Active patients may benefit from surgical repair of the achilles tendon with the aim of preserving functional length and optimising push-off power. A mini-open device assisted technique has the potential to reduce wound complications, but risks nerve injury. We present the largest published series of midsubstance achilles tendon repairs using the Achillon® device. A prospective cohort study was run at the Princess Royal Devon & Exeter Hospital between 2008 and 2015. We included all patients who presented with a midsubstance Achilles tendon rupture within 2 weeks of injury, and device assisted mini-open repair was offered to a young active adult population. All patients in the conservative and surgical treatment pathway had the same functional rehabilitation protocol with a plaster for 2 weeks, and a VACOped boot in reducing equinus for a further 8 weeks.Introduction
Methods
Tibiotalocalcaneal arthrodesis is an important salvage method for patients with complex hindfoot problems including combined arthritis of the ankle and subtalar joints, complex hindfoot deformities and failed total ankle arthroplasty. The aim of this study was to report the elective results of combined subtalar and ankle arthrodesis using one design of dynamic retrograde intramedullary compression nail-the T2 Ankle Arthrodesis Nail(Stryker) Retrospective review identified 53 consecutive patients who had 55 tibiotalocalcaneal arthrodesis procedures by two surgeons(ITS and NJT) using T2 Ankle nail fixation. 3 patients died of unrelated causes before follow up was complete which left 50 patients(52 nails); the largest consecutive series in the use of this device. Mean follow up was 23.5(3–72) months with the average age of patients being 61(range 22–89) years. An 84% response was achieved to a function and patient satisfaction questionnaire. Main indications for treatment were combined ankle and subtalar arthritis(63%-33/52) or complex hindfoot deformities(23%-12/52). Outcome was assessed by a combination of Clinical notes review, clinical examination, and telephone questionnaire.Background
Methods
Tibiotalocalcaneal arthrodesis is an important salvage method for patients with complex hindfoot problems including combined arthritis of the ankle and subtalar joints, complex hindfoot deformities and failed total ankle arthroplasty. The aim of this study was to report the elective results of combined subtalar and ankle arthrodesis using one design of dynamic retrograde intramedullary compression nail-the Retrospective review identified 53 consecutive patients who had 55 tibiotalocalcaneal arthrodesis procedures by two surgeons(ITS and NJT) using T2 Ankle nail fixation. 3 patients died of unrelated causes before follow up was complete which left 50 patients(52 nails); the largest consecutive series in the use of this device. Mean follow up was 23.5(3-72) months with the average age of patients being 61(range 22-89) years. An 84% response was achieved to a function and patient satisfaction questionnaire. Main indications for treatment were combined ankle and subtalar arthritis(63%-33/52) or complex hindfoot deformities(23%-12/52). Outcome was assessed by a combination of Clinical notes review, clinical examination, and telephone questionnaire. 46 patients(83.6%) achieved union at a mean time of 3.7 months. 8 patients required an allograft(femoral head) bone block procedure. 4 patients(10%) subjectively thought that the procedure was of no benefit or had a poor result whilst 35(83%) had a good or excellent result. The mean visual analog scale(VAS) score for preoperative functional pain was 7.1 compared to the mean post operative (VAS) score of 1.9(p<0.001). Complications consisted of 2 amputations, 2 deep infections and 5 removals of broken or painful screws. The use of preoperative functional aids and orthotics dropped from 32% to 18% and 22% to 18% respectively. This device and technique is a safe and effective treatment of hindfoot arthrosis and deformity giving reliable compression and subsequent fusion with excellent results in terms of patient satisfaction and pain relief.
The purpose of this study was to evaluate the longterm results of 736 cases of operatively treated clubfeet, and to examine if there is any difference in the results between our patients and referred patients. A follow-up examination was carried out in 736 cases of clubfeet operated on between 1966 and 1990. The average follow-up period was 14.7 years. Treatment was based on three pillars: well-organized care, conservative treatment and early operative treatment. In all of the reviewed cases, posteromedial soft tissue release was performed. Surgical intervention was indicated in cases of residual deformity after conservative treatment, cases of recurrent deformity, and cases of untreated clubfeet. Clinical evaluation contained the examination of residual deformities and the passive and active motions of the foot. In the radiological assessment, the anteroposterior talocalcaneal angle, the lateral talocalcaneal angle and the talometatarsal angle was measured. In the clinical evaluations equinus deformity was found in 3.35%, varus in 7.23%, valgus in 8.55%, adducted forefoot in 30.8%, inflexion of the forefoot in 7.14%, and overcorrection to the vertical talus in 3.35%. Range of motion was normal in only 36% of the cases. Average anteroposterior talocalcaneal angle was 13.05 preoperatively and 22.13 postoperatively. Average lateral talocalcaneal angle was 10.78 preoperatively and 27.66 postoperatively. Average talometatarsal angle changed from 26 to 5.5 after the operation. The overall success rate of the operated cases was 65%. After long-term follow-up, 65% of the cases were classified as successful. When comparing our patients with referred patients, there were considerable differences found in the rate of reoperation, age at the time of the first operation, and also in the results. These differences point out the importance of the early beginning of operative treatment, with regular follow-up and care.
The purpose of this study was to evaluate the longterm results of 736 cases of operatively treated clubfeet, and to examine if there is any difference in the results between our patients and referred patients. A follow-up examination was carried out in 736 cases of clubfeet operated on between 1966 and 1990. The average follow-up period was 14.7 years. Treatment was based on three pillars: well-organized care, conservative treatment and early operative treatment. In all of the reviewed cases, posteromedial soft tissue release was performed. Surgical intervention was indicated in cases of residual deformity after conservative treatment, cases of recurrent deformity, and cases of untreated clubfeet. Clinical evaluation contained the examination of residual deformities and the passive and active motions of the foot. In the radiological assessment, the anteroposterior talocalcaneal angle, the lateral talocalcaneal angle and the talometatarsal angle was measured. In the clinical evaluations equinus deformity was found in 3.35%, varus in 7.23%, valgus in 8.55%, adducted forefoot in 30.8%, inflexion of the forefoot in 7.14%, and overcorrection to the vertical talus in 3.35%. Range of motion was normal in only 36% of the cases. Average anteroposterior talocalcaneal angle was 13.05 preoperatively and 22.13 postoperatively. Average lateral talocalcaneal angle was 10.78 preoperatively and 27.66 postoperatively. Average talometatarsal angle changed from 26 to 5.5 after the operation. The overall success rate of the operated cases was 65%. After long-term follow-up, 65% of the cases were classified as successful. When comparing our patients with referred patients, there were considerable differences found in the rate of reoperation, age at the time of the first operation, and also in the results. These differences point out the importance of the early beginning of operative treatment, with regular follow-up and care.
