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Category: Bunion Introduction/Purpose: Hallux valgus (HV) is commonly treated with proximal or distal first metatarsal osteotomies. Despite good correction, these procedures bear inherent risks such as malunion, nonunion, metatarsal shortening, loss of fixation, and avascular necrosis (AVN). Suture button fixation has been used as another form of HV treatment that avoids the use of corrective osteotomies and maintains reduction of the intermetatarsal angle (IMA). The goal of this study was to assess the radiographic and functional outcomes of patients undergoing HV correction with a distal soft tissue procedure and proximal suture button fixation. Methods: Twenty-two patients underwent HV correction utilizing a distal soft tissue correction and proximal fixation with the Mini TightRope (Arthrex, Inc, Naples, Florida) device. The IMA, hallux valgus angle (HVA), and sesamoid station were measured on radiographs obtained preoperatively as well as in the immediate post-operative period and at final follow-up. Preoperative and postoperative Short Form-36 (SF-36) and Foot and Ankle Ability Measure (FAAM) scores were collected. Postoperative Visual Analog Scale (VAS) scores, complications, and any additional surgical procedures performed were also recorded. Results: Mean follow-up was 27.7 months.The mean preoperative IMA and HVA were 16.9 and 32.6 degrees.The mean immediate postoperative IMA was 5.2 degrees(p20degrees.All components of the FAAM and SF-36 showed improvement from preoperative to final follow-up, although these changes were not statistically significant.The average final postoperative VAS was11.05.Of the 22 cases, three experienced complications, including an intra-operative second metatarsal fracture, a postoperative second metatarsal stress fracture, and a postoperative deep vein thrombosis(DVT). Conclusion: The use of a distal soft tissue procedure in conjunction with proximal suture button fixation is a safe and effective procedure for treating symptomatic HV deformity. Our results show that this technique can correct the IMA, HVA, and sesamoid station without the need for osteotomy and with minimal risk of complications.

Category: Sports Introduction/Purpose: Acute Achilles tendon ruptures have a 2.4-4.7% rate of infection and wound healing complications when treated operatively. The incidence doubles in those with risk factors such as diabetes, smoking or steroid use. To diminish complications minimally invasive approaches have received increasing interest. Meta-analyses have demonstrated equivalent rerupture rates, significantly lower risk of superficial infection, and higher patient satisfaction rates with minimally invasive repairs compared with traditional open Achilles repair techniques. We have previously published a novel technique for limited open Achilles repair using modified ring forceps. The objective of the present study is to review the clinical outcomes of this technique, and to analyze functional results using validated outcomes measures. Methods: Between 2009 and 2016, the clinical records of 29 consecutive patients (average age 45 years [range, 21-76 years], 24 males [83%]) who underwent limited-open repair of an acute Achilles tendon rupture with modified ring forceps were retrospectively reviewed. Through a 2.5-3 cm midline incision a pair of ring forceps bent 30 degrees were used to grasp the tendon stumps deep to paratenon. Three #2 non-absorbable sutures were placed in the proximal and distal segments and delivered out of the wound. The tendon ends were reapproximated and the sutures tied down to secure the tendon. At a minimum of 6 months follow-up the 10-cm Visual Analog Scale (VAS), the Foot and Ankle Ability Measure (FAAM), and the Victorian Institute of Sports Assessment – Achilles (VISA-A) were assessed. Results: At final follow-up (average 43.5 months[range, 5.7-90.1]) 28 of 29 patients reported no pain in their Achilles with an average Achilles VAS of 0.8 out of 100(SD±4.5). The average post-operative VISA-A score was 87.9 out of 100(SD±13.2). The average FAAM Activities of Daily Living and Sports subscales were 96.4%(SD±5.5) and 85.1%(SD±21.3), respectively. Post- operatively patients reported their overall functional level was 94.2% of their pre-injury level when performing ADLs, and 80.1% when participating in sports. Seventeen of 29 patients(58.6%) rated their current functional level as “normal,” nine(31.0%) as “nearly normal,” three(10.3%) as “abnormal,” and none as “severely abnormal.” There was one case of superficial wound infection that resolved with oral antibiotics and local wound care; there were no cases of deep infection, sural neuritis or rerupture. Conclusion: These results demonstrate that limited-open Achilles repair with modified ring forceps provides an economical repair with excellent pain relief and good functional outcomes at mid-term follow-up. Additionally, this is one of the first studies to report validated Achilles specific outcomes(VISA-A) in the setting of acute repair. The wide age range, and subsequent variability in elective sport involvement, may have differentially lowered the sports-related functional outcomes in this study. The complication rate was extremely low making it an attractive alternative to traditional open techniques. Furthermore, this technique is easy to learn and cost-effective without the requirement of commercially available single-use kits.