Lengthening With a Porous Titanium Wedge. Foot Ankle Int 2015; 36:953-60. [PMID: 25810461 DOI: 10.1177/1071100715577788] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lateral column lengthening (LCL) is commonly utilized in treating stage II posterior tibialis tendon dysfunction. This study aimed to analyze the outcomes of LCL with porous titanium wedges compared to historic controls of iliac crest autograft and allograft. We hypothesized that the use of a porous titanium wedge would have radiographic improvement and union rates similar to those with the use of autograft and allograft in LCL. METHODS Between May 2009 and May 2014, 28 feet in 26 patients were treated with LCL using a porous titanium wedge. Of the 26 patients, 9 were males (34.6%). The average age for males was 43 years (range, 17.9-58.7), 48.7 years (range, 21-72.3) for females. Mean follow-up was 14.6 months. Radiographs were examined for correction of the flatfoot deformity and forefoot abduction. All complications were noted. RESULTS Radiographically, the patients had a significant deformity correction in the anteroposterior talo-first metatarsal angle, talonavicular coverage angle, lateral talo-first metatarsal angle, and calcaneal pitch. All but 1 patient (96%) had bony incorporation of the porous titanium wedge. The average preoperative visual analog scale pain score was 5; all patients but 3 (12%) had improvements in their pain score, with a mean change of 3.4. CONCLUSION LCL with porous titanium had low nonunion rates, improved radiographic correction, and pain relief. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | | | - Joni Gray
- Duke University Medical Center, Durham, NC, USA
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