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    Outcomes of Total Ankle Arthroplasty in Postfracture Ankle Arthritis
    (2023)
    Jaeyoung Kim
    ;
    Ruben Radkievich
    ;
    Rami Mizher
    ;
    Isabel Shaffrey
    ;
    Martin O’Malley
    <jats:sec><jats:title>Background:</jats:title><jats:p> Ankle arthritis that develops after fracture accounts for a significant portion of ankle arthritis necessitating total ankle arthroplasty (TAA). It remains unknown whether TAA in postfracture patients produces equivalent outcomes to those without fracture history. The purpose of this study was to evaluate the medium-term outcomes of TAA in postfracture ankle arthritis compared to those without fracture history. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> This study reviewed 178 ankles from 171 consecutive patients who underwent TAA in our institution between 2007 and 2017 and completed a minimum 5-year follow-up. Four different TAA systems were utilized by 6 surgeons. Based on fracture history, patients were divided into 2 groups: the postfracture group (n = 63; median age 65.7 years; median follow-up 5.9 years) and the nonfracture group (n = 115; median age 64.4 years; median follow-up 6.2 years). Types and rates of complications including revision and reoperation were compared. Minimum 5-year Foot and Ankle Outcome Score (FAOS) and postoperative improvement were investigated. A subgroup analysis was performed to determine whether outcomes differ between intraarticular fracture patients (n = 43) and extraarticular fracture patients (n = 20). </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Both groups exhibited comparable postoperative improvement and final FAOS scores. The postfracture group had a significantly higher reoperation rate than the nonfracture group (20 of 63, 31.7%, vs 17 of 115, 14.8%; P = .011), with gutter impingement being the most common cause. There were 3 revisions in each group. In the subgroup analysis, we found no evidence of statistical difference between the intraarticular fracture group and the extraarticular fracture group in terms of FAOS scores, revision, and reoperation rates. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> In this single-center, retrospective comparative study, we found total ankle arthroplasty in patients with a history of fractures around the ankle joint had no evidence of statistical difference in patient-reported outcomes and implant survivorship but led to a higher rate of nonrevision reoperation following surgery. In the much smaller subset of patients with previous fracture, we did not find that those with a history of intraarticular fracture had inferior outcomes after TAA when compared to those with a history of extraarticular fracture. </jats:p></jats:sec><jats:sec><jats:title>Level of Evidence:</jats:title><jats:p> Level III, case-control study. </jats:p></jats:sec>
      6Scopus© Citations 2
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    Acute Deltoid Injury in Ankle Fractures: A Biomechanical Analysis of Different Repair Constructs
    (2023)
    WAGNER HITSCHFFELD, EMILIO  
    ;
    WAGNER HITSCHFELD, PABLO  
    ;
    Mario I. Escudero
    ;
    Florencia Pacheco
    ;
    David-osvaldo Salinas-sanchez
    <jats:sec><jats:title>Background:</jats:title><jats:p> The importance of the deltoid ligament in the congruency and coupling of the tibiotalar joint is well known. The current trend is to repair it in cases of acute injuries in the context of ankle fractures; however, there is limited information on how it should be reconstructed. The objective of this study was to compare different deltoid ligament repair types in an ankle fracture cadaveric model. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Sixteen cadaveric foot-ankle-distal tibia specimens were used. All samples were prepared as a supination external rotation ankle fracture model. Axial load and cyclic axial rotations were applied on every specimen using a specifically designed frame. This test was performed without deltoid injury, with deltoid injury, and after repair. The reconstruction was performed in 4 different ways (anterior, posterior, middle, and combined). Medial clear space (MCS) was measured for each condition on simulated weightbearing (WB) and gravity stress (GS) radiographs. Reflective markers were used in tibia and talus, registering the kinematics through a motion analysis system to record the tibiotalar uncoupling. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> After deltoid damage, in all cases the MCS increased significantly on GS radiographs, but there was no increase in the MCS on WB radiographs. After repair, in all cases, the MCS was normalized. Kinematically, after deltoid damage, the tibiotalar uncoupling increased significantly. All isolated repairs achieved a similar tibiotalar uncoupling value as its baseline condition. The combined repair resulted in a significant decrease in tibiotalar uncoupling. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> Our results show that deltoid repair recovers the tibiotalar coupling mechanism in an ankle fracture model. Isolated deltoid repairs recovered baseline MCS and tibiotalar uncoupling values. Combined repairs may lead to overconstraint, which could lead to postoperative stiffness. Clinical studies are needed to prove these results and show clinically improved outcomes. </jats:p></jats:sec><jats:sec><jats:title>Clinical Relevance:</jats:title><jats:p> This study helps in finding the optimum deltoid repair to use in an acute trauma setting. </jats:p></jats:sec>
    Scopus© Citations 4  8
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    Soleus muscle and Achilles tendon compressive stiffness is related to knee and ankle positioning
    (2022)
    Carlos Cruz-Montecinos
    ;
    BESOMI MOLINA, MANUELA  
    ;
    Nicolás Acevedo-Valenzuela
    ;
    Kevin Cares-Marambio
    ;
    Alejandro Bustamante
      3Scopus© Citations 10
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    Item type:Publication,
      30  1Scopus© Citations 4