Techniques in Foot & Ankle Surgery

Guest Editorial: Innovations in Foot and Ankle Sports Injury Treatment No abstract available

New Option for Achilles Tendon Ruptures, Combining the Best of All: The PARS-Dresden Surgical treatment remains the standard of care for active patients with acute midsubstance Achilles tendon ruptures. Minimal invasive surgery, rupture’s site hematoma preservation, strong fixation, avoidance of sural nerve entrapment, and early rehabilitation are essential concepts desirable for any Achilles tendon repair. Hereby, we present a technique modification that incorporates all these advantages in one single procedure.

New Flexible Fixation for Subtle Lisfranc Injury Lisfranc ligament injuries are not so common and often overlooked. If missed, they can cause long-term disability and pain. The treatment of these injuries are still controversial and very little is known about which types of injury can be treated without surgery. Successful surgical management of these injuries is predicated on anatomic reduction and stable fixation. Open reduction and internal fixation remains the standard treatment, although ligament reconstruction has emerged as a viable option for certain types of tarsometatarsal joint injuries. This paper describes the authors’ approach to treat Lisfranc’s pure ligament injury. It presents a particular view of the problems resulting from the diagnosis and a specific type of ligament reconstruction. Level of Evidence: Level V.

Treatment of Osteochondral Lesions of Talus With Extracellular Matrix Cartilage Allografts The treatment of osteochondral lesions of the talus (OLTs) can be challenging. Currently, there exists a wide variety of treatment options to address OLTs, and the development of new, innovative surgical techniques has continued to evolve. The use of extracellular matrix cartilage allografts, or BioCartilage, is a biological agent that can be utilized as an adjunct to bone marrow stimulation. There are early promising clinical, radiographic, and histologic results. Therefore, it is prudent to understand the application of extracellular matrix cartilage allograft in the treatment of OLTs. We will provide a detailed review of the surgical technique and postoperative management, as well as guidelines for the indications for the procedure.

Ankle Ligament Reconstruction: The Role of Augmentation The most reliable reconstruction for chronic ankle ligament instability continues to be debated. The conventional Broström is widely used, but there are limitations to the technique. By virtue of the tissue repair a conservative rehabilitation approach is advocated, and there is an increasing concern that the repair does not match the strength of the native ligament. That begs the question of whether an augmentation is needed and if it is done, how does it affect the native ligament repair and how does it stand up over time? This chapter will discuss these questions as well as our current approach to lateral ligament reconstruction.

Ankle Microinstability Ankle sprains are one of the most common injuries in foot and ankle, and the superior fascicle of the anterior talofibular ligament (ATFL) frequently is injured as a consequence. Patients with isolated rupture of ATFL’s superior fascicle can sustain a subtle ankle instability or ankle microinstability. Patients with symptomatic ankle microinstability may describe a subjective feeling of ankle instability, recurrent symptomatic ankle sprains, chronic anterolateral pain or a combination of any of them. When conservative management fails, anatomic all-inside ATFL’s superior fascicle repair under direct arthroscopic visualization is the preferred surgical technique.

Peroneal Tendon Tears: When to Use an Allograft Allograft reconstruction of chronic peroneal tendon tears is a safe and effective option to help restore patient function and limit pain. Both the author’s experience, along with cadaveric and clinical studies, have shown that this technique can restore function and stability. The authors provide step-by-step instruction of their preferred allograft reconstruction technique for chronic peroneal attritional injuries, while limiting the comorbidities that may be seen with autograft reconstruction. Level of Evidence: Level IV—review article, expert opinion, operative technique.

Total Talus Replacement for Traumatic Bone Loss or Idiopathic Avascular Necrosis of the Talus More than a dozen surgical techniques have been described for management of avascular necrosis or traumatic loss of large portions of the talus. The smaller the area of necrosis, the better the outcomes. Procedures to induce revascularization (core decompression/drilling, vascularized bone grafts) have been reported with variable success. Patients with avascular necrosis of large portions of the talus present unique treatment difficulties. These techniques largely focus on pantalar or tibiotalar-calcaneal arthrodesis with large bone blocks. These surgeries eliminate motion, lead to high levels of patient dissatisfaction, and risk the possibility of multiple surgeries with nonunions. Total talus replacement, first described in Southeast Asia, used traditional manufacturing techniques to try to replicate a patient’s anatomy while preserving motion and eliminating pain. Modern techniques involve 3D printing technology to identically recreate the patient’s native anatomy and preserve tibiotalar, subtalar and talonavicular joint motion. The surgery is reliable, relatively simple technically, and provides another option for treatment of this very difficult problem. Level of Evidence: Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence.