Predictors of Functional Outcomes following Operative Treatment of Acute Achilles Tendon Ruptures

Introduction: Previous studies involving operative management of Achilles tendon ruptures have attempted to determine if patient factors influence outcomes. No previous study has attempted to identify outcome predictors in patients exclusively undergoing surgical repair. The purpose of this study is to determine if any injury or patient variables were predictive of outcomes following operative management of Achilles ruptures. Methods: Patient demographics including age, sex, body mass index (BMI), comorbidities (diabetes mellitus, depression, anxiety), mechanism of injury (sports, non-sports), and date of injury were collected. Postoperative notes were reviewed to determine compliance. Patients completed the Foot & Ankle Ability Measure (FAAM)-Activities of Daily Living (ADL) and –Sports subscales, and visual analog scale (VAS) for pain. Multivariable regression analysis was performed, and regression coefficients with 95% confidence intervals and p-values were reported. Results: Female sex was associated with lower FAAM-Sports score (-10.11 [-19.73,-0.50]) and a lower Single Assessment Numeric Evaluation score from the FAAM-Sports subscale (-13.79 [-26.28,-1.30]; p=0.0325). History of anxiety was related to a lower FAAM-ADL score (-29.02 [-45.68, -12.36]; p=0.0009), FAAM-Sports score (-33.41 [-64.46, -2.37]; p=0.0368), and a higher VAS pain score (19.83 [4.43, 35.23]; p=0.0128). Age, BMI, a history of depression or diabetes mellitus, mechanism of injury, timing of repair, and patient compliance were not predictive. Discussion: Females and patients with anxiety have significantly poorer outcomes following Achilles tendon repair. Further study is indicated to determine whether these factors are also predictive of outcomes of Achilles ruptures treated non-surgically and how this may affect surgical indications in these patients

What Is the Role of Molecular Techniques for Detection of Pathogen Deoxyribonucleic Acid (DNA) (Polymerase Chain Reaction [PCR] or Next-Generation Sequencing) in Patients With Infected Total Ankle Arthroplasty (TAA)?

Molecular techniques, particularly next-generation sequencing and the Ibis T5000 technology, have the potential to be used as an important adjunct in the diagnosis of bacterial infection following total ankle arthroplasty (TAA), although sufficient clinical evidence is lacking. Limited. Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

Mid-term Results of Radiographic and Functional Outcomes After Tibiotalocalcaneal Arthrodesis with Bulk Femoral Head Allograft

Category: Hindfoot Introduction/Purpose: Tibiotalocalcaneal (TTC) arthrodesis with bulk femoral head allograft has previously been reported as a way to fill large osseous hindfoot deficits in order to restore limb length, but few studies have been performed evaluating outcomes and prognostic factors. The purposes of this study were to assess functional and radiographic outcomes after TTC arthrodesis with femoral head allograft and retrospectively identify prognostic factors. Methods: A retrospective review of patients undergoing TTC arthrodesis with bulk femoral head allograft performed at an academic institution by a single fellowship-trained foot and ankle surgeon between 2004 and 2015 was conducted. Patient charts and operative reports were reviewed for patient and procedural variables, respectively. Radiographic union was assessed at the ankle and subtalar joints by another fellowship-trained foot and ankle surgeon not involved in any patient’s surgical care. Radiographic stability, defined as proper maintenance of hardware and graft positioning in the hindfoot, was also assessed. A procedure was “failed” if there was a need for revision surgery. Patients with a successful arthrodesis were contacted to score the Foot and Ankle Ability Measure-Active Daily Living (FAAM-ADL) questionnaire, visual analog scale (VAS) for pain, and Short Form-12 (SF-12) mental (MCS) and physical (PCS) components. 22 patients were identified, with average radiograph and functional follow-up times of 39.7 and 57.1 months, respectively. Results: Complete radiographic union of involved joints was achieved in 13 patients (59.1%) and in 72.7% (32/44) of all joints. Eighteen patients (81.8%) were assessed to be radiographically stable at final follow-up. Three patients (13.6%) underwent revision arthrodesis at a mean of 18.9 months postoperatively, and 19 patients (86.4%) did not require additional surgery as of final follow-up. At an average of 57.1 months postoperatively, patients significantly improved to a mean FAAM-ADL score of 71.5 from 36.3 (P<.001). The mean VAS for pain significantly improved from 76.8 to 32.9 (P<.001). The mean postoperative SF-12-MCS and SF- 12-PCS scores were 53.9 and 40.6. Additionally, 73.3% (11/15) reported being satisfied with their surgical outcomes. Male sex (P=.03) and a lateral operative approach (P=.03) both resulted in significantly worse outcomes. Conclusion: The utilization of a femoral head allograft with TTC arthrodesis in patients with large hindfoot defects is an acceptable method that can offer improved functional and sustained radiographic outcomes and patient satisfaction. Male sex and a lateral approach may be associated with an inferior prognosis

Value of Supine Positioning in Repair of Achilles Tendon Ruptures

Category: Hindfoot Introduction/Purpose: The optimal method of Achilles tendon repair remains undefined. Few previous studies have quantified the financial expenses of Achilles tendon repairs in relation to functional outcomes in order to assess the overall value of the accepted repair techniques. The purpose of this study is to demonstrate the value of supine positioning during open repair (OS) of acute Achilles tendon ruptures through the quantification of operative times, costs, and outcomes in comparison to the commonly performed percutaneous prone (PP) repair technique. Methods: A retrospective review was conducted on 67 patients undergoing OS and 67 patients undergoing PP primary Achilles tendon repair with two surgeons at four surgical locations. Total operating room usage times and operating times were collected from surgical site records. Total operating room times were used to estimate the costs of room usage and anesthesia, while costs of repair equipment were collected from the respective manufacturers. Patients undergoing OS repair completed the Foot and Ankle Ability Measure (FAAM) questionnaire, with activities of daily living (ADL) and sports subscales, Short Form-12 (SF-12), with mental (MCS) and physical (PCS) health subcategories, and the visual analog scale (VAS) for pain preoperatively and at final follow-up. Results: Even with a significantly longer mean surgical time (P=.035), OS repairs had a shorter duration of total operating room time when compared to that of PP repairs (58.4 versus 69.7 minutes, P<.001). Estimated time-dependent costs were lower in OS repairs ($739 versus$861 per procedure, P<.001), while the estimated average total per procedure cost was also lower for OS repairs ($801 versus$1,910 per procedure, P<.001). For patients undergoing OS repair, FAAM-ADL (P<.001), FAAM-Sports (P<.001), SF-12-PCS (P<.001) all increased and VAS grades (P<0.001) decreased from time of initial encounter to final follow-up and were comparable to reported outcomes in the current literature. The complication rate in OS repairs (6.0%) was lower than PP repairs (11.9%), with revisions only occurring in the latter technique. Conclusion: Performing open Achilles tendon repair in the supine position offers substantial value, or “health outcomes achieved per dollar spent”, to providers due to decreased total operating room times and costs with satisfactory functional outcomes

Total Ankle Arthroplasty

Category: Ankle, Ankle Arthritis Introduction/Purpose: Reports of ankle range of motion and how it affects patient outcomes following total ankle arthroplasty (TAA) have been mixed. Furthermore, recent studies have relied on clinical exam to obtain postoperative range of motion and have lacked preoperative functional scores. The purpose of our study was to analyze how preoperative range of motion and functional scores change with time following TAA using postoperative functional scores and radiographs for range of motion calculations. Methods: A retrospective chart review was performed on 107 patients (109 ankles) that had undergone fixed-bearing implant TAA by a single surgeon between 2010 and 2015. Preoperative range of motion was gathered clinically in office by the senior author. Postoperative range of motion through the ankle joint was evaluated with dedicated weight-bearing maximum dorsiflexion and plantarflexion lateral radiographs at 3 and 6 months, 1 and 2 years. The range of motion was measured using the angle measurement tool on the picture archiving and communication system. Patients completed visual analogue scale (VAS) for pain and the Foot and Ankle Ability Measure (FAAM) questionnaire subcategorized into activities of daily (ADL) and sports subscale preoperatively and at postoperative intervals of 3 and 6 months, 1 and 2 years. The mean age was 65 years (range, 31-83 years). Mean BMI was 28.1 (range, 14.9-44.9). There were 53 males (50%). Results: The mean total arc of ankle motion preoperatively was 20.7 degrees and improved significantly to 28.3, 34.3, 33.3, and 33.3 degrees at 3 and 6 months, 1 and 2 years, respectively (P<0.001) (Figure 1). Mean VAS pain and mean FAAM ADL preoperative scores improved significantly at each postoperative time point as seen in Figure 1 (P<0.001). Increased ankle range of motion was correlated with lower VAS preoperatively (r=-0.38, P=0.007), and at 1 year (r=-0.36, P<0.001), and 2 years (r=-0.2, P=0.033) postoperatively. Increased ankle range of motion was significantly correlated with higher FAAM-ADL at 3 months (r=0.48, P=0.012), 1 year (r=0.24, P<0.034), and 2 years (r=0.37, P<0.001) postoperatively. Conclusion: Patients undergoing fixed-bearing TAA had continued and sustained improvement from preoperative total arc of motion, pain, and function at each postoperative visit, up to 2 years. Ankle range of motion was noted to peak at 6 months, while pain and FAAM-ADL continued to improve up to 2 years postoperatively. Patients with greater ankle range of motion correlated with less pain and improved function at 1 and 2 years postoperatively. Though pain and function may continue to improve even as far out as 2 years postoperatively, it is not likely that range of motion will continue to increase