Surgical repair of acute Achilles tendon rupture using a "mini-open" technique

For active patients, surgery is usually the preferred treatment for an acute Achilles tendon rupture. Classical open techniques require a long tendon exposure, which can result in damage to its blood supply and gliding structures. Adhesions may form, which impair the final functional result. Closed surgical techniques do not allow for a perfect adaptation of the tendon stumps and have a higher rate of rerupture. The "mini-open" technique has advantages over both of these techniques. Percutaneously introduced threads prevent adhesions along the tendon. The rupture is exposed through a minimal incision and is carefully sutured with fine threads to allow a direct healing process without the formation of intermediate scar tissue. The minimally invasive approach and the introduction of percutaneous threads considerably reduce the time spent in surgery. An aggressive rehabilitation program can be initiated 1 week after surgery and allows good early functional results

Which Are the Most Frequently Used Outcome Instruments in Studies on Total Ankle Arthroplasty?

The number of studies reporting on outcomes after total ankle arthroplasty is continuously increasing. As the use of valid outcome measures represents the cornerstone for successful clinical research, we aimed to identify the most frequently used outcome instruments in ankle arthroplasty studies and to analyze the evidence to support their use in terms of different quality criteria. A systematic review of the literature identified 15 outcome instruments reported in 79 original studies. The most commonly used measures were the American Orthopaedic Foot and Ankle Society hindfoot score (n = 41), the Kofoed ankle score (n = 21), a visual analog scale assessing pain (n = 15), and the generic SF-36 (n = 6). Eight additional instruments were used only once or twice. The American Orthopaedic Foot and Ankle Society and Kofoed instruments include a clinical examination and score up to 100 points. Evidence to support their use in terms of validity, reliability, responsiveness, and interpretability is limited, raising the question whether their use is justified. Self-reported questionnaires related to ankle osteoarthritis or arthroplasty are rather disregarded in the current literature, and only the Foot Function Index is associated with evidence in terms of the above-mentioned quality criteria. Future research is warranted to improve the outcome assessment after total ankle arthroplasty

Impact of Ethnicity on Tibial Morphometrics Relevant to Total Ankle Replacement

Category: Ankle Introduction/Purpose: Total ankle replacement (TAR) success has improved since first-generation implants, but patient satisfaction continues to be less than knee and hip replacements. Little is known about variations in distal tibia anatomy between genders and across ethnicities; therefore it is unclear the extent to which current TAR prostheses accommodate variability in patient size and shape. This study quantified distal tibia morphometrics relevant to TAR design, and assessed differences between ethnicities and genders. The hypotheses were: (1) The anterior-posterior (AP) location of the dwell point of the tibia is centralized; (2) The sagittal radius of curvature of the tibial articulation increases with bone size; (3) Differences in dwell point location or sagittal radii between genders and ethnicities can be attributed to size differences between those populations. Methods: Tibial CT scans were obtained from cadavers or individuals of various ethnicities (Table 1). Landmarks were defined on digital models created from the scans, including medial and lateral edges of the distal tibial articulation (Figure 1a), and sagittal contours of the articulation (Figure 1b). The articulation center was defined as the average center point of all contours (Figure 1c). The AP center and AP length at the level of a distal tibial resection for TAR were determined, and the AP offset of the articulation center was calculated (Figure 1c). Differences in metrics for each ethnic and gender group were determined using a one-way Anova (P< .05) with Tukey’s method for differentiating groups. Regression fits of AP offset, average medial radius, and average lateral radius were determined. Utilizing AP length as a covariate, ANCOVA was utilized to assess differences in AP offset and sagittal radii between gender and ethnic groups (P< .05). Results: Descriptive statistics for AP length, AP offset, and medial/lateral radii are shown in Table 1, with Tukey groupings assigned. The relationship between medial and lateral radius was not consistent across all groups. AP length was a significant covariate for medial and lateral radii, but not AP offset. The relationship between lateral radius and AP length was significantly impacted by ethnicity (P< .001), but not by gender (P=.067) (Figure 2a). Medial radius versus AP length was significantly impacted by both ethnicity (P=.01) and gender (P< .03) (Figure 2b). Conclusion: This study illustrates for the first time the complexity of anatomical variation of the distal tibia across ethnic groups and between genders. The location of the articulation center is invariant to tibia size across each ethnicity. Medial and lateral sagittal radii generally increase with bone size, but the relative radii of the medial and lateral compartments are not consistent across ethnicities. These results highlight the need for increased anatomic understanding of the distal tibia, and implications on TAR design and technique