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Purpose: The objective of this study was to provide a comprehensive review of the existing literature regarding the treatment of osteochondral lesions of the talus (OLT) using autologous matrix-induced chondrogenesis (AMIC), while also discussing the mid-long term functional outcomes, complications, and surgical failure rate. Methods: We searched Embase, PubMed, and Web of Science for studies on OLT treated with AMIC with an average follow-up of at least 2 years. Publication information, patient data, functional scores, surgical failure rate, and complications were extracted. Results: A total of 15 studies were screened and included, with 12 case series selected for meta-analysis and 3 non-randomized controlled studies chosen for descriptive analysis. The improvements in the Visual Analog Scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot, and Tegner scores at the last follow-up were (SMD = − 2.825, 95% CI − 3.343 to − 2.306, P < 0.001), (SMD = 2.73, 95% CI 1.60 to 3.86, P < 0.001), (SMD = 0.85, 95% CI 0.5 to 1.2, P < 0.001) respectively compared to preoperative values. The surgery failure rate was 11% (95% CI 8–15%), with a total of 12 patients experiencing complications. Conclusion: The use of AMIC demonstrates a positive impact on pain management, functional improvement, and mobility enhancement in patients with OLT. It is worth noting that the choice of stent for AMIC, patient age, and OLT size can influence the ultimate clinical outcomes. This study provides evidences supporting the safety and efficacy of AMIC as a viable treatment option in real-world medical practice. [ABSTRACT FROM AUTHOR]

Introduction: Charcot arthropathy is a progressive disorder of the ankle and foot joints that can lead to foot deformity and instability. Surgical intervention is often necessary for deformity and ulcer management during the chronic phase. The device used for arthrodesis remains a challenge. Methods: This clinical trial study included diabetic patients aged 40 years or older with Charcot foot. Lateral approach with lateral malleolar osteotomy was used to access the ankle joints and remove the cartilage. A small incision was made on the plantar aspect of the foot to pass an appropriately sized intramedullary nail. Demographic information, medical history, surgical details and Clinical data were collected at 2-week and 1-year follow-ups using the Ankle-Hindfoot Scale (AOFAS) score and the EuroQol 5-Dimensional 5-Level (EQ-5D-5L) health utility score. Results: Twenty-six patients with a mean age of 63 ± 0.23 years were included in the study. The findings showed significant improvements in AOFAS questionnaire items related to pain score, length of the walk, walking surfaces, walking disorders, sagittal alignment, back leg alignment, sustainability, alignment and the total score (P value < 0.001). The EQ-5D-5L questionnaire also showed a significant improvement in the total score (P value = 0.002). Conclusion: This study provides evidence supporting the effectiveness of tibiotalocalcaneal arthrodesis by hindfoot nailing in diabetic patients with Charcot foot joints and demonstrated comparable and superior outcomes in terms of patient satisfaction and complication rate when compared to previous studies. [ABSTRACT FROM AUTHOR]

Background: Talar malignant tumor is extremely rare. Currently, there are several alternative management options for talus malignant tumor including below-knee amputation, tibio-calcaneal arthrodesis, and homogenous bone transplant while their shortcomings limited the clinical application. Three-dimensional (3D) printed total talus prosthesis in talus lesion was reported as a useful method to reconstruct talus, however, most researches are case reports and its clinical effect remains unclear. Therefore, the current study was to explore the application of 3D printed custom-made modular prosthesis in talus malignant tumor. Methods: We retrospectively analyzed the patients who received the 3D printed custom-made modular prosthesis treatment due to talus malignant tumor in our hospital from February 2016 to December 2021. The patient's clinical data such as oncology outcome, operation time, and volume of blood loss were recorded. The limb function was evaluated with the Musculoskeletal Tumor Society 93 (MSTS-93) score, The American Orthopedic Foot and Ankle Society (AOFAS) score; the ankle joint ranges of motion as well as the leg length discrepancy were evaluated. Plain radiography and Tomosynthesis-Shimadzu Metal Artefact Reduction Technology (T-SMART) were used to evaluate the position of prosthesis and the osseointegration. Postoperative complications were recorded. Results: The average patients' age and the follow-up period were respectively 31.5 ± 13.1 years; and 54.8 months (range 26–72). The medium operation time was 2.4 ± 0.5 h; the intraoperative blood loss was 131.7 ± 121.4 ml. The mean MSTS-93 and AOFAS score was 26.8 and 88.5 respectively. The average plantar flexion, dorsiflexion, varus, and valgus were 32.5, 9.2, 10.8, and 5.8 degree respectively. One patient had delayed postoperative wound healing. There was no leg length discrepancy observed in any patient and good osseointegration was observed on the interface between the bone and talus prosthesis in all subjects. Conclusion: The modular structure of the prosthesis developed in this study seems to be convenient for prosthesis implantation and screws distribution. And the combination of solid and porous structure improves the initial stability and promotes bone integration. Therefore, 3D printed custom-made modular talus prosthesis could be an alternative option for talus reconstruction in talus malignant tumor patients. [ABSTRACT FROM AUTHOR]

Prosthetic substitution of the talus presents a significant challenge to the foot and ankle surgeon. The shear and compressive forces on the talus and its tenuous blood supply lead to high rates of avascular necrosis and eventual talar collapse. The purpose of this systematic review is to evaluate whether total ankle total talus replacement (TATTR) leads to improved clinical and radiographic outcomes with appropriate safety metrics in patients with a history of avascular necrosis or significant trauma. We searched the concepts of talus, prosthesis, and arthroplasty in MEDLINE (PubMed), Embase (Elsevier), CINAHL Complete (EBSCOhost), and Scopus (Elsevier) from the database's inception through March 9, 2023. Inclusion Criteria were 1) previous trauma to the talus, 2) post-traumatic arthritis to the tibiotalar joint, 3) avascular necrosis of talus, 4) multiple failed prior interventions, 5) degenerative osteoarthritis to the tibiotalar joint, and 6) inflammatory arthropathy to tibiotalar joint. Patients less than 18 years of age and manuscripts in non-English languages were excluded. Of the 7625 references, 16 studies met the inclusion criteria, yielding data from 136 patients (139 ankles). The studies varied in design, with case reports and retrospective case series being predominant. The overall weighted average modified Coleman Methodology Score (mCMS) was 70.4 out of 100, indicating moderate flaws in study design that may be subject to various forms of bias and possible confounders. Demographics showed a diverse range of etiologies, with alumina ceramic being the primary prosthesis material. Functional scores demonstrated improvements in dorsiflexion and plantarflexion, although patient-reported outcome measures (PROs) were inconsistently reported. Complications included fractures, heterotopic ossification, prolonged wound healing, and infections. Revision details were sparsely reported. TATTR is a promising treatment modality for improving short-term functional outcomes for patients with avascular necrosis or trauma-related issues. However, this systematic review underscores the need for standardized reporting, longer-term follow-ups, and further research to establish the procedure's efficacy and safety, particularly in comparison to other treatment modalities. III, Systematic Review of Level IV Studies [ABSTRACT FROM AUTHOR]

Background: Fresh osteochondral allograft (OCA) transplantation is a viable treatment option for osteochondral defects of the talus. However, sufficient data are not available on patients' participation in sports or recreational activities after the procedure. Purpose: To assess whether patients undergoing OCA transplantation of the talus participated in sports or recreational activities postoperatively. Study Design: Case series; level of evidence, 4. Methods: A total of 36 ankles in 34 patients underwent OCA transplantation of the talus. At a mean follow-up of 9.2 years, information on participation in sports or recreational activities pre- and postoperatively was obtained, as well as postoperative pain, function, and satisfaction. Results: The mean age at the time of surgery was 36.1 years (range, 20.5-57.7 years), and 50% of patients were men. The mean graft size was 3.6 cm2 (range, 1-7.2 cm2) or 41.1% of the talar dome. Before the injury, 63.9% of patients (23/36 ankles) reported being highly competitive athletes or well trained and frequently sporting; 36.1% of patients (13/36 ankles) reported sometimes sporting or were nonsporting. Also, 66.7% of patients (24/36 ankles) were able to participate in sports or recreational activities after OCA transplantation and 50% (18/36 ankles) were still participating in sports or recreational activities at the latest follow-up. In a subset of well-trained or highly competitive athletes, 73.9% (17/23 ankles) were able to return to sports or recreational activities at any point after OCA transplantation, and 65.2% (15/23 ankles) were still participating at the latest follow-up. Further surgery occurred in 16.7% of patients (6/36 ankles). Graft survivorship was 94.3% at 5 years and 85.3% at 10 years. There was a significant improvement in the mean Olerud-Molander Ankle Scores, and the mean Foot and Ankle Ability Measure scores were high postoperatively. Moreover, 79.4% of patients (27/34 ankles) were either satisfied or extremely satisfied with the allograft surgery. Conclusion: Fresh OCA transplantation is a reasonable surgical option for osteochondral defects of the talus for young, active patients who have failed previous operative management or have massive defects. [ABSTRACT FROM AUTHOR]

Background: To investigate the clinical effects of a unilateral external fixator combined with bone transport and tibio-talar fusion in the treatment of severe postoperative infection of peri-ankle fractures. Methods: The clinical data of 32 patients (22 men and 10 women) with severe postoperative infection of peri-ankle fractures were retrospectively analyzed. Patients' age ranged from 26 to 62 (mean, 42 ± 9.5) years old. The types of fractures were distal tibia fracture (25 cases), distal tibia and fibula fracture (5 cases), and talus fracture (2 cases). All patients underwent treatment with unilateral external fixation combined with bone transport and tibio-talar fusion. 6 patients with severe infection received two-stage treatment involving focal debridement and external fixation, osteotomy, and bone transport. The remaining 26 patients underwent debridement, external fixation, and osteotomy simultaneously. The length of bone transport, total fixation time of the external fixator, and postoperative complications were recorded for all patients. The efficacy of the treatment was assessed using the American Association of Foot and Ankle Society (AOFAS) ankle–hindfoot score. Results: Patients were followed up for 16–36 months, with an average follow-up time of 24 months. The length of tibia bone transport ranged from 5 to 15 cm, with a mean length of 8.5 cm. The external fixator was applied for 12–24 months, with an average duration of 16 months. One patient suffered from refracture at tibio-talar fusion site, and one patient had external fixation pin-tract infection. No complications, such as recurrent infections (especially the MRSA infection), poor mineralization, refracture, iatrogenic nerve damage or fusion failure, were found in the remaining patients. The preoperative AOFAS ankle–hindfoot function score was 40.0 ± 3.8 (range, 30–52) points, and it increased to 75.0 ± 3.0 (range, 67–78) points at the last follow-up. Conclusion: A unilateral external fixator combined with bone transport and tibio-talar fusion is an effective method for treating severe postoperative infection of peri-ankle fractures. This approach is capable of reconstructing large bone defects that remain after clearing the infected lesion. Additionally, it provides stability to the ankle, enhances ankle–hindfoot function, and improves the patient's quality of life. [ABSTRACT FROM AUTHOR]

Background: Various fixation methods are available for tibiotalocalcaneal arthrodesis: nail, plate, or screws. An intramedullary bone stabilization system within a balloon catheter has not previously been used in tibiotalocalcaneal arthrodesis. The aim of this study was to compare the stability of these techniques. Methods: Twenty-four lower legs from fresh-frozen human cadavers were used. Tibiotalocalcaneal arthrodesis was performed with a retrograde nail, a lateral locking plate, three cancellous screws, or an intramedullary bone stabilization system. The ankles were loaded cyclically in plantarflexion and dorsiflexion. Results: For cyclic loading at 125 N, the mean range of motion was 1.7 mm for nail, 2.2 mm for plate, 6.0 mm for screws, and 9.0 mm for the bone stabilization system (P <.01). For cyclic loading at 250 N, the mean range of motion was 4.4 mm for nail, 7.5 mm for plate, 12.1 mm for screws, and 14.6 mm for the bone stabilization system (P <.01). The mean cycle of failure was 4191 for nail, 3553 for plate, 3725 for screws, and 2132 for the bone stabilization system (P =.10). Conclusions: The stability of the tibiotalocalcaneal arthrodesis differs depending on the fixation method, with nail or plate showing the greatest stability and the bone stabilization system the least. When three screws are used for tibiotalocalcaneal arthrodesis, the stability is intermediate. As the biomechanical stability of the bone stabilization system is low, it cannot be recommended for tibiotalocalcaneal arthrodesis. [ABSTRACT FROM AUTHOR]

Purpose: Autologous osteochondral transplantation (AOT) is indicated for patients with a large osteochondral lesion of the talus (OLT), accompanying subchondral cyst, and the failure of bone marrow stimulation (BMS) procedures. Despite the many reports on the clinical results of surgical treatment for medial osteochondral lesions, those of lateral lesions are rare. This paper reports the intermediate-term clinical outcomes after AOT for lateral OLTs. Materials and Methods: Twenty-one patients with lateral OLTs were followed up for at least three years after AOT. The clinical evaluations comprised the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). The radiographic assessment included the irregularity of the articular surface (subchondral plate), the progression of degenerative arthritis, and the changes in talar tilt angle and anterior talar translation. Results: The mean FAOS and FAAM scores improved significantly from 42.1 to 89.5 and 39.5 to 90.6 points, respectively, at the final follow-up (p<0.001). The radiological evaluation revealed two cases (9.5%) of articular step-off ≥2 mm and 1 case (4.8%) of progressive arthritis. The mean talar tilt angle and anterior talar translation improved significantly. As postoperative complications, there was one case of a local wound problem, one case of superficial peroneal nerve injury, and one case of donor site morbidity. At a mean follow-up of 62.3 months, no patient showed a recurrence of instability or required reoperation for OLT. Conclusion: AOT for the lateral OLTs demonstrated satisfactory intermediate-term clinical outcomes, including daily and sports activity abilities. Most OLT could be accessed through lateral ligament division and capsulotomy, and the incidence of iatrogenic complications, such as recurrent sprains or chronic instability, was minimal. AOT appears to be an effective and relatively safe treatment for patients with large lateral osteochondral lesions unresponsive to conservative therapy, with subchondral cysts, or with failed primary BMS. [ABSTRACT FROM AUTHOR]

Chondroblastoma is a rare benign cartilaginous neoplasm that accounts for 1% of bone tumors and is common in the epiphysis of the long bones. The condition is rarely found in the talus bone (4% of cases). This paper reports a 15-year-old male patient treated for a talus bone lesion discovered incidentally on imaging. Excisional biopsy, curettage, and an autobone and allobone graft were performed, with good results. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical effect of the anteromedial cannulated screw approach in the treatment of Hawkins II/III talus fractures in children. Methods: A retrospective study was conducted on 20 children with talar fractures admitted to Renmin Hospital from September 2018 to February 2022. The fracture healing and functional recovery of the affected limb were strictly followed up after the operation. There were 14 males and 6 females. The average age was 9 years (range 6–12 years). According to the Hawkins classification, there were 12 cases of talar neck fracture type II and 8 cases of type III. All patients were fixed with cannulated compression screws via an anteromedial approach. According to the American Orthopedic Foot and Ankle Society ankle and hindfoot function scoring system, limb function was evaluated before and after the operation. A visual analog scale was used to evaluate the degree of postoperative pain. Results: All 20 children were followed up for 12 months to 30 months, with an average of 15 months. We found that there was no significant difference in the excellent and good rate (76.9%) and necrosis rate (30.8%) between male children and female children (71.4%) and necrosis rate (28.6%) (P > 0.05). The excellent and good rates (92.9%) of children younger than 9 years old at the time of injury were higher than those of children older than 9 years old (33.3%), and the incidence of avascular necrosis of the talus was lower. The differences between the two groups were statistically significant (P < 0.05). The average prognosis score of children who underwent surgery within 5 days after injury was 89.2 ± 6.4, which was significantly higher than that of children who underwent surgery after 5 days (72.9 ± 13.1), and the difference was statistically significant (P < 0.05). There was no significant difference between patients who underwent surgery within 5 days after injury (15.4%) and those who underwent surgery after 5 days (51.7%) (P > 0.05). The excellent and good rates of talar neck fracture type II and talar neck fracture type III were 90.1% and 55.6%, respectively. Conclusion: The anteromedial approach combined with cannulated compression screws for the treatment of Hawkins II/III talus fractures in children not only has a clear surgical field, but the fracture can also be reduced and fixed under direct vision using this technique. It does not affect the stability of the ankle joint and is conducive to the recovery of ankle function. It can be used as a surgical scheme for the treatment of talar fractures in children. [ABSTRACT FROM AUTHOR]

A medial opening wedge supramalleolar osteotomy (SMO) introduced by Takakura et al. is a useful realignment procedure for patients with ankle joint arthritis and varus malalignment by shifting the weight-bearing axis laterally and redistributing the loads on the ankle joint. When pain persists after arthroscopic microfracture in patients with medial osteochondral lesion of the talus (OLT), redo arthroscopy, osteochondral autograft transplantation, autologous chondrocyte implantation, or matrix-induced chondrogenesis might be indicated. On the other hand, there is insufficient scientific evidence for realignment surgery through SMO, while the effect of realignment surgery has been studied consecutively for osteochondral lesions of the knee. Therefore, this paper reports a patient with medial OLT who underwent redo arthroscopy combined with SMO for persistent pain after primary arthroscopic microfracture. [ABSTRACT FROM AUTHOR]

Talus fractures were accompanied historically with unsatisfying results as the osseus perfusion is vulnerable. Especially dislocated neck and body fractures of the talus have high incidences of posttraumatic avascular necrosis and arthritis of the talus and ankle, respectively. Main treatment goals are exact anatomic reduction and fixation as joint in-congruency lead to early osteoarthritis. The main emphasis of this article is to give an overview of the different talar fracture types with relevant prognostic implications and to discuss the influence of immediate definitive surgical osteosynthesis of the talus. To date the more recent studies showed that after emergency reposition and immobilization delayed definitive osteosynthesis of the talus had no prognostic disadvantages. [ABSTRACT FROM AUTHOR]

A 15-year-old multisport athlete with chronic left ankle pain and instability 2 years following initial injury was diagnosed with an unstable osteochondral fracture of the lateral talar dome, osteochondritis dissecans, and lateral ligament instability. The patient underwent open surgical repair consisting of loose body excision, lateral ligament reconstruction, and talar dome debridement and microfracture followed by postoperative therapeutic exercise for 7 months. The patient successfully returned to competitive sports within a calendar year. Although not considered particularly rare among adult populations, osteochondral fracture of the talus is relatively rare in adolescents. This case demonstrates that a diagnosis of unstable osteochondral fracture and/or gross lateral ligament instability should be considered in cases involving adolescent athletes with significant ankle injury and prolonged pain and/or loss of function. [ABSTRACT FROM AUTHOR]

Introduction: The too-long anterior process (TLAP) increases mechanical stress on the hindfoot and could lead to osteochondral lesions of the talus (OLT) by localized hyper-pressure. The purpose of this study is to investigate an association between TLAP and OLT in children.Methods: This is a retrospective, multicenter, case-control study conducted between 2010 and 2020. The OLT group was compared to a control group (CoG). TLAP is characterized by a distance between the anteromedial process of the calcaneus and the navicular bone (CN) of< 5 mm.Results: Forty-three feets were included in the OLT group and 92 in the CoG. The OLT group had a lower CN distance on CT than the CoG, a median of 2.8 mm versus 3.75 mm (p = 0.002); 86% of patients (37 feet/43) in the OLT group had a CN distance of< 5 mm (OR=3.0 [1.1; 9.5], p = 0.023) compared to 67% in the CoG.Discussion: The OLT group had an increased risk of developing TLAP compared to the CoG.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Background: In 2011, the European Foot and Ankle Society developed a Score (EFAS Score) to generate a standardized questionnaire for several European languages. The aim of this study is to analyse how the newly defined score correlates with already established function scores.Methods: This study is a monocentric prospective study. The questionnaires were completed at least 12 months postoperatively at the same time point. All patients had undergone surgery with the Autologous Matrix-Induced Chondrogenesis® procedure for osteochondral lesions of the talus.Results: A total of 69 patients (33 women, 36 men) participated in the study. The EFAS Score correlates very strongly with the Manchester-Oxford Foot Questionnaire (MOXFQ) and strongly with the Foot Function Index (FFI).Conclusion: This study shows that the EFAS Score correlates significantly with the FFI and the MOXFQ. The EFAS seems to be a more patient-friendly alternative due to fewer questions and response choices. [ABSTRACT FROM AUTHOR]

Background: Osteochondral lesions of the talus (OLT) are defects affecting the articular cartilage as well as the subchondral bone, on the lateral shoulder possibly associated with trauma. This study presents the results of reconstructing OLT using vascularized osteochondral flaps from the femoral trochlea.Methods: We treated 19 patients with osteochondral talar shoulder defects, using osteochondral flaps from the medial (MFT) or lateral (LFT) femoral trochlea. Functional outcome was evaluated by clinical investigation, visual analogue scale (VAS, 0-10), American Orthopaedic Foot and Ankle Society-Ankle and Hindfoot Scale (AOFAS, 0-100) and The Foot and Ankle Disability Index (FADI, 0-104). Radiographic postoperative follow-up was done by anterior-posterior and lateral X-rays and union of the transferred osteochondral flaps was documented by CT scans.Results: The osteochondral flaps fused in all of the 19 cases. After a median follow-up of 45.5 months, the patients showed an average FADI of 94.9 and AOFAS-Ankle and Hindfoot Scale of 91.2. All of them were walking free and normal. Subjective median satisfaction was 1.3 in a scale from 1 to 5.Conclusion: Vascularized transfer of osteochondral flaps from the femoral trochlea is a reliable treatment option for symptomatic OLT of the medial and lateral talar edge.Level Of Clinical Evidence: Therapeutic IV. [ABSTRACT FROM AUTHOR]

Background: The bone marrow stimulation (BMS) technique is performed for osteochondral lesions of the talus (OLTs) with a lesion size of <100 mm2. The lesion defect is covered with fibrocartilage, and the clinical outcomes deteriorate over time. In contrast, the osteochondral fragment fixation can restore the native articular surface. The difference in clinical outcomes between these procedures is unclear. Purpose: To compare the clinical outcomes of BMS and osteochondral fragment fixation for OLTs and examine the characteristics of patients with poor clinical outcomes of BMS. Study Design: Cohort study; Level of evidence, 3. Methods: In total, 62 ankles in 59 patients with OLTs were included. BMS was performed for 26 ankles, and fixation was performed for 36 ankles. Clinical outcomes, including the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Scale and bone marrow edema (BME) as identified on magnetic resonance imaging, were compared between the 2 groups. On computed tomography scans, the lesion location was compared with or without BME in each group. Results: The AOFAS scores in the fixation group (97.3 ± 4.3 points) were significantly higher than those in the BMS group (91.3 ± 7.7 points), even when the lesion size was <100 mm2 (P <.05). When comparing the ankles with or without BME in each group, the AOFAS scores at the final follow-up were significantly lower for the ankles with BME (88.6 ± 7.8 points) than for those without BME (95.0 ± 6.1 points) in the BMS group (P <.05). Lesions with BME in the sagittal plane were located more centrally than those without BME in the BMS group. In the fixation group, there were no significant differences in AOFAS scores and location of the lesion in ankles with or without BME. Conclusion: The clinical outcomes of osteochondral fragment fixation are superior to those of BMS in OLTs, even for lesions sized <100 mm2. Fixation is recommended even for small lesions, especially for more centralized lesions in the medial and lateral sides of the talus. [ABSTRACT FROM AUTHOR]

Background: No consensus has been reached regarding the optimal surgical treatment for focal chondral defects of the talus. Purpose: A Bayesian network meta-analysis was conducted to compare the clinical scores and complications of mosaicplasty, osteochondral auto- and allograft transplant, microfracture, matrix-assisted autologous chondrocyte transplant, and autologous matrix-induced chondrogenesis (AMIC) for chondral defects of the talus at midterm follow-up. Study Design: Bayesian network meta-analysis; Level of evidence, 4. Methods: This Bayesian network meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions. PubMed, Embase, Google Scholar, and Scopus databases were accessed in February 2021. All clinical trials comparing 2 or more surgical interventions for the management of chondral defects of the talus were accessed. The outcomes of interest were visual analog scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, rate of failure, and rate of revision surgery. The network meta-analysis were performed through the routine for Bayesian hierarchical random-effects model analysis. The log odds ratio (LOR) effect measure was used for dichotomous variables, and the standardized mean difference (SMD) was used for continuous variables. Results: Data from 13 articles (521 procedures) were retrieved. The median length of the follow-up was 47.8 months (range, 31.7-66.8 months). Analysis of variance revealed no difference between the treatment groups at baseline in terms of age, sex, body mass index, AOFAS score, VAS score, and mean number of defects. AMIC demonstrated the greatest AOFAS score (SMD, 11.27) and lowest VAS score (SMD, –2.26) as well as the lowest rates of failure (LOR, 0.94) and revision (LOR, 0.94). The test for overall inconsistency was not significant. Conclusion: At approximately 4 years of follow-up, the AMIC procedure for management of focal chondral defects of the talus produced the best outcome. [ABSTRACT FROM AUTHOR]

Background: Outcomes of bone marrow stimulation for osteochondritis dissecans (OCD) of the talus in pediatric patients is not optimal. The objective was to evaluate the retroarticular drilling technique for talar OCD.Methods: A retrospective case-series study of pediatric cases treated for talar OCD with retroarticular drilling was done. Clinical and radiological outcome scores were recorded as follows: the percentage of patients who had a successful treatment, the percentage for every category of the Berndt and Harty treatment result grading and the percentage for every radiographical outcome score were computed.Results: Nineteen patients (18 girls; mean age: 14.6 ± 2.1 years) were included. The mean follow-up was 14.8 (±11.7) months. 26.3% required revision surgery. The Berndt and Harty scores were: 57.9% good, 10.5% fair, 31.6% poor. Radiological outcomes were: 21% healed, 47.4% partially healed, 31.6% no healing. The radiological outcome score was better for younger patients (P = 0.01) and those with an open physis (P = 0.001).Conclusion: 26.3% of patients needed revision surgery after talar OCD retroarticular drilling and 21% were healed radiographically. Skeletal immaturity and a younger age were associated to a better radiological outcome. [ABSTRACT FROM AUTHOR]

Background: Fusion of the talonavicular joint has proven challenging in literature. The optimal surgical approach for talonavicular arthrodesis is still uncertain. This study compares the amount of physical joint preparation between dorsal and medial approaches to the talonavicular joint.Methods: Twenty fresh frozen cadaver specimens were randomly assigned to receive either a dorsal or medial operative approach to the talonavicular joint. The joint surface was prepared, and the joint was disarticulated. Image analysis, using ImageJ, was performed by two blinded reviewers to assess the joint surface preparation and this was compared by surgical approach.Results: The dorsal approach had a higher median percentage of talar and total talonavicular joint surface area prepared (75% vs. 59% (p = .007) and 82% vs. 70% (p = .005)). Irrespective of approach, the talus was significantly more difficult to prepare than the navicular (62% vs 88% (p = .001)).Conclusion: The dorsal approach provides superior talonavicular joint preparation. The lateral ¼th of the talar head was the most difficult surface to prepare, and surgeons performing double or triple arthrodesis may prepare the lateral talar head from the lateral approach.Level Of Evidence: Level V. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the clinical and radiographic outcomes of different surgical procedures in atraumatic osteochondrosis dissecans (OCD) of the talus in youth and adolescence.Methods: 32 joints in 30 patients (mean age 14.7 ± 2.2 years) were evaluated. Numeric Rating Scale (NRS), Foot and Functional Index (FFI), American Orthopedic Foot and Ankle Society ankle-hindfoot score (AOFAS), Pediatric Outcome Data Collection Instrument (PODCI), and sport participation were recorded. We compared preoperative and follow-up ankle radiographs to identify specific features in the OCD morphology and any signs of joint degeneration.Results: After a median follow-up period of 72.5 months the drilling group showed significantly better scores than the combined fixation and reconstruction groups (AOFAS, p = 0.024; PODCI, p = 0.003; NRS, p = 0.027). Signs of joint degeneration were observed in 50% of all ankles, especially in those treated by OCD-fixation and reconstruction.Conclusions: Advanced fixation and reconstruction procedures in unstable and non-salvageable atraumatic talar OCD resulted in inferior clinical scores and a higher prevalence of joint degeneration than drilling procedures in stable OCD in young patients. [ABSTRACT FROM AUTHOR]

Background: Osteochondral lesions of the talus are common, particularly after trauma. Arthroscopic bone marrow stimulation has emerged as the first-choice surgical treatment for small primary lesions less than 100 mm2. Individual studies on the topic are small and heterogeneous, and they have differed in their main findings; for this reason, systematically reviewing the available evidence seems important.Questions/purposes: In this systematic review, we asked: (1) What patient-reported outcomes and pain scores have been observed after arthroscopic bone marrow stimulation for secondary osteochondral lesions of the talus? (2) What complications were reported? (3) What demographic and clinical factors were reported to be associated with better patient-reported outcome scores?Methods: We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using Embase, EmCare, PubMed, CINAHL, and Scopus (databases last searched June 23, 2021). A two-stage title/abstract and full-text screening process was performed independently by two reviewers. Randomized control trials, cohort studies, and observational studies published in English that evaluated the outcome of arthroscopic bone marrow stimulation for secondary osteochondral lesions of the talus were included. Case reports, review articles, commentaries, abstracts, and letters to the editor were excluded. A total of 12 articles (10 case series and two retrospective comparative studies) involving 446 patients were included. Of these, 111 patients with a mean age of 33 years (range 20 to 49) received arthroscopic bone marrow stimulation for a secondary osteochondral lesion of the talus. The Methodological Index for Non-randomized Studies (MINORS) criteria were used to assess the methodologic quality of included studies. The MINORS is a numerical score ranging from 0 to 16 for studies with no comparison group and 0 to 24 for comparative studies, with higher quality studies receiving higher scores. Of the 10 noncomparative case series, the highest score was 10 of 16, with a median (range) score of 7.5 (4 to 10), while the two comparative studies scored 22 of 24 and 19 of 24, respectively.Results: Studies varied widely in terms of patient-reported outcome measures such as the American Orthopaedic Foot and Ankle Society score (AOFAS), with inconsistent reporting across studies regarding whether or how much patients improved; there was variation in some effect sizes with regard to improvement seeming close to or below the minimum clinically important difference (MCID). Although no perioperative complications were reported in any included studies, 34% (26 of 77, in seven studies that reported on this endpoint) of patients who underwent a revision procedure. One study found a negative association between lesion size and AOFAS and VAS score. No other studies reported on factors associated with patient-reported outcome scores, and most studies were far too small to explore relationships of this sort.Conclusion: We found that arthroscopic bone marrow stimulation for secondary osteochondral lesions of the talus yielded inconsistent and often small improvements in patient-reported outcomes, with approximately one in three patients undergoing a revision procedure. Reported outcomes likely represent a best-case scenario, inflated by low-level study designs and major sources of bias that are known to make treatment effects seem larger than they are. Therefore, the use of arthroscopic bone marrow stimulation in such patients cannot be recommended, unless we are able to refine selection criteria to effectively identify patients who show a substantial clinical benefit.Level Of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

Background: Since talus fractures are rare, study populations are frequently small. The aim of this study is to describe how surgical treatment of talar neck and body fractures and postoperative complications affect functional outcome and quality of life measured by validated questionnaires.Methods: All patients following surgically treated talar neck and/or body fracture between January 2000 and December 2019 at a level 1 trauma center were included in this retrospective cohort study. Primary outcomes were functional outcomes measured by Lower Extremity Functional Score (LEFS), the Foot Function Index (FFI), and the Quality of Life (QOL) measured by the EuroQol 5-dimension questionnaire (EQ-5D). Linear regression was used to assess the relationship between continuous variables and the outcome, and multivariable linear regression was used to identify the predictors of the functional outcome.Results: Ninety patients were included, of which 73 responded to our questionnaires. The median follow-up time was 50.5 (interquartile range (IQR), 18.3-97.3) months. Our study showed the following results: a mean LEFS of 58.4 (range, 17-80), a median FFI of 15.7 (IQR, 3.5-35.2), a median EQ-5D index score of 0.83 (IQR, 0.81-1.00), a median patient satisfaction of 9.0 (IQR, 8.0-10.0), a patient reported health status of 76.8 (range, 20-100), and a mean AOFAS score of 75.7 (range, 28-100). Implant removal and secondary arthrodesis were associated with a reduced AOFAS outcome score (p=0.001, p<0.001), and implant removal was also a predictive factor for a less favorable LEFS outcome score (p=0.001).Conclusion: Patients who underwent implant removal and/or secondary arthrodesis had poorer functional outcome compared to patients who did not undergo additional procedures. Careful consideration of re-intervention must be made in combination with patient expectation management. Future studies should focus on how to lower the rate of complications and the effect of secondary intervention with the use of validated questionnaires. [ABSTRACT FROM AUTHOR]

Background: Total talar replacement has been reported to have favorable short-term and intermediate-term results for the treatment of osteonecrosis of the talus. The purpose of this study was to evaluate the long-term clinical results of total talar replacement for a minimum of 10 years after the surgical procedure.Methods: From October 2005 to April 2011, 19 ankles in 18 patients (1 male and 17 female) were treated using a total talar prosthesis for osteonecrosis of the talus. The median follow-up period was 152 months (interquartile range [IQR], 138, 160 months). The Ankle Osteoarthritis Scale (AOS) score, the Japanese Society for Surgery of the Foot (JSSF) Ankle-Hindfoot Scale score, and the presence of osteophytes and degenerative changes in the adjacent joints were assessed preoperatively and at the final follow-up. Subsidence of the prosthesis was also assessed at the earliest opportunity for full weight-bearing and the final follow-up. The postoperative range of motion of the ankle was assessed at the final follow-up.Results: The median scores for all subscales of the AOS significantly improved. The median JSSF Ankle-Hindfoot Scale score significantly improved from 58 (IQR, 55, 59.5) to 97 (IQR, 87, 99.5). In the subcategories of this scale, the median pain score improved from 20 (IQR, 20, 20) to 40 (IQR, 30, 40), and the median function score improved from 28 (IQR, 26, 30.5) to 47 (IQR, 47, 50). The median postoperative range of motion of the ankle was 45° (IQR, 42.5°, 55°). Subsidence of the implant was not recognized at the final follow-up (p = 0.083). Proliferation of osteophytes and degenerative changes in the adjacent joints did not affect the overall results.Conclusions: The customized alumina ceramic total talar prosthesis produced stable clinical outcomes over 10 years, and the patients treated with total talar replacement showed favorable clinical results over this time frame.Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Osteochondral lesions of the talus (OLT) are common after ankle trauma. Studies have shown that bioactive substances, such as hyaluronic acid (HA), alone, or in combination, with surgical treatment could improve cartilage regeneration and repair, but the effect of HA on patient reported outcomes is unclear.Methods: Literature searches were performed across four databases (PubMed, SPORTDiscus, Scopus, and The Cochrane Library) for randomized controlled trials in which at least one treatment arm involved use of HA as an adjunct to microfracture to treat patients with OLT. Primary outcomes included the American Orthopaedic Foot and Ankle Society scores (AOFAS), and the Visual Analog Scale (VAS) for pain. The level of evidence and methodological quality were evaluated using the Modified Coleman Methodology Score (MCMS).Results: Three randomized studies were eligible for review with a total of 132 patients (35, 40, 57 patients, respectively) and follow-up ranged from 10.5 to 25 months. Utilization of HA at the time of microfracture resulted in greater improvement in AOFAS scores compared to microfracture alone. The pooled effect size was moderate (Standardized Mean Difference [SMD] 0.45, 95% Confidence Interval [CI] 0.06, 0.84; P = .02) and between-study heterogeneity was low (I-squared = 0%). Utilization of HA during microfracture also led to greater improvement in VAS-pain scores compared to microfracture alone. The pooled effect size was very large (SMD -3.86, 95% CI -4.75, - 2.97; P < .001) and heterogeneity was moderate (I-squared = 69%).Conclusion: Hyaluronic acid injection as an adjunct to arthroscopic MF in OLT provides clinically important improvements in function and pain at short-term follow-up compared to MF alone. Future longer-term follow-up studies are warranted to investigate the durability of MF with HA for treatment of OLT. [ABSTRACT FROM AUTHOR]

Background: Talus fractures are devastating injuries in both adults and children. Well recognised complications such as avascular necrosis (AVN), post-traumatic arthritis and non-union contribute to patient morbidity. This systematic review aimed to assess the literature on these injuries in children and their associated incidence, classification, management and outcome.Methods: A systematic review of Embase and Medline databases was carried out in accordance with PRISMA guidelines. Inclusion criteria were clinically orientated studies looking at talus fractures in paediatric patients (less than 18 years old). Exclusion criteria were conference abstracts, opinion-based reports, articles not published in English and articles published prior to 1980. Data extracted included patient demographics, fracture classification, management and outcomes.Results: 31 studies were included encompassing 143 patients and 167 fractures with a mean age of 11.9 years (1.2-18). The majority of fractures (43.7%, n = 73) were of the talar neck. 70.6% (n = 101) were managed operatively. The overall rate of AVN was 15.4% (n = 22), with a 96.5% union rate. Observed rates of AVN were 5.7% in Hawkin's 1, 11.8% in Hawkin's 2, 53.3% in Hawkin's 3 and 0 in Hawkin's 4 injuries. All cases of non-union occurred in children over 12 years, and seven children required arthrodesis (1x pantalar, 1x subtalar and 5x subtalar and tibiotalar) with a mean age of 14.4 years (9-17).Conclusions: Talus fractures are rare but potentially devastating injuries in children. This systematic review has shown comparable rates of AVN in children to their adult counterparts, with higher rates of non-union and arthrodesis in adolescent patients. A lower threshold for operative intervention to achieve anatomical reduction in these patients should be considered. [ABSTRACT FROM AUTHOR]

Background: Autologous osteoperiosteal transplantation (AOPT) using graft harvested from the iliac crest is used to treat large cystic osteochondral lesions of the talus (OLTs). However, no studies have compared clinical and radiologic outcomes between AOPT and autologous osteochondral transplantation (AOCT) using graft harvested from the nonweightbearing zone of the femoral condyle of the ipsilateral knee in patients with large cystic OLTs. Purpose: To compare clinical and radiologic outcomes between patients undergoing AOPT and those undergoing AOCT for large cystic OLTs. Study Design: Cohort study; Level of evidence, 3. Methods: Between March 2015 and March 2018, patients who underwent AOCT and AOPT to treat medial large cystic OLTs (>10 mm) were retrospectively evaluated. For comparability, the 2 groups were matched 1:1 based on their characteristics, including sex, age, body mass index, side of injury, follow-up period, and the preoperative cyst volume. After propensity score matching, 23 patients were enrolled in each group for the analysis. Clinical outcomes were assessed using the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) score, and the Tegner score. Donor-site morbidity was recorded according to the symptoms, including pain, stiffness, swelling, and discomfort. In addition, the Lysholm score was used to assess the most common knee donor-site morbidity. Radiologic outcomes were evaluated using the magnetic resonance observation of cartilage repair tissue (MOCART) score, and the International Cartilage Regeneration & Joint Preservation Society (ICRS) score was obtained during second-look surgery. Results: The mean follow-up period was about 48 months. There were no significant differences in patient characteristics and lesion volumes between groups. Postoperative ankle pain VAS score, AOFAS score, and Tegner score were not significantly different between groups at final follow-up. Total donor-site morbidity (P =.004) and discomfort morbidity (P =.009) were significantly lower in the AOPT group than in the AOCT group. However, the Lysholm score showed no significant difference between the donor knee and the opposite knee (P =.503) in the AOCT group. The MOCART and ICRS scores were not significantly different between groups. Conclusion: Clinical and radiologic outcomes of patients who underwent AOPT from the iliac crest were found to be comparable with those of patients who underwent AOCT from the ipsilateral knee for the treatment of medial large cystic OLTs. These results may be helpful for orthopaedic surgeons to decide appropriate treatments for patients with large cystic OLTs. [ABSTRACT FROM AUTHOR]

Background: Meniscoid lesions have been reported in patients with chronic ankle injuries, especially in soccer athletes, and such lesions cause soft-tissue impingement and pain. To our knowledge, we are the first to report a meniscoid lesion in the ankle joint presenting as a long-term sequela of avascular necrosis of the talus that developed in childhood.Case Presentation: In this paper, we describe a 55-year-old Caucasian male patient who presented with a 1-year history of intermittent locking, "giving way," weight-bearing pain, and swelling over the anterior aspect of the ankle joint. Imaging showed a rare case of avascular necrosis of the talus associated with an unstable plica-like lesion that was removed arthroscopically after unsuccessful conservative treatment.Conclusion: We demonstrate that unstable meniscoid lesions of the ankle joint can be treated successfully with arthroscopic debridement. We obtained satisfactory short-term clinical results at the 2-year follow-up, even though advanced osteoarthritis was present. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to investigate the second-look arthroscopic evaluation after osteochondral autogenous transfer (OAT) for osteochondral lesion of the talar dome (OLT) with the criteria of the International Cartilage Repair Society (ICRS).Methods: Ten patients (twelve ankles) with OLT underwent OAT with osteotomy of the medial malleolus. Clinical outcomes were evaluated using the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale. The condition of the transplanted cartilage was evaluated at the time of second-look arthroscopy using the ICRS Cartilage Repair Assessment.Results: The AOFAS ankle-hindfoot scale was significantly improved from 65.1 ± 1.9 points before surgery to 98.1 ± 2.8 points at the time of second-look arthroscopy (p < 0.01). The ICRS Cartilage Repair Assessment was 11.4 points on average (9-12 points).Conclusions: The OAT for OLT is considered to be a useful treatment even if invasion by medial malleolus osteotomy is added.Level Of Evidence: Level IV, Case series. [ABSTRACT FROM AUTHOR]

Background: Autologous osteochondral transplantation (AOT) using a cylindrical graft in the treatment of osteochondral lesions of the talus (OLTs) is typically indicated for patients with larger lesions. However, with lesions that are irregular in shape, the AOT graft may not completely replace the lesion. For these lesions, we utilize extracellular matrix cartilage allograft (EMCA) augmentation in AOT to act as a physiologic grout at the host-graft interface. Purpose: To determine if the combination of EMCA with concentrated bone marrow aspirate (CBMA) would improve integration of the host-graft interface and subsequently reduce postoperative cyst formation after AOT. It was also hypothesized that EMCA in conjunction with CBMA would demonstrate improved MOCART (magnetic resonance observation of cartilage repair tissue) scores and functional outcome scores at a minimum 2 years after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis was performed comparing patients treated with AOT/CBMA alone and AOT with CBMA/EMCA. Clinical outcomes were evaluated with the Foot and Ankle Outcome Score. Magnetic resonance imaging appearance was evaluated with the use of the MOCART (magnetic resonance observation of cartilage repair tissue) score. Cyst formation was also evaluated on postoperative magnetic resonance imaging. Results: A total of 26 patients were included in the AOT + CBMA/EMCA group (10 male, 16 female), and 34 patients were included in the AOT/CBMA group (17 male, 17 female). The mean Foot and Ankle Outcome Score significantly improved in both groups (P <.001) across all subscales (symptoms, pain, activities of daily living, sports activities, and quality of life), but there was no significant difference between groups at final follow-up. There was no significant difference in mean MOCART scores between the groups (P =.118). In the AOT/CBMA group, 3 patients (8.8%) complained of knee pain, and 1 (2.9%) required additional surgery (hardware removal). In the AOT + CBMA/EMCA group, 2 patients (7.7%) complained of knee pain, and 6 patients (23%) required additional surgery (3 hardware removals and 3 arthroscopic debridements of scar tissue in the ankle). Conclusion: We found that while EMCA with CBMA has benefit in regeneration and repair of OLT treated with bone marrow stimulation, there appears to be little benefit of EMCA over CBMA alone as a physiologic grout at the graft-host interface in OLT treated with AOT. [ABSTRACT FROM AUTHOR]

Background: Surgical management of talar body fractures is influenced by soft-tissue condition and fracture pattern. Two common surgical approaches for the treatment of talar body fractures are the medial malleolar osteotomy (MMO) and the posteromedial approach (PMA). The purpose of this study was to compare the observable talar body surface area with the MMO and the PMA. We hypothesized that visualization following a PMA improves with distraction and distraction with a gastrocnemius recession.Methods: Five pairs of cadaver limbs were used. Each pair of specimens underwent both approaches to act as an internal control. The laterality of the PMA was determined by randomization, and the MMO was performed on the contralateral ankle. The PMA was performed to visualize the talus, and the talar surface area was recorded using a handheld 3D surface scanner. A distractor was then placed across the joint, and the surface area was remeasured. Finally, a gastrocnemius recession was performed, and the measured surface area under the distraction was recorded. The MMO was performed in standard fashion using fluoroscopy, and the observable talar surface area was recorded. Scans were performed twice for each approach, and the surface areas were averaged. The talus was excised and scanned after each approach in order to compare the visualized surface area with the total surface area of the native talus.Results: The MMO and the PMA exposed a mean of 11.2 and 6.7 cm2, respectively, of the talar surface. Visualization with the PMA was improved with distraction, revealing 8.3 cm2 of the talus (p = 0.01 when compared with an isolated PMA). A PMA with distraction and gastrocnemius recession exposed 9.9 cm2 of the talar dome and body. There was no significant difference in exposure between the MMO and the PMA with distraction and gastrocnemius recession (p = 0.32).Conclusions: The MMO and the PMA both afford excellent visualization for reduction and fixation of talar body fractures. Visualization using the PMA is improved with distraction and distraction with a gastrocnemius recession. The results of this study may assist surgeons in selecting the optimal approach for surgical repair of talar body fractures. [ABSTRACT FROM AUTHOR]

An aneurysmal bone cyst (ABC) can occur in many parts of the human body, but a primary ABC of the talus is extremely rare. ABCs are benign, but aggressively growing tumors that usually occur in the first two decades of life. Patients mainly complain of pain, limited movement of the involved joint or a palpable mass. Pain may worsen suddenly because of pathological fractures. If not treated properly, ABC has a risk of local recurrence, followed by the destruction of the joint and a significant functional deficit. While the complete removal of the bone tumor is essential, it is also important to treat the resultant bone defect after removal. The talus has an important part to play in weight-bearing. Therefore, an appropriate bone graft is required for large bone defects that occur after an ABC removal from the talus. We report a primary ABC of the talus in a 28-year-old male that was treated by curettage and a bone pillar pattern graft of au-tologous tricortical iliac crest bone. The patient had an excellent functional outcome with early weight-bearing, and there was no recurrence at 16 months of follow-up. [ABSTRACT FROM AUTHOR]

Background: There have been debates on the necessity of fibular osteotomy (FO) in supramalleolar osteotomy (SMOT) for the treatment of varus ankle osteoarthritis. The purpose of the current study was to compare the clinical and radiological outcomes between SMOT with and without FO in the treatment of varus ankle osteoarthritis. Methods: The SMOT group included 39 patients, and the SMOT with FO group included 24 patients. The basic information reached no significant difference between groups. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Ankle Osteoarthritis Scale (AOS), modified Takakura stage and range of motion (ROM) were used for the functional evaluation. The radiologic parameters were assessed at the last follow-up to compare the degree of talar reduction between the two groups. Results: Both groups achieved significant improvements in AOFAS scores, modified Takakura stage, as well as AOS pain and functional scores (P < 0.001). The ROM of the ankle joint in the SMOT group was significantly decreased (P = 0.022). In both groups, all of the radiological parameters were significantly improved (P < 0.01). The tibiofibular clear space (TFCS) was significantly widened in the SMOT group (P < 0.001). No significant difference was found between the two groups according to the functional outcomes. However, the talar tilt angle (TT) and hindfoot alignment angle (HFA) in the SMOT with FO group were significantly smaller than those in the SMOT group (P < 0.05). The TFCS was significantly widened in the SMOT group (P = 0.001). The medial displacement of the talus (MDT) was better reduced in the SMOT with FO group (P = 0.006). Conclusion: SMOT is a promising procedure for functional improvement and malalignment correction in varus ankle osteoarthritis but reduces ankle range of motion. If SMOT is combined with FO, talar tilt and medial displacement will be better reduced. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to systematically review the literature on clinical outcomes of patients who have undergone autologous matrix-induced chondrogenesis (AMIC) for treatment of osteochondral lesions of the talus (OCL) and compare the studies' outcomes.Methods: Pubmed and Embase were searched in January 2020 for articles concerning OCL surgery. Studies were included if they had a minimum 1-year follow-up and the primary measures were functional outcomes. The meta-analysis compared the Visual Analogic Score (VAS), the American Orthopedic Foot and Ankle Score (AOFAS), and the Foot Function Index (FFI) between baseline and follow-up of 1-2years, and 3-5years. A random effects model was used to evaluate outcome changes.Results: The search returned 15 studies, with a total of 492 patients. The VAS improved 4.45 and 4.6 points from baseline to the 1-2year and 3-5yearfollow-up, respectively (p<0.001). AOFAS improved 31.59 and 32.47 points from baseline to the 1-2year and 3-5yearfollow-up, respectively (p<0.001). The FFI showed a significant improvement of 30.93 points from baseline to year 3-5 (p<0.001). A total of 6 patients with revision surgeries have been reported within the follow up period. It was not possible to correlate clinical features like lesion size, surgical approach, and bone marrow stimulation technique to the reported outcome.Conclusion: Surgical treatment of OCL via the AMIC procedure provided significant improvement in the functional outcome and pain scores when compared to the pre-operative values. Improvements were observed up to 5years post-operatively. [ABSTRACT FROM AUTHOR]

Introduction. Traditionally, centralization of the fibula with fusion across the tibiotalar joint has been used to reconstruct distal tibial defects. Although effective, it requires long periods of protected weight-bearing. The fibula or the fixation often fails before fibular hypertrophy necessitating multiple additional surgeries. A method of using ECRT with the available ipsilateral fibula (nonvascularized) to reconstruct the distal tibia defect with the aim of early return to weight-bearing was evolved. This paper documents our early experience. Patients and Methods. Four patients; with the diagnosis of osteosarcoma in 3 patients and recurrent giant cell tumor of the bone in 1 patient, underwent resection of the distal tibia for tumors between 2017 and 2019. Extracorporeally irradiated (50 Gy) distal tibia along with ipsilateral nonvascularized fibula was used to bridge the defect and fuse the tibiotalar joint. A plate was used to rigidly hold the construct. The final outcome was compared to the historical control group that underwent only pedicled ipsilateral fibula transposition and ankle arthrodesis without recycled autograft or allograft between 2009 and 2017. Oncological reconstruction and functional outcomes were compared for each group. Patient reported outcomes on the acceptability of ankle fusion; cosmesis and function were analyzed and compared between the two groups. Results. The mean resection length in the study group (4 patients) was 7.75 cm (7 to 8.5 cm). As compared to the historical cohort of 7 patients, the study population showed statistically superior results in all reconstruction, functional, and patient-reported outcomes except time to proximal junction union (p = 0.068). There were no reconstruction failures, infection, or nonunions in the study group, whereas the control comparative group had 2 proximal junction nonunions and a mean time to fibular hypertrophy of 143 weeks (82 to 430 weeks) with fibula centralization. Earlier weight-bearing was allowed (mean 26.75 weeks; median 27 weeks) compared to (mean 80.75 weeks; median 80 weeks) in the control group. Conclusion. We think that ECRT with ipsilateral vascularized fibula is a promising method of reconstructing the distal tibia. The recycled autograft tibia added strength to the distal tibia construct in our study and aided the anatomical reconstruction of the distal tibia. The patient-reported outcomes for cosmesis and acceptability add to the benefits of performing this procedure. Consistent early union across the proximal junction and earlier weight-bearing were clear advantages of this method. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to analyse the re-operation rate after surgical treatment of osteochondral lesions of the talus (OCLTs) in children and adolescents. Methods: Between 2009 and 2019, 27 consecutive patients with a solitary OCLT (10 male, 17 female; mean age 16.9 ± 2.2 years; 8 idiopathic vs. 19 traumatic) received primary operative treatment (arthroscopy + bone marrow stimulation [BMS], n = 8; arthroscopy + retrograde drilling, n = 8; autologous chondrocyte implantation [ACI]/autologous bone grafting, n = 9; arthroscopy + BMS + retrograde drilling; n = 1; flake fixation, n = 1). Seventeen OCLTs were located at the medial and ten at the lateral talus. 'Re-operation' as the outcome measure was evaluated after a median follow-up of 42 months (range 6–117 months). Patients were further subdivided into groups A (re-operation, n = 7) and B (no re-operation, n = 20). Groups A and B were compared with respect to epidemiological, lesion- and therapy-related variables. Results: Seven of 27 patients needed a re-operation (re-operation rate 25.9% after a median interval of 31 months [range 13–61 months]). The following operative techniques were initially used in these seven patients: arthroscopy + BMS n = 2, arthroscopy + retrograde drilling n = 4, ACI + autologous bone grafting n = 1. A comparison of group A with group B revealed different OCLT characteristics between both groups. The intraoperative findings according to the International Cartilage Repair Society (ICRS) classification revealed significantly more advanced cartilage damage in group B than in group A (p = 0.001). Conclusions: We detected a re-operation rate of 25.9% after primary surgical OCLT treatment. Patients with re-operation had significantly lower ICRS classification stages compared to patients without re-operation. [ABSTRACT FROM AUTHOR]

Background: Internal fixation of an osteochondral lesion of the talus (OLT) can restore the congruency of the talus and maintain the subchondral bone and innate hyaline cartilage. However, OLT that is indicated for fixation is rarely encountered; hence, not many studies report on the results after the procedure. Purpose: To evaluate the clinical and radiological outcomes after internal fixation of chronic OLT involving a large bone fragment of at least 10 mm in diameter and 3 mm in depth on computed tomography (CT). Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed the data of 26 patients with OLT treated with internal fixation between August 2014 and April 2018. Of the patients, 15 were male and 11 were female, with a mean age of 16 years (range, 11-29 years). The primary radiological outcome measurement was bone union assessed on the 6-month postoperative CT scan. Clinical outcomes were assessed at a mean of 27.7 months postoperatively. Results: Twenty patients (77%) achieved bone union on postoperative CT scan. The mean 100-mm visual analog scale (VAS) improved from 30.5 ± 8.5 preoperatively to 13.4 ± 9.7 postoperatively (P <.001). The mean Foot Function Index (FFI) improved from 30.5 ± 6.7 preoperatively to 13.7 ± 9.8 postoperatively (P <.001). A malleolar osteotomy was not necessary to approach the lesion in 88% of patients. A bone fragment with an irregular margin and low density on the preoperative CT scan was significantly associated with nonunion (odds ratio: 7.67, 95% confidence interval: 2.67 to 22.02, P =.008). The difference in clinical outcomes between patients with skeletally immature ankles and those with skeletally mature ankles was not statistically significant. Patient age did not correlate with postoperative 100-mm VAS (Pearson correlation coefficient, r = −0.07, P = 0.72) or the postoperative FFI (Pearson correlation coefficient, r = –0.05, P =.80). Conclusion: Internal fixation of an OLT involving a large bone fragment resulted in satisfactory clinical and radiologic outcomes. We found that patients with skeletally immature and mature ankles attained healing at comparable rates after the internal fixation of OLT. [ABSTRACT FROM AUTHOR]

Background: Cartilage degeneration is a common issue in patients with chronic lateral ankle instability. However, there are limited studies regarding the effectiveness of lateral ligament surgery on preventing talar and subtalar joint cartilage from further degenerative changes. Purpose: To longitudinally evaluate talar and subtalar cartilage compositional changes using magnetic resonance imaging T2* mapping in anatomic anterior talofibular ligament (ATFL)–repaired and ATFL-reconstructed ankles and to compare them with measures in asymptomatic controls. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2015 and December 2016, patients with chronic lateral ankle instability who underwent anatomic ATFL repair (n = 19) and reconstruction (n = 20) were prospectively recruited. Patients underwent 3.0-T magnetic resonance imaging at baseline and 3-year follow-up. As asymptomatic controls, 21 healthy volunteers were recruited and underwent imaging at baseline. Talar dome cartilage was divided into (1) medial anterior, central, and posterior and (2) lateral anterior, central, and posterior. Posterior subtalar cartilage was divided into (1) central talus and calcaneus and (2) lateral talus and calcaneus. Ankle function was assessed using the American Orthopaedic Foot & Ankle Society scores. Results: There were significant increases in T2* values in medial and lateral posterior and central talus cartilage from baseline to 3-year follow-up in patients who underwent repair. T2* values were significantly higher in ATFL-repaired ankles at follow-up for all cartilage regions of interest, except medial and lateral anterior and lateral central, compared with those in healthy controls. From baseline to 3-year follow-up, ATFL-reconstructed ankles had a significant increase in T2* values in lateral central and posterior cartilage. T2* values in ATFL-reconstructed ankles at follow-up were elevated in all cartilage regions of interest, except medial and lateral anterior, compared with those in healthy controls. ATFL-repaired ankles showed a greater decrease of T2* values from baseline to follow-up in lateral calcaneus cartilage than did ATFL-reconstructed ankles (P =.031). No significant differences in American Orthopaedic Foot & Ankle Society score were found between repair and reconstruction procedures (mean ± SD, 19.11 ± 7.45 vs 16.85 ± 6.24; P =.311). Conclusion: Neither anatomic ATFL repair nor reconstruction could prevent the progression of talar dome and posterior subtalar cartilage degeneration; however, ankle function and activity levels were not affected over a short period. Patients who underwent ATFL repair exhibited lower T2* values in the lateral calcaneus cartilage than did those who underwent reconstruction. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to enhance data about the effectiveness of HemiCAP® implantation after failed previous surgery for osteochondral defects (OCDs).Methods: 12 consecutive patients were retrospectively included in this study. The American Orthopedic Foot and Ankle Society Score (AOFAS), the Visual Analogue Scale (VAS) score for pain, the sub-scales Pain and Disability of the Foot Function Index (FFI-P and FFI-D) Score, and the patients' satisfaction were evaluated.Results: AOFAS increased from poor to fair (p < 0.001), VAS score decreased from moderate to mild pain (p = 0.001), the final FFI-P and FFI-D were 37.50 ± 18.54 and 33.44 ± 16.24, respectively (p < 0.001). Five patients were not satisfied, three were moderately satisfied and four were highly satisfied. One implant repositioning, one ankle fusion (implant failing) and an additional surgery (double arthrodesis) were performed during the follow-up. Neither intra- nor postoperative complications were registered.Conclusion: Despite the clinical improvement, pain was still present at the final follow-up. Metal resurfacing might not be considered a definitely valid alternative for treatment of OCDs after failed previous surgery.Level Of Evidence: Level III, retrospective study. [ABSTRACT FROM AUTHOR]

Introduction/purpose: Osteochondral lesion of the talus (OCLT) is defined as a defect on the articular surface of the talus with/without subchondral bone involvement. Several surgical techniques are described in literature to treat OCLT. Particulated Juvenile Cartilage Allograft Transplantation (PJCAT) is a new emerging technique that has the potential of restoring the native cartilage. However, available data on PJCAT in treating OCLT is confined to a small number of studies with heterogeneous population. The aim of this study is to systematically review the literature on clinical and radiological outcomes of PJCAT in treating OCLT.Methods: A systematic search of Medline database was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Number of patients and demographic data included age, gender and body mass index (BMI) were extracted. The level of evidence of each included study was identified. When feasible, mechanism of injury, lesion size and average follow up were recorded. The American Orthopedic Foot and Ankle Society Score (AOFAS), and Foot and Ankle Outcome Score (FAOS) were obtained to assess the functional outcomes. Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was selected to evaluate the radiological outcomes.Results: A total of 10 studies were eligible for this review involving 132 patients. Postoperative AOFAS scores were available for 44 patients who underwent PJCAT with an average of 86.14 at 25.5 months follow up. FAOS scores have been reported in 3 studies for 81 patients. The average preoperative score was 47.35 which has been improved to 62.88 at follow up of 23.6 months. MOCART was evaluated in 42 feet after the mean follow up of 18.2 months. The repair tissue was characterized by variable features; however, certain peculiarities were observed with higher frequency including infill hypertrophy, incomplete border zone integration, deep surface disruption, structure inhomogeneity, patches of hyperintense signals, damage of subchondral lamina and subchondral bone, adhesions and absence of effusion.Conclusion: PJCAT seems to be a promising modality of treatment for OLT in terms of functional outcomes. Fair attempts of defect filling can be confirmed with MRI. Nevertheless, heterogeneous picture of regenerate cartilaginous tissue and lack of repair in subchondral bone and subchondral lamina are not in favor with claims of full restoration of lost normal hyaline articular cartilage. [ABSTRACT FROM AUTHOR]

Background: The purpose of this human specimen experimental study was to compare the fixation stability of clinically used bilayer collagen membrane with fibrin glue with trilayer collagen prototype without fibrin glue in chondral defects at the medial or lateral talar shoulder (both matrices from Geistlich Pharma AG, Wollhusen, Switzerland).Methods: Eleven human specimens were used. The membranes were implanted in standardized chondral defects at the medial and lateral talar shoulder randomized. All tests were performed in load-control 15 kg. Range of motion ROM of each ankle was examined individually before testing. The average ROM was 10° dorsiflexion range 0°-20° and 30° plantarflexion range 20°-45°. 1,000 testing cycles with the defined ROM were performed. Two independent investigators, blinded to membrane and fixation type, visually assessed the membrane fixation integrity for peripheral detachment, area of defect uncovered, membrane constitution and delamination.Results: The clinically used bilayer collagen membrane plus fibrin glue showed higher fixation stability than the trilayer prototype (all p < 0.05). No significant differences occurred between medial and lateral talar shoulder location (all p > 0.05).Conclusions: The fixation stability of the trilayer collagen prototype without fibrin glue is lower than of the clinically used bilayer membrane with fibrin glue in chondral defects at the medial and lateral talar shoulder in an experimental human specimen test. Clinical use of trilayer collagen prototype without fibrin glue has to be validated by clinical testing to evaluate if the lower stability of fixation is still sufficient. [ABSTRACT FROM AUTHOR]

Purpose: The first descriptions on medial talar tubercle fractures are attributed to Cedell. He described avulsion fractures of the insertion of the posterior talotibial ligament. However the true etiology has not been established. Since little is known about these fractures, they are easily misdiagnosed as simple ankle sprains. Untreated, these fractures may lead to chronic ankle pain. To improve the understanding of the etiology and outcome of these fractures a systematic review was conducted of all cases of isolated fractures of the medial tubercle of the posterior talar process. In addition we present the first series of competitive athletes treated by means of the two-portal hindfoot approach for isolated medial talar tubercle fractures.Methods: A systematic search was performed to identify all cases of medial tubercle fractures. Data on trauma mechanism, clinical presentation, imaging and treatment were extracted. In addition we retrospectively report on the results of endoscopically treated patients in our institution over the last fifteen years. Of all patients Numeric Rating Scores (NRS) for Satisfaction, Pain and Function, Foot Ankle Outcome Scores (FAOS), return to sport and complications were reported.Results: Eightteen articles were included reporting on 33 patients with an isolated fracture or avulsion of the posteromedial talar process. Most of the fractures occurred during sport activities (58%), followed by motor vehicle accidents (21%) and fall from height (12%). Of the activities during sport, 73% resulted following an ankle sprain. Reasonable to good outcomes are described in cases treated with immobilization, open reduction internal fixation or open excision. Of the nine patients treated in our institution, five were male and the median age was 29. All were participating in sports at a competitive level, with four of them being a professional athlete. In most patients the diagnosis was made more than a year after initial trauma. Ankle sprain was most common trauma mechanism. In some patients it was evident the avulsion was part or the deep portion of the deltoid ligament, however in two cases it was more likely an avulsion of the flexor hallucis longus (FHL) retinaculum. The median follow-up was 69 months (IQR 12.0-94.3). At final follow-up patients had little pain, NRS 1. Median NRS for satisfaction and function were 7 and 8, respectively. All patients did resume sport activities, however only four reached the preinjury level. Of the five patients that did not return to their pre-injury level of activity, two were professional athletes at the end of their career, and retired not due to ankle complaints. One complication was reported.Conclusion: Fractures of the medial tubercle are rare and based on the available literature there is not one distinct trauma mechanism. Based on literature no recommendation for treatment can be made. Our results show endoscopic excision of the fragment as a save alternative for open surgical treatment. [ABSTRACT FROM AUTHOR]

We analyzed the characteristics of 112 consecutive patients who were operatively treated for osteochondral lesions of the talus from August 2014 to April 2019 in our hospital. The patients were divided into three age groups: young-adult (<40 years), middle-age (40–60 years) and old-age (>60 years). The basic clinical features, localization and size of the lesions, Hepple stage, and surgical procedures were compared among groups. Several significant differences were found on the characteristics of osteochondral lesions of the talus among age groups. There were more female patients in the old-age group (p<0.01), and old patients had a longer duration of symptoms (p<0.05). The OLTs in middle- and old-age patients were mostly located in the medial part of the talus with larger depth (p<0.01). Hepple stage 5, the cystic type, was very common in the old-age group (p<0.01). With regard to surgical procedures, more osteochondral autograft transplantations were applied in the old-age group (p<0.01). Female and deep medial talar subchondral cyst is the typical characteristics of patients over 60 years old. Age is an important factor that must be considered when choosing surgery procedure for patients with osteochondral lesions of the talus. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare patients with osteochondral lesions of the talus (OCLT) with and without concomitant chronic ankle instability (CAI).Methods: Data from the German Cartilage Registry (KnorpelRegister DGOU) for 63 patients with a solitary OCLT were used. All patients received autologous matrix-induced chondrogenesis (AMIC) for OCLT treatment. Patients in group A received an additional ankle stabilisation, while patients in group B received AMIC alone. Both groups were compared according to demographic, lesion-related, and therapy-related factors as well as baseline clinical outcome scores at the time of surgery. The Foot and Ankle Ability Measure (FAAM), the Foot and Ankle Outcome Score (FAOS), and the Numeric Rating Scale for Pain (NRS) were used.Results: Patients in group A were older compared to group B [median 34 years (range 20-65 years) vs. 28.5 years (range 18-72 years)]; the rate of trauma-associated OCLTs was higher (89.7% vs. 38.3%); more patients in group A had a previous non-surgical treatment (74.1% vs. 41.4%); and their OCLT lesion size was smaller [median 100 mm2 (range 15-600 mm2) vs. 150 mm2 (range 25-448 mm2)]. Most OCLTs were located medially in the coronary plane and centrally in the sagittal plane in both groups. Patients in group A had worse scores on the FAOS quality-of-life subscale compared to patients in group B.Conclusion: Patients with OCLT with concomitant CAI differ from those without concomitant CAI according to demographic and lesion-related factors. The additional presence of CAI worsens the quality of life of patients with OCLT. Patients with OCLT should be examined for concomitant CAI, so that if CAI is present, it can be integrated into the treatment concept.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Background: Tibio-talo calcaneal (TTC) arthrodesis is increasingly performed for hindfoot arthrosis and other indications. Peri-implant fracture around hindfoot fusion nails has been previously reported and can be problematic to treat given multiple surgical considerations including the status of hindfoot arthrodesis at time of fracture. We present a systematic review of the literature regarding peri-implant fractures around hindfoot fusion nails and propose a classification system to help guide treatment based on findings from the current literature as well as the collective experience of the senior authors.Methods: A review of the literature was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify clinical investigations in which peri-implant fractures or other hardware failures were observed as complications following TTC arthrodesis using hindfoot nails. The electronic database of PubMed/Medline/Cochrane Library was explored using specific search terms. Inclusion criteria was any clinical investigation that reported on outcomes after TTC arthrodesis using a hindfoot nail in at least one patient. Cadaveric and non-clinical investigations were excluded.Results: A total of 36 studies were identified which met inclusion criteria and reported clinical outcomes after TTC arthrodesis using a hindfoot fusion nail. Of the 36 studies, there was a total of 13 intraoperative fractures, 43 tibial stress fractures and 24 peri-implant fractures recorded in 12 of the 36 studies.Conclusion: Peri-implant fracture following tibio-talo calcaneal arthrodesis using a hindfoot intramedullary nail is an uncommon but problematic condition to treat. General heterogeneity of patients and indications as well as a lack of descriptive detail in the current literature makes meta-analysis difficult. Given the lack of consensus on treatment, a classification system may be helpful to guide clinical practice. [ABSTRACT FROM AUTHOR]

Background: Treatment of osteochondral lesions of the talus (OLTs) in children presents a difficult clinical challenge, with few large series reported. Purpose: To evaluate functional and radiographic outcomes for children and adolescents undergoing arthroscopic treatment of symptomatic OLT with a minimum follow-up of 2 years. Study Design: Case series; Level of evidence, 4. Methods: Patients were identified who had symptomatic OLT treated arthroscopically with marrow stimulation techniques. Inclusion criteria were age ≤18 years, symptomatic chronic OLT as the surgical indication, failure of nonoperative treatment, and minimum follow-up of 24 months. Outcome measures included Foot Function Index, American Orthopaedic Foot and Ankle Society Hindfoot Score, Tegner Activity Scale, 36-Item Short Form Health Survey (Short Form-36, v 2), visual analog scale, ankle range of motion, and patient satisfaction survey. Weightbearing radiographs were compared with preoperative radiographs via an ankle arthritis classification system. Magnetic resonance imaging (MRI) was used to evaluate postoperative lesion characteristics per the MOCART scale (magnetic resonance observation of cartilage repair tissue). The size, location, lesion stability, traumatic etiology, skeletal maturity, and length of follow-up were recorded and analyzed through univariate logistic regression. Results: The study group consisted of 22 patients (11 male, 11 female) with a mean age of 14.4 years (range, 8-18 years) and a mean follow-up of 8.3 years (range, 2-27 years). Of 22 patients, 20 were satisfied with the results from surgery and would recommend it to others. Mean follow-up visual analog scale for pain was reported as 2.2 on a 10-point scale, and mean American Orthopaedic Foot and Ankle Society score at follow-up was 86.6. Mean postoperative Foot Function Index scores for the study group were as follows: pain, 17.1; disability, 16.5; activity, 4.7; and overall, 38.7. Mean Short Form-36 physical component score was 50.7. Postoperative radiographs indicated a van Dijk osteoarthritis grade of 0 in 56%, I in 38%, II in 6%, and III in 0%. Postoperative MRI MOCART scores showed complete filling of the cartilage in 27% of cases, complete graft integration in 22%, and intact repair surface in 22%, with a mean MOCART score of 48.0. No correlation was found between radiographic and MRI findings and clinical outcomes. None of the prognostic factors were significantly associated with patient satisfaction, progression of arthritis, or MOCART scores. Conclusion: Arthroscopic treatment of symptomatic OLT in adolescent patients (≤18 years) demonstrated high functional outcomes, high clinical satisfaction rates, and minimal radiographic osteoarthritic progression despite low MOCART scores. [ABSTRACT FROM AUTHOR]

Bone marrow aspirate concentrate and matrix-induced chondrogenesis (BMIC) is an interesting treatment option for osteochondral lesions of the talus with promising short- to mid-term results. The various terminologies used to describe this surgical method need to be addressed. These include bone marrow-derived cell transplantation, matrix-induced bone marrow aspirate concentrate, and matrix-associated stem cell transplantation. BMIC is a one-stage, minimally invasive surgery performed arthroscopically or using a mini-open arthrotomy approach without a malleolar osteotomy in most cases. The lesion is replaced with hyaline-like cartilage, and treatment-related complications are rare. BMIC is a safe and effective treatment option and should be considered in large lesions or lesions with a prior treatment history. [ABSTRACT FROM AUTHOR]

Increased loading in a localized area is a possible cause of pain-related osteochondral lesions of the talus (OLT), but the reported effects of realignment surgery for OLT have been anecdotal. Moreover, no report of realignment surgery for OLT could be found in the English literature. This study reviewed previous articles on lower extremity alignment and OLT to determine if OLT can be treated with realignment surgery. [ABSTRACT FROM AUTHOR]

Background: It was hypnotized that presence and larger size of os trigonum (OT) can affect flexor hallucis longus tendon (FHL), so tenosynovitis, degeneration and partial tear can be developed.Methods: A total of 98 (Study group: 50, Control: 48) subjects included to study and compered status of FHL lesions. Sagittal length and axial width of OT were measured on MRI to determine effect of OT on FHL lesions and correlated with arthroscopic findings.Results: FHL tenosynovitis (p: 0,025), degeneration (p: 0,01) and partial tear (p: 0.008) was identified statistically high in study group. Statistical analysis revealed that as length of OT increased, frequency of degeneration (p: 0.03) and partial tear (p: 0.00) of FHL increased.Conclusion: Analyzes were showed that the presence of os trigonum had an important role on the FHL pathologies. Additional finding of study was to demonstrate that possibility of FHL lesion increased as length of OT extended.Levels Of Evidence: Level 3. [ABSTRACT FROM AUTHOR]

Background: HemiCAP for complex osteochondral defects (OCDs) in talus has been on the market since 2008. Few follow-up studies exist. Patients with complex OCDs were followed for up to 81 months.Methods: 31 consecutive patients were assessed preoperatively and at final follow-up, mean 50 months. All patients were treated with the HemiCAP®, Arthrosurface Inc., USA inlay. Inclusion criteria were complex OCDs of the medial or lateral talus dome.Results: All outcome measures i.e. AOFAS, FAOS and NRS improved significantly. 71.8 % of the cohort were employed preoperatively. At final follow up 87.5% were employed. No revisions of the HemiCAP was performed, but 41,9% had supplementary surgery. 1 patient had a superficial infection otherwise no complications were found. Preoperative and final follow-up x-rays were analysed.Conclusions: Mid-term results after HemiCAP talus are good. Patient information and selection is mandatory due to the high numbers of additional surgeries following the HemiCap implantation. [ABSTRACT FROM AUTHOR]