Clinical Research: Foot & Ankle Surgery
Selected Abstracts 2008-2009
Steven Raikin, MD
Jamal Ahmad, MD
A comparison of outcomes of bimalleolar and trimalleolar ankle fracture.
Ahmad J, Tannoury C, Raikin SM.
Presented at American Academy of Orthopaedic Surgeons (AAOS), Las Vegas, 2009.
Introduction: This is a retrospective comparison of the medium and long-term outcomes of bimalleolar and trimalleolar ankle fractures following surgical treatment.
Materials and Methods: Between February 2001 and January 2007, 74 patients with bimalleolar and 43 patients with trimalleolar ankle fractures received surgical treatment. Patients were followed from 21-92 months with the mean being 50.2 months. Postoperative function was graded using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scoring System and a Visual Analog Scale (VAS) of pain. Radiographs were assessed for fracture union, mortise congruency and degenerative changes.
Results: 112 of 117 patients (95.7%) returne dfor final evaluation. The mean AOFAS scores for patients with bimalleolar and trimalleolar ankle fractures were 88.9 and 82.1 out of 100 respectively (P = 0.085). The mean VAS scores for patients with bimalleolar and trimalleolar ankle fractures were 1.9 and 3.1 out of 10 respectively (P = 0.046). All bimalleolar and trimalleolar fractures progressed to union by a mean time of 12.0 weeks from surgery. No patients in either group displayed loss of mortise congruency. 1 bimalleolar (1.4%) and 2 trimalleolar (4.8%) patients developed ankle arthritic changes at final follow-up.
Discussion: To date, there is scant literature comparing the medium and long-term clinical and radiographic outcomes of bimalleolar and trimalleolar ankle fractures following surgical treatment. Both of our study populations progressed to complete fracture union with no joint instability. However, patients with bimalleolar fractures had higher levels of function with less residual pain and degenerative changes than patients with trimalleolar fractures at the time of final follow-up.
The use of bioabsorbable screw fixation of the syndesmosis in unstable ankle injuries.
Ahmad J, Raikin SM, Pour AE, Haytmanek C.
Foot and Ankle International 2009 Feb;30:99-105.
Purpose: The purpose of this study was to retrospectively evaluate the clinical and radiographic outcomes of the medium and long-term results of Bionx bioabsorbable screw fixation of the ankle syndesmosis in unstable ankle injuries.
Materials and Materials: Between May 2001 and July 2006, 75 patients underwent syndesmotic fixation with a bioabsorbable screw. All patients had closed primary ankle fractures or dislocations with syndesmotic instability. Open reduction and internal fixation of the ankle fracture was performed using current standard orthopaedic technique. Patients were followed clinically and radiographically from 12 to 74 months with the mean being 32.5 months.
Results: Seventy of 75 patients (93%) returned for the final evaluation. Mean AOFAS Ankle-Hindfoot score was 90 of 100 and mean VAS for pain was 1.8 out of 10 at the time of final followup. No patients in this population showed radiographic syndesmotic instability, loss of mortise congruency, or post-traumatic arthritis in the sigmoid notch area at final followup. No patients required revision surgical fixation of the syndesmosis.
Conclusion: This study demonstrates that the use of bioabsorbable screw for syndesmotic fixation is associated with satisfactory restoration of ankle function and syndesmotic stability.
Outcomes of chronic insertional Achilles tendinosis using FHL autograft through single incision.
Elias I, Raikin SM, Besser MP, Nazarian LN.
Foot Ankle International 2009 Mar;30:197-204.
Background: The purpose of this study was to evaluate the clinical outcomes and objective isokinetic dynamometry on a cohort of patients with chronic insertional Achilles tendinosis, who underwent surgical reconstruction using an FHL tendon autograft transfer through a single incision.
Materials and Methods: Forty patients (16 male and 24 female; mean age, 57 years; age range, 39 to 76 years) with persistent chronic Achilles tendinosis were evaluated after surgical reconstruction at an average of 27 months after surgery. At the time of final followup, ankle strength and active range of motion (AROM) were evaluated using Biodex isokinetic dynamometry. Additionally, patients were assessed with AOFAS Ankle Hindfoot scores, pain on a Visual Analog Scale (VAS) and their self-reported level of satisfaction (Very Good, Good, Fair, Poor).
Results: We found no loss of plantarflexion strength or plantarflexion power in the operated ankles; an average of 4-degree loss of AROM was found. The study population scored an average of 96/100 for the total AOFAS-AH score post-repair. The average VAS decreased from 7.5 pre-op to 0.3 post-op. Thirty-eight of 40 patients (95%) were satisfied with their outcome (rated Very Good or Good), two patients rated their outcome as Fair and none as Poor.
Conclusion: For individuals with chronic insertional Achilles tendinosis, operative repair using an FHL tendon with the single-incision technique achieved a high percentage of satisfactory results as well as excellent functional and clinical outcomes including significant pain reduction.
MRI of injuries to the first interosseous cuneometatarsal (Lisfranc) ligaments.
Macmahon PJ, Dheer S, Raikin SM, Elias I, Morrison WB, Kavanagh EC, Zoga A.
Skeletal Radiol. 2009 Mar;38(3):255-60.
Objective: The objective of this study was to assess the utility of MRI in diagnosing injury to the first interosseous cuneometatarsal (Lisfranc) ligament and to additionally determine the associated patterns of traumatic soft tissue and osseous injury.
Materials and Methods: Fifteen patients (16 feet) who were referred for MRI evaluation of the Lisfranc ligament, and had operative exploration or examination under anesthesia, were included for analysis. Standard non-contrast MRI foot imaging was performed in all cases. Evaluation of the following components was performed: the dorsal and plantar bundles of the Lisfranc ligament, the plantar tarsal metatarsal ligaments, soft tissue edema and fluid, and bone marrow edema and fractures. Surgical reports were regarded as the reference standard in all cases.
Results: Seven of 10 cases of grade 3 Lisfranc ligament injuries at surgery were correctly graded at MRI. No cases of surgically proven complete Lisfranc ligament tears (grade 3) were interpreted as normal at MRI. All Lisfranc ligament sprains (grade 2 or 3) at surgery were detected at MRI. Two of six cases reported as grade 1 injuries at MRI were normal at surgery. No cases of surgically proven normal or sprained Lisfranc ligaments were interpreted as grade 3 tears on MRI. Four of six of our cases of normal or sprained Lisfranc ligaments demonstrated fractures; while the minority of complete Lisfranc ligament tears (3/10) contained fractures.
Conclusion: MRI is reasonably accurate at detecting traumatic injury to the Lisfranc ligament. However, in clinically suspected cases of traumatic Lisfranc ligament injury, true positive rate for sprain is low.