Thursday 17 October |
08:00 |
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R1
08:00 - 08:30
Registration
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08:30 |
"Thursday 17 October"
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OC
08:30 - 08:40
Opening Ceremony
Speakers:
Kristian BUEDTS (Md) (Speaker, Brussels, Belgium), Manuel MONTEAGUDO (CONSULTANT ORTHOPAEDIC SURGEON) (Speaker, Madrid, Spain), Manfred THOMAS (Head of department) (Speaker, Augsburg, Germany)
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AUDITORIUM |
08:40 |
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PS1
08:40 - 10:00
PLENARY SESSION 1: NEUROFOOT/ANKLE
08:40 - 10:00
Moderators.
Jean-Luc BESSE (Praticien Hospitalier) (Moderator, Lyon, France), Joris HERMUS (Orthopedic surgeon) (Moderator, Maastricht, The Netherlands)
08:40 - 08:50
Subtle flexible cavovarus.
Manfred THOMAS (Head of department) (Speaker, Augsburg, Germany)
08:50 - 09:00
Severe rigid deformity.
Elena SAMAILA (Associated Professor) (Speaker, Verona, Italy)
09:00 - 09:10
The triceps – when/how to lenghten and when not.
Jan Willem LOUWERENS (orthopaedic surgeon) (Speaker, Nijmegen, The Netherlands)
09:10 - 09:20
When to transfer tendons and soft tissue balancing?
Norman ESPINOSA (Owner / Member) (Speaker, Zurich, Switzerland)
09:20 - 09:30
Charcot-Marie-Tooth.
Senthil KUMAR (Consultant Orthopaedic Surgeon) (Speaker, Glasgow, United Kingdom)
09:30 - 10:00
Discussion.
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AUDITORIUM |
10:00 |
"Thursday 17 October"
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CB1
10:00 - 10:30
Coffee Break, Exhibition and Poster Walks
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10:30 |
"Thursday 17 October"
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SY1
10:30 - 11:30
SYMPOSIUM: Most relevant EFAS publications (2022-2024)
10:30 - 10:42
EFAS in depth: our journal, your journal.
Martinus RICHTER (Director) (Speaker, Rummelsberg, Germany)
10:42 - 10:54
Trends in publishing papers in foot and ankle surgery.
Ian WINSON (Consultant Orthopaedic and Trauma Consultant) (Speaker, Bristol, United Kingdom)
10:54 - 11:00
Most relevant 1 - Distraction arthroplasty in the management of osteoarthritis of the ankle: A systematic review.
Arshad ZAKI (Student) (Speaker, Cambridge, United Kingdom)
11:00 - 11:06
Most relevant 2 - Diagnostic applications and benefits of weightbearing CT in the foot and ankle: A systematic review of clinical studies.
11:06 - 11:12
EFAS Best Paper Award.
11:12 - 11:30
Discussion.
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AUDITORIUM |
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SY2
10:30 - 11:30
SYMPOSIUM: Removal of Metalwork in the Foot and Ankle
Moderators:
Norman ESPINOSA (Owner / Member) (Moderator, Zurich, Switzerland), Manuel SOUSA (Foot and Ankle Surgeon) (Moderator, Lisbon, Portugal)
10:35 - 10:45
When and why?
Jesus VILA Y RICO (Chief of Department) (Speaker, Madrid, Spain)
10:45 - 10:55
Tips and tricks for difficult removals.
Karan MALHOTRA (Consultant Orthopaedic Surgeon) (Speaker, London, United Kingdom)
10:55 - 11:05
Any role for bioabsorbable implants?
Helka KOIVU (Consultant) (Speaker, Turku, Finland)
11:05 - 11:15
Metal hypersensitivity/allergy.
James RITCHIE (orthopaedic Foot and Ankle Surgeon) (Speaker, Tunbridge Wells, United Kingdom)
11:15 - 11:30
Discussion.
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AQUARIUM |
11:35 |
"Thursday 17 October"
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BSFFAF
11:35 - 12:30
BSFFAF: Brussels Short Film Foot and Ankle Festival
11:35 - 12:30
Moderators:.
Helka KOIVU (Consultant) (Moderator, Turku, Finland), Jesus VILA Y RICO (Chief of Department) (Moderator, Madrid, Spain)
11:35 - 11:43
Youngswick osteotomy for Hallux Rigidus?
Alessio BERNASCONI (Foot and Ankle - Orthopaedic Surgeon) (Speaker, Napoli, Italy)
11:43 - 11:51
TAR.
Johnny FRØKJÆR (consultant foot and ankle surgeon) (Speaker, Odense, Denmark)
11:51 - 11:59
Lateral ankle instability – personal technique.
Yves TOURNÉ (Chirurgien) (Speaker, Grenoble, France)
11:59 - 12:07
Calcaneal osteotomy with plate and screws.
Paulo AMADO (Director of Orthopedic Departement) (Speaker, Porto, Portugal)
12:07 - 12:30
Discussion.
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F1
11:35 - 12:30
Paediatric Foot and Ankle FORUM:
11:35 - 12:30
Moderators.
Anja HELMERS, Christina STUKENBORG-COLSMAN (XXX) (Speaker, Hannover, Germany)
11:35 - 11:45
What is a symptomatic flatfoot?
Maurizio DE PELLEGRIN
11:45 - 11:55
Which is the best method to document flatfoot deformity?
Martin Michael WACHOWSKY
11:55 - 12:05
Is flatfoot in adults the result of untreated flatfoot in children?
Antonio MAZZOTTI (Orthopaedic Surgeon) (Speaker, Bologna, Italy)
12:05 - 12:30
Discussion.
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AQUARIUM |
12:15 |
"Thursday 17 October"
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L1
12:15 - 14:30
Lunch, Exhibition, Industry Workshops and Poster Walks
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EXHIBITION AREA |
12:40 |
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PWK1
12:40 - 13:00
Poster Walks presentations 1
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
Moderators:
Peter BOCK (Vienna, Austria), Matthew WELCK (Efas youth committee) (london, United Kingdom)
12:40 - 13:00
#40849 - PWK01 Does prior anterior talofibular ligament dysfunction protect from development of deep deltoid ligament laxity? A cadaveric study.
Does prior anterior talofibular ligament dysfunction protect from development of deep deltoid ligament laxity? A cadaveric study.
Introduction
In Adult Acquired Flatfoot Deformity (AAFD), progression to anteromedial ankle instability (AMI) prior to complete deltoid ligament rupture is not fully understood. Clinical observations suggest reduced deep deltoid ligament (DD) laxity and AMI in the presence of anterior talofibular ligament (ATFL) laxity. The protective effect of ATFL rupture/laxity (the most common foot ligament injury) has on mitigating the development DD laxity and AMI in AAFD has not been investigated to date.
Methods
Unstable planus was induced in 12 cadaveric feet from 6 donors and paired feet were randomly assigned to having ATFL sectioned or intact. Feet underwent cyclic loading (2000 cycles) on a custom-mounted jig and photos were taken with positional markers on the medial malleolus, fibula, and the talus before and after antero-posterior force application. ImageJ quantified anteromedial and anterolateral ankle joint displacement to reflect DD and ATFL laxity respectively.
Results
In ATFL-intact feet, anteromedial displacement increased by 3.46 ± 0.41 µm/cycle (mean ± SD; P = 0.000005; two-tailed, one-sample t-test). In ATFL-sectioned feet, displacement increased 0.61 ± 0.66 µm/cycle (p = 0.072), an 82% reduction in DDL laxity development (P = 0.00006; two-tailed, paired t-test). Absolute anterolateral displacement increased in ATFL-sectioned feet by 7.40 ± 0.12 mm (p = 0.00002).
Conclusion
These findings corroborate our clinical findings; in AAFD/PCFD, feet with ATFL laxity paradoxically do not develop DD laxity and AMI, which we ascribe the ‘deep deltoid paradox sign’. There are implications for surgical management of ATFL ruptures, and AAFD classifications may require updating.
Zhikai LI (Cambridge, United Kingdom), Zhiheng LI, Gavin JARVIS, Stephanie POTTEN, Cecilia BRASSETT, Chandra PASAPULA
12:40 - 13:00
#42584 - PWK02 Axial rotation analysis in total ankle arthroplasty using weight-bearing computer tomography and three-dimensional modeling.
Axial rotation analysis in total ankle arthroplasty using weight-bearing computer tomography and three-dimensional modeling.
Background
Post-operative alignment is the most critical indicator for a successful total ankle arthroplasty (TAA). Total ankle malrotation is associated with an increased risk for polyethylene wear and medial gutter pain. Currently, there is no consensus on the correct way to measure the alignment of the tibial and talar component rotations in the axial plane. In the current study, the post-operative analysis system was assessed using weight-bearing computer tomography and a three-dimensional (3D) model. The purpose of the study was to assess the inter-observer and intra-observer agreement of this system.
Material and method
Four angles were measured by two raters independently in two separate readings: posterior tibial component rotation angle (PTIRA), posterior talar component rotation angle (PTARA), tibia talar component axial angle (TTAM), and tibial component to the second metatarsal angle (TMRA). Agreement analysis was quantified according to the interclass coefficient.
Results
Sixty TAAs across 60 patients were evaluated. A good inter-observer agreement and intra-observer agreement when measuring the PTIRA, PTARA, and TTAM angles was observed along with an excellent inter-observer agreement and intra-observer agreement when measuring the TMRA angle.
Conclusion
In conclusion, the current 3D model-based measurement system demonstrates good to excellent inter and intra-agreement. According to these results, 3D modelling can be reliably used to measure and assess the axial rotation of TAA components.
Efrima BEN, Agustin BARBERO (Milan, Italy), Joshua OVADIA, Cristian INDINO, Camilla MACCARIO, Federico USUELLI
12:40 - 13:00
#42714 - PWK03 Failure of ankle arthroplasty - Predictive factors for revision procedures.
Failure of ankle arthroplasty - Predictive factors for revision procedures.
The study aimed to analyze revision procedures after failed total ankle arthroplasty (TAA), including polyethylene exchange (PEE), revision total ankle arthroplasty (RTAA), and revision ankle arthrodesis (RAA).
Method
The cohort comprised 194 patients (106 men, 88 women). The mean age was 62.02 ± 11.83 years. The data was prospectively collected as part of the National Ankle Arthroplasty Registry. The average follow-up (FU) was 74.65 ± 47.18 months.
Endpoints were a new revision and/or an unsatisfactory outcome in the EFAS score (< 10). AI algorithms, univariate Cox proportional hazards regression models, multiple logistic regression, and decision tree analysis were applied.
Results and conclusion
70 patients underwent PEE, 52 underwent RTAA, and 72 underwent RAA. The failure rate (repeat revision and/or EFAS score < 10) over a 5-year observation period was 35.45%, with actual surgical revisions accounting for 23.27%.
PEE, as an isolated procedure, had the highest rate of repeat revision and poor outcomes (38.57%), while RAA (31.94%) and RTAA (32.69%) showed statistically significant differences.
The most decisive negative predictive factor for surgical revision was periprosthetic infection (PJI) (p=0.0001) and periprosthetic ossifications (P = 0.001) for an EFAS score < 10.
In PEE, osteotomies for axis correction had a significant positive effect on the outcome (p=0.01), while increased BMI had a negative impact. In RTAA, preoperative osteolysis >1 cm in diameter was associated with a significantly higher failure rate (p=0.005).
Conclusion: The analysis of predictive factors allows a selection of the most promising treatment concept for each patient.
Markus WALTHER (München, Germany), Kathrin PFAHL, Anke RÖSER
12:40 - 13:00
#42915 - PWK04 Recovery Curve of Prospectively Collected Patient-Reported Outcome Measurement Information System (PROMIS) in Total Ankle Arthroplasty.
Recovery Curve of Prospectively Collected Patient-Reported Outcome Measurement Information System (PROMIS) in Total Ankle Arthroplasty.
Objectives:
To determine the post-operative recovery curve of patients undergoing total ankle arthroplasty (TAA) for end stage ankle arthritis using Patient-Reported Outcome Measurement Information System (PROMIS) for physical function (PF), pain interference (PI), and depression (DP).
Methods:
Prospectively collected pre-operative and post-operative PROMIS scores including PF, PI and DP were collected for 127 feet in 123 patients undergoing TAA between 2018 and 2023 for up to one year after surgery. Patients were excluded if they had a prior history of infection, revision TAA and lacked pre-operative or post-operative PROMIS scores. A Linear mixed model was used to predict improvement in PROMIS scores at different time points during recovery.
Results:
Mean follow-up time in which PROMIS scores were collected post-operatively was 238 ± 135days. Mean PF, PI and DP at 1 year was 43±5, 54±8 and 45±8 respectively. A normal PF score was achieved in 87.5% of patients, 64.3% achieved a normal PI score, and 60% achieved a normal DP score at one year from surgery. Predicted change of improvement for each PROMIS subset were calculated at 3, 6 and 12 months post-operatively. For PF scores improved by 1, 3 and 5 respectively. For PI scores improved by 1, 3 and 5 respectively. For DP scores improved by 0, 2 and 3 respectively.
Conclusion:
Most patients reach normal PROMIS scores at one year from surgery after TAA. Improvement plateaued at 6 months post-operatively suggesting that the first 6 months after surgery are the most crucial in the recovery period.
Andres PISCOYA, Callie LIU, Stephanie CHEN (Los Angeles, USA), Zachary ROCKOV, David THORDARSON, Timothy CHARLTON
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13:10 |
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PKW2
13:10 - 13:30
Poster Walks presentation 2
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
Moderators:
Oliver MICHELSSON (Consultant) (Helsinki, Finland), Stephan WIRTH (Head of foot and ankle surgery) (Zürich, Switzerland)
13:10 - 13:30
#42582 - PWK05 Significant clinical improvement after arthroscopic autologous matrix-induced chondrogenesis for osteochondral lesions of the talus: A 5-year follow-up.
Significant clinical improvement after arthroscopic autologous matrix-induced chondrogenesis for osteochondral lesions of the talus: A 5-year follow-up.
Purpose
This study aims to evaluate the clinical outcomes of arthroscopic autologous matrix-induced (A-AMIC) chondrogenesis for osteochondral lesions of the talus (OLT) at 24 months and 60 months of follow-up. The secondary aim was to assess whether age, body mass index (BMI), and lesion surface affect outcomes.
Design
Sixty-three patients (32 males, 31 females) with a median age of 37 years [IQR 25-48] were included. Preoperative and postoperative (24 months and 60 months) clinical outcomes were evaluated using a Visual Analog Score (VAS) for pain during walking, the American Orthopedic Foot and Ankle Society (AOFAS), Short-Form Survey (SF-12), the Halasi, and the University of California (UCLA) scores. Patients were categorized according to age, BMI, and lesion surface (1-1.5 cm2 and over 1.5 cm2). The effect of each category was evaluated.
Results
There were significant improvements in the VAS, AOFAS, SF12, and UCLA, comparing the preoperative scores to the 60-month follow-up scores (p < 0.001). There were no significant differences in the above-mentioned outcomes between the follow-up periods. Patients older than 33 had lower SF-12, Halasi, and UCLA scores (p-value = 0.005, 0.004, and <0.001, respectively). Overweight patients had lower VAS, SF-12, Halasi, and UCLA scores (p-value = 0.006, 0.002, 0.024, and 0.007). Lesion size was uninfluential.
Conclusion
A-AMIC yielded clinical improvements at a minimum follow-up of 60 months in patients with symptomatic OLTs, with clinical improvement peaking in the first two years, followed by a plateau period. Increased age and BMI were significantly associated with inferior outcomes.
Efrima BEN, Agustin BARBERO (Milan, Italy), Camilla MACCARIO, Cristian INDINO, Chiara NOCERA, Jari DAHMEN
13:10 - 13:30
#42980 - PWK06 Osteochondral Repair With Autologous Cartilage Transplantation With or Without Bone Grafting: A Short Pilot Study in Mini-pigs.
Osteochondral Repair With Autologous Cartilage Transplantation With or Without Bone Grafting: A Short Pilot Study in Mini-pigs.
Objective: Treatment strategies for osteochondral defects, for which particulated autologous cartilage transplantation (PACT) is an emerging treatment strategy, aim to restore the structure and function of the hyaline cartilage. Herein, we compared the efficacy of PACT with control or human transforming growth factor-β (rhTGF-β), and clarified the necessity of bone grafting (BG) with PACT to treat shallow osteochondral defects in a porcine model.
Design: Two skeletally mature male micropigs received 4 osteochondral defects in each knee. The sixteen defects were randomized to 1) empty control, 2) PACT, 3) PACT with BG, or 4) rhTGF-β. Animals were euthanized after 2 months, and histomorphometry, immunofluorescence analysis, semi-quantitative evaluation (O’Driscoll score), and magnetic resonance Observation of Cartilage Repair Tissue (MOCART) score were performed.
Results: Hyaline cartilages, glycosaminoglycan synthesis, and collagen type II staining were more abundant in the PACT than the control and rhTGF-β groups. The O’Driscoll score was significantly different between groups (P < 0.001), with both PACT groups showing superiority (P = 0.002). PACT had the highest score (P = 0.002), with improved restoration of subchondral bone compared to PACT with BG. The MOCART score showed significant differences between groups (P = 0.021); MOCART and O’ Driscoll scores showed high correlation (r = 0.847, P < 0.001).
Conclusion: Treatment of osteochondral defects with PACT improved tissue quality compared to that with control or rhTGF-β in a porcine model. BG in addition to PACT may be unnecessary for shallow osteochondral defects.
Dong Woo SHIM (Seoul, Republic of Korea), Wonwoo LEE, Yeokwon YOON, Kwang Hwan PARK, Seung Hwan HAN, Jin Woo LEE, Bom Soo KIM
13:10 - 13:30
#42984 - PWK07 Clinical and Radiologic Outcomes of Modified Broström Techniques: A Comparative Study on Arthroscopic Ultrasound-assisted and Open Approaches.
Clinical and Radiologic Outcomes of Modified Broström Techniques: A Comparative Study on Arthroscopic Ultrasound-assisted and Open Approaches.
Background
Despite the growing utilization of Ultrasound-Guided Arthroscopic Modified Broström Operation (MBO), comparative studies assessing its clinical outcomes and recurrence rates relative to the open surgical approach remain scarce. The purpose of this study was to compare the clinical and radiologic outcomes between patients undergoing ultrasound-guided arthroscopic MBO and those undergoing open MBO.
Material and methods
This retrospective study evaluated 66 patients with chronic lateral ankle instability who underwent MBO between January 2020 and April 2023, including only those with at least one year of follow-up, with 35 in the arthroscopic group and 31 in the open group. Clinical outcomes were assessed using the Foot and Ankle Outcome Score (FAOS) preoperatively and at 3, 6, and 12 months postoperatively. Radiologic outcomes were evaluated by measuring the anterior talar translation and talar tilt angle from stress radiographs at the same intervals.
Results
Both surgical procedures resulted in significant improvements in pain, instability, recurrence rate, and FAOS scores at one year postoperatively. No significant differences were observed between the groups in preoperative demographics or outcomes at 3, 6, and 12 months postoperatively, including FAOS, anterior talar translation or talar tilt (all p > .05). Recurrence of instability was noted in two cases in the arthroscopic group and two cases in the open group. (p = .45)
Conclusion
Both techniques provide excellent clinical and radiologic outcomes for patients with chronic lateral ankle instability. Ultrasound guided arthroscopic MBO should be considered a viable alternative to open surgery for patients with chronic lateral ankle instability.
Younguk PARK, Younwook SEO (Seoul, Republic of Korea), Jinyoung JUN
13:10 - 13:30
#43072 - PWK08 Drain versus no drain after total ankle arthroplasty: are there any differences in complications rate?
Drain versus no drain after total ankle arthroplasty: are there any differences in complications rate?
Introduction:
While the efficacy of closed suction drains has been extensively studied in hip, knee, and shoulder surgery, it lacks scientific evidence in the foot and ankle domain, especially after total ankle arthroplasty (TAA). Thus, this study aims to compare the incidence of post-operative complications with and without the application of a closed suction drain following TAA.
Methods:
A retrospective monocentric chart review of all patients who had undergone TAA with an anterior approach from January 2020 to March 2023 was performed. Data were analysed to assess the effect of drain usage on post-operative complications.
Results:
A total of 110 patients were enrolled, 59 in the drain group and 51 without a drain. The mean age at surgery was 58.4 (range, 28 – 81) years. No statistical differences were found between the two groups in the total complication rate (19.6% in no-drain group vs 20.3% in drain group, p= 0.227).
Conclusions:
This study showed no effect of applying a closed suction drain after TAA in the incidence of post-operative complications. Since the use of a drain did not negatively affect the outcome, nor did it provide a significant benefit, it can be asserted that there is no evidence to support the routine use of closed suction drains in TAA. Drains should be applied on an individual basis. Further high-level research is needed to confirm these results.
Elena ARTIOLI, Antonio MAZZOTTI (Bologna, Italy), Alberto ARCERI, Simone Ottavio ZIELLI, Laura LANGONE, Cesare FALDINI
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13:35 |
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PKW3
13:35 - 13:55
Poster Walks presentations 3
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
Moderators:
Laurent GOUBAU (Foot and Ankle Surgeon) (Ghent and Brussels, Belgium), Bruno PEREIRA (Surgeon) (Braga, Portugal)
13:35 - 13:55
#42965 - PWP09 Clinical Outcomes Of All-Inside Arthroscopic Lateral Ankle Ligament Reconstruction For Chronic Lateral Ankle Instability: A Prospective Series With Minimum 12 Month Outcomes.
Clinical Outcomes Of All-Inside Arthroscopic Lateral Ankle Ligament Reconstruction For Chronic Lateral Ankle Instability: A Prospective Series With Minimum 12 Month Outcomes.
Background: Chronic lateral ankle instability (CAI) is a common condition that can be effectively treated with lateral ankle ligament reconstruction to restore ankle stability and function. The aim was to assess the functional outcomes of arthroscopic lateral ligament reconstruction using the Manchester-Oxford Foot Questionnaire (MOXFQ), Visual Analog Score (VAS) and Euroqol-5D-5L (EQ-5D) patient-reported outcome measures (PROMs).
Methods: This prospective series included 36 consecutive patients who underwent isolated arthroscopic lateral ligament reconstruction for CAI between November 2020 and November 2022 with minimum 12-month follow up. All patients completed the MOXFQ, VAS, and EQ5D PROMs preoperatively, and 12 months postoperatively. The MOXFQ is a foot and ankle-specific PROM that assesses foot and ankle function, the VAS measures pain and the EQ5D evaluates general health-related quality of life
Results: Patients were followed up for 12-25 months. In all patients, there was significant improvement in all postoperative PROMs (p<0.05). The MOXFQ index decreased from 59.1±19.2 to 13.5±18.1 (p<0.01), EQ-5D index increased from 0.607±0.224 to 0.854±0.175 (p<0.01) and VAS pain decreased from 36.6±22.3 to 13.6±18.4 (p<0.01).A total of 6 patients(16.3%) were lost to follow up and mean follow-up time was 1.63±0.54 years.
Conclusion: Arthroscopic lateral ankle ligament reconstruction is an effective treatment for chronic ankle instability, with significant improvements in clinical and health-related quality of life outcomes.
Vikramman VIGNARAJA, Thomas LEWIS, Samuel FRANKLIN, Gabriel FERREIRA, Gustavo NUNES, Yasser ALJABI, Peter LAM, Robbie RAY (London, United Kingdom)
13:35 - 13:55
#43091 - PWP10 Evaluating tibiotalar joint coverage at varying high heel heights.
Evaluating tibiotalar joint coverage at varying high heel heights.
INTRODUCTION: While high heeled shoes (HH) are popular, studies have shown that HH can alter the strain of ligaments in the ankle, increasing risk of ankle instability. No studies have analyzed changes in ankle joint mechanics. This study aimed to evaluate changes in tibiotalar joint coverage at various HH heights using weight bearing computed tomography (WBCT) and coverage mapping. We hypothesized that as HH height increased, there would be reduced tibiotalar coverage due to increased plantarflexion.
METHODS: 20 healthy, non-frequent HH wearing volunteers received a total of 4 bilateral WBCT scans: (1) control/no heel, (2) 3 cm heel, (3) 6 cm heel, (4) 9 cm heel. Scans were semi-automatically segmented to create three-dimensional bone mesh models using a commercially available software package. Manual selection of the talar dome was performed by two readers. Talar dome uncoverage was defined by distances and areas over a specific threshold distance of 5mm. Percent coverage was calculated by dividing the sum of triangulation areas below the threshold by the total sum of areas.
RESULTS: Between all HH heights, there was a significant difference in tibiotalar coverage (p < 0.0001).The 6 cm and 9 cm groups relative to the control had significant differences in coverage (p < 0.05). The most significant uncoverage was found in the anteromedial aspect of the talar dome across all high heel heights.
CONCLUSION: This study is the first of its kind to analyze changes in tibiotalar coverage in HH and builds upon the existing literature of ankle instability high heels.
Emily LUO (Durham, NC, USA), Grayson TALASKI, Andrew BEHRENS, Tania SZEJNFELD, Aaron THERIEN, Katherine KUTZER, Kevin WU, Kepler CARVALHO, Erik HUANUCO CASAS, Antoine ACKER, Cesar DE CESAR NETTO
13:35 - 13:55
#43147 - PWP11 Postoperative radiographs two weeks after ankle fracture fixation: a waste of resources and rarely justified.
Postoperative radiographs two weeks after ankle fracture fixation: a waste of resources and rarely justified.
Background
British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) guidelines recommend follow-up within six weeks after ankle fracture open reduction internal fixation (ORIF) to check maintenance of reduction. The optimal timing for radiographs is debated, especially as patients often do not weightbear for the first two weeks. This study aimed to evaluate the frequency and impact of radiographic follow-up at two and six weeks, and whether early imaging influenced management.
Methods
A retrospective review of patients who had ankle ORIF between December 2020 and November 2023 was conducted. Data collected included patient demographics, weight-bearing status, Lauge-Hansen classification, surgeon level, and indication for two-week imaging.
Results
Out of 374 patients who underwent ORIF, 177 had two-week radiographs. Only 4/374 patients required revision surgery for loss of reduction, all identified within the two-week period with intra-operative concerns about fixation quality. Among the 173 patients with two-week imaging, 83 had further imaging at six weeks; early imaging did not alter management. In 77% of cases with early imaging, no indication was recorded. Early imaging was associated with more complex injuries, such as a higher incidence of posterior malleolus fractures, but not with the surgeon's level.
Conclusion
Two-week radiographs rarely changed management, and often no indication for early imaging was documented. Radiographs were frequently repeated at six weeks, wasting departmental resources. We recommend performing routine radiographs at six weeks, reserving two-week imaging for cases with intra-operative concerns about fracture fixation quality.
Arpita DEVASHETTY (Reading, United Kingdom), Noah KHAN, Dan BURNS, Daniel MARSLAND
13:35 - 13:55
#43154 - PWP12 Evaluation of Leg-foot Range of Motion. Which Measurement Method is Most Reliable?
Evaluation of Leg-foot Range of Motion. Which Measurement Method is Most Reliable?
Objective To evaluate the methods of measuring leg-foot movement in normal ankles and feet by comparing the results of clinical measurements with those of radiographic measurement and to determine the range of leg-foot movement considered normal.
Methods Leg-foot movement was measured in 44 patients (60 feet) using a traditional goniometer, digital goniometer, inclinometer, smartphone application, in addition to radiographic measurement (considered gold standard). Maximum dorsiflexion was achieved by asking the patient to take a step forward with the contralateral foot and perform as much dorsiflexion as possible in the ankle studied without removing the heel from the ground. For maximum plantar flexion, the patient was asked to take a step back with the contralateral foot and make as much plantar flexion as possible without removing the studied forefoot from the ground.
Results The values obtained in radiographic measurement were higher than those obtained with clinical measurement. When we compared only the results of clinical measurement, the traditional goniometer was inaccurate. According to the radiographic method, the mean leg-foot range of motion was 65.6 degrees. The mean maximum plantar flexion was 34.9 degrees, and the mean maximum dorsiflexion was 30.7 degrees.
Conclusions The most appropriate method for the evaluation of leg-foot range of motion is the radiographic one. The traditional goniometer proved to be the most imprecise clinical method. The mean leg-foot range of motion in healthy young adults was 65 degrees.
Marco Tulio COSTA (Sao Paulo, Brazil), Javier Felipe Salinas TENEJIRA, Cesar Augusto Lima SILVA, Italo Epaminondas De Queiroz REGO, Marcelo Marcucci CHAKKOUR, Noé DE MARCHI NETO, Jordanna Maria Pereira BERGAMASCO
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PWP4
14:00 - 14:20
Poster Walks presentations 4
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
Moderators:
Johnny FRØKJÆR (consultant foot and ankle surgeon) (Odense, Denmark), Karan MALHOTRA (Consultant Orthopaedic Surgeon) (London, United Kingdom)
14:00 - 14:20
#42677 - PWK13 The K-toe trial: Fixed hammertoe correction with or without K-wire fixation? A multicentre randomized controlled trial.
The K-toe trial: Fixed hammertoe correction with or without K-wire fixation? A multicentre randomized controlled trial.
Many surgical correction techniques for the hammertoe are described. Proximal interphalangeal joint resection (PIJ) is one of these. Often temporary K-wire fixation is used. This K-wire leads to potential discomfort and complications. Scientific insight into the value of a K-wire is scarce.
This multicenter RCT evaluates the results of PIJ resection with- and without K-wire fixation. Primary aim was to test if both treatment options, in terms of the AOFAS lesser toe metatarsophalangeal scale (AOFAS) one year postoperatively, were comparable. Secondary, complications and reoperations were compared and improvement considering pain, function, alignment and patient satisfaction were investigated.
Adults with a single hammertoe as a solitary foot problem were eligible for inclusion. Exclusion criteria were rheumatoid arthritis and insulin depending diabetes mellitus. A standardized surgical technique was used and randomization took place during surgery. Six weeks and one year post surgery the AOFAS, Foot Function Index and VAS satisfaction were asked.
Twenty-one patients were randomized for PJI with and 25 for PJI without K-wire.
Median difference on AOFAS score one year follow up fell within the non-inferiority margin. However, 95% CI intervals crossed both the non-inferiority and zero margin. Four complications in the K-wire group and 2 in the no K-wire group complications occurred, reoperations were equal.
Both groups showed significant improvement looking to pain, function, alignment and satisfaction.
The difference between the procedures is not significant but the result regarding non-inferiority is inconclusive.
Because both options showed significant improvement in the other outcomes, both can be discussed with the patients.
Mathijs FUCHS (Eindhoven, The Netherlands), Marieke VAN DER STEEN, Marijn VAN DEN BESSELAAR, Martijn DIETVORST, Bart VAN GRONINGEN, Walter VAN DER WEEGEN, Dirk DAS, Hans HENDRIKS
14:00 - 14:20
#42955 - PWK14 A prospective observational study of Distal Metatarsal Minimally invasive osteotomy (DMMO) for the treatment of metatarsalgia.
A prospective observational study of Distal Metatarsal Minimally invasive osteotomy (DMMO) for the treatment of metatarsalgia.
Metatarsalgia, characterized by pain and inflammation in the ball of the foot, is often caused by biomechanical abnormalities, overuse, or certain medical conditions. Treatment options range from conservative approaches like orthotics and physical therapy to surgical interventions. Distal Metatarsal Minimally Invasive Osteotomy (DMMO) has gained popularity due to its minimal invasiveness, reduced recovery time, and fewer complications compared to traditional open surgical methods.
This study aims to evaluate patient-reported and clinical outcomes of DMMO.
A prospective observational study was conducted on 42 patients undergoing DMMO for metatarsalgia from April 2022 to February 2024. The American Orthopaedic Foot & Ankle Society (AOFAS) questionnaire was used to assess the lateral metatarsophalangeal joints pre-operatively and post-operatively at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year. Data were analyzed using repeated measures ANOVA, mixed effect models with the Geisser-Greenhouse correction, and paired t-tests.
The study included 42 patients with a mean age of 61 years (range: 35-75). The total mean AOFAS score showed a significant improvement of 82% at 1 year postoperatively compared to preoperative scores (p < 0.05). Significant improvements were observed in pain (76%), functional restriction (69%), footwear modification (44%), metatarsophalangeal joint mobility (63%), interphalangeal joint mobility (31%), callus formation (278%), and alignment (81%). Joint stability did not significantly improve. (13%, p=0.16)
DMMO is an effective surgical technique for treating metatarsalgia, providing significant pain relief and functional improvement. The improvement in AOFAS scores underscores its value in managing metatarsalgia. Further long-term studies are recommended to confirm these findings.
Vansh KAPILA (Brugge, Belgium), Laura LOOMANS, Patrick DEMEY, Farhad TAJDAR, Patrick DEPREZ
14:00 - 14:20
#42968 - PWK15 Significance of Dorsal aspect evaluation in Hallux Rigidus: Insights through Distance and Coverage Mapping in Weight Bearing CT scan.
Significance of Dorsal aspect evaluation in Hallux Rigidus: Insights through Distance and Coverage Mapping in Weight Bearing CT scan.
INTRODUCTION
Hallux rigidus (HR) is a painful condition with physiopathology poorly understood. Recently, weight-bearing computed tomography (WBCT), has demonstrated the capability to provide detailed joint evaluation through Coverage Mapping (CM) and Distance Mapping (DM). This study aimed to assess HR through 3D evaluation across its stages.
METHODS
Thirty-one HR patients with WBCT scans were analyzed retrospectively. The WBCT scans were segmented to create 3D bone models. The 1st MTP joint was divided into four quadrants (dorsal medial, dorsal lateral, plantar medial, plantar lateral). Differences in DM and CM were assessed statistically using One-Way ANOVA between quadrants. P values <0.05 indicated significance.
RESULTS
Regarding CM, no significant difference was found across all Coughlin and Shurnas Classification (CSC) stages. However, significant differences were found between the plantar and dorsal aspects (p <.0001). DM showed progressive joint space narrowing with worsening CSC stage, however, this trend was not statistically significant. Nonetheless, the dorsal aspect consistently showed joint space narrowing compared to the plantar aspect across all CSC stages, particularly the dorsal lateral aspect.
DISCUSSION AND CONCLUSION
Differences between the dorsal and plantar aspects of the 1st MTP joint were observed in both CM and DM. A decrease in the dorsal aspect in CM may suggest Metatarsus Primus elevates, linked to HR pathophysiology. No significant global joint space narrowing was observed among all CSC stages using DM. However, dorsal joint space narrowing was consistently most pronounced across all stages. Thus, focusing on the dorsal aspect in HR cases could provide more pathology insights.
Erik HUANUCO CASAS, Antoine ACKER (Geneva, Switzerland), Chien-Shun WANG, Emily LUO, Tommaso FORIN VALVECCHI, Grayson TALASKI, Andrew BEHRENS, Jeffrey LILES, Andrew HANSELMAN, Cesar DE CESAR NETTO
14:00 - 14:20
#43077 - PWK16 A game changing tool in the assessment of hypermobility of the first ray: a reliability study.
A game changing tool in the assessment of hypermobility of the first ray: a reliability study.
Background: First ray instability is responsible for several foot disorders. The treatment strategy is based upon the surgeon’s experience and manual sensitivity to quantify first ray hypermobility. We present a novel electromechanical tool measuring the relative dorsal mobility of the first ray (FRRM) compared to that of the lateral rays, by simulating ground reaction forces during gait. The aim of the study is to assess the intra- and inter-examiners reliability of measurements.
Methods: 2 examiners assessed 22 feet of 11 healty volunteers. An automated adjustment of the position of the two bearings supporting M1 and M2 to M5 is performed by optical sensors. The device equally applies a standardized, electronically controlled force (from 0 up to 100N) under the two bearings. The FRRM is then measured as a function of the applied force. 15 measurements were performed on each foot (3 sets of 5 trials). The interclass correlation coefficient (ICC), the error of measurement (SEM) and the Bland and Altman (B&A) graphical analysis were computed.
Results: Excellent ICC values (≥0.93) were obtained for inter-rater (ICC = 0.96, IC95 [0.90-0.98]) and intra-rater reliability (ICC= 0.96, IC95 [0.91-0.99]). The mean FRRM values are 5.89±2.34 (mm). The B&A analysis presented a bias between examiners of only −0.12 mm ranging from −0.54 to 0.29 mm.
Conclusion: This study demonstrates that this device reliably measures the relative dorsal mobility of the first ray compared to the lateral rays, proving that it is a reliable tool for more scientifically defining the hypermobility of the first ray.
Filippo PIEROBON (Geneva, Switzerland), Quentin PRAZ, Spyridon SCHOINAS, Elisabeth SCHAUER, Laura PEURIERE, Victor DUBOIS-FERRIÈRE, Mathieu ASSAL
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14:30 |
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FP1
14:30 - 16:30
FREE PAPERS 1: Ankle & Sports
Moderators:
Henryk LISZKA (senior assistant) (Krakow, Poland), Xavier OLIVA MARTIN (Barcelona, Spain)
14:30 - 14:36
#42647 - OP01 The role of deltoid and interosseous tibiofibular syndesmosis ligaments in stability after ankle fractures: a cadaveric study.
The role of deltoid and interosseous tibiofibular syndesmosis ligaments in stability after ankle fractures: a cadaveric study.
Background: Isolated fibula Weber B/Supination-External Rotation (SER) stage 4 fractures, with deltoid ligament rupture, are considered unstable. However, assessment of stability remains controversial. We conducted a cadaveric study to define the effect of damage of the superficial and deep deltoid ligament, and the distal tibiofibular syndesmosis on ankle stability. The pathologies represented were associated with SER type ankle fractures.
Methods: Eight fresh frozen lower leg cadaveric specimens were tested: a) with manipulation (external rotation applied force) and b) using an axial loading machine with a force of 750N, after lesions were induced. The stages of dissection included: 1) Trans-syndesmotic fibula osteotomy and anterior inferior tibiofibular ligament (AiTFL), 2) posterior inferior tibiofibular ligament (PiTFL), 3) superficial deltoid (SDL), 4) deep deltoid (DDL) and 5) interosseous tibiofibular ligament (IoTFL). Clinical photographs and videos were recorded and Computerised Tomography (CT) imaging was obtained in all stages.
Results: Findings were consistent in all cadavers. Specimens were stable when loaded after sectioned lateral column, PiTFL and superficial deltoid ligament (stages 1-3), with no medial clear space (MCS) opening on CT images. Additional dissection of deep deltoid ligament revealed talar shift, with widening of MCS on CT. Lastly, sectioning of the interosseous tibiofibular ligament resulted in subluxation of the ankle indicating severe instability.
Conclusion: In isolated trans-syndesmotic fibula fractures SDL injury did not result in detectable instability. These fractures become unstable when DDL was sectioned and grossly unstable when IoL was torn. Thus, complete syndesmosis disruption needs to be considered in the management of these injuries.
Vasileios LAMPRIDIS (UK, United Kingdom), Nikolaos GOUGOULIAS, Panagiotis CHRISTIDIS, Vasileios RAOULIS, Evangelos ALEXIOU, Alexis KERMANIDIS, Aristidis ZIBIS
14:36 - 14:42
#42588 - OP02 Total ankle arthroplasty as a correction tool for foot deformities: analyzing the impact on medial column alignment through weight-bearing computed tomography and three-dimensional modeling.
Total ankle arthroplasty as a correction tool for foot deformities: analyzing the impact on medial column alignment through weight-bearing computed tomography and three-dimensional modeling.
Background: While weight-bearing computed tomography (WBCT) has been crucial in analyzing total ankle arthroplasty (TAA) positioning, its specific impact on the foot's medial column alignment is under-researched. Advances in image analysis software, enabling semi-automatic segmentation, 3D modeling, and semi-automatic angle measurements, have enhanced foot and ankle assessments' accuracy and reliability. This study aims to compare preoperative and postoperative alignments of the foot's medial column to evaluate TAA's corrective capabilities in this area and determine the reliability of these measurements.
Materials and Methods: The study included 42 patients who underwent isolated TAA, with both preoperative and postoperative WBCT scans. Two raters measured eight angles related to the longitudinal arch's sagittal angle, forefoot abduction/adduction, intermetatarsal angles, and tarsometatarsal angles across two sessions to assess TAA's corrective impact on the medial column.
Results: Statistically significant improvements were found in the longitudinal arch's sagittal angle, forefoot abduction/adduction angles, and sagittal tarsometatarsal angle postoperatively. The intermetatarsal and axial tarsometatarsal angles showed no significant change. Interclass correlation reliability analysis revealed good to excellent interobserver and intraobserver reliability.
Conclusion: The use of WBCT, combined with semi-automatic analysis, shows significant potential for isolated TAA to correct deformities within the foot's medial column. The high reliability of these semi-automatic measurements suggests that WBCT, integrated with image analysis software assessing the entire lower limb, could enhance preoperative planning for TAA positioning. This approach ensures accurate ankle alignment and aids in planning additional hindfoot and forefoot realignment surgeries, potentially improving surgical outcomes and extending TAA's longevity
Efrima BEN, Agustin BARBERO (Milan, Italy), Amit BENADY, Cristian INDINO, Camilla MACCARIO, Federico USUELLI
14:42 - 14:48
#42716 - OP03 10 yrs follow-up of OCL of the talus, treated with autologous membrane-induced chondrogenesis (AMIC).
10 yrs follow-up of OCL of the talus, treated with autologous membrane-induced chondrogenesis (AMIC).
Background: This study investigates the long-term effect of an I/III collagen bilayer matrix (AMIC) in treating osteochondral lesions (OCL) of the talus.
Methods: The 10-year results of a prospective, single-center cohort study are presented. All patients underwent an open AMIC procedure without malleolar osteotomy for OCL. Data analysis included demographics, MRI, intraoperative details, EFAS-, AOFAS Hindfoot Score, and Foot-Function-Index (FFI-D) pre-, one-, five-, and ten years following surgery. The primary outcome variable was the longitudinal effect of the procedure.
Results: 21 (45%) out of 47 patients treated from 2010 to 2012 met the inclusion criteria (8 (38%) female, 13 (62%) male patients with a mean age of 37±15 years (15-62 years) and a BMI of 26±5 kg/m² (20-38 kg/m²). The defect size was 1.4 cm²±0.9 cm² (0.2-4.0 cm²). The defect location was medial in 76%, central in 10%, and lateral in 14%. 95% of the patients received additional procedures. The FFI-D decreased significantly from pre- to one-year post-operative (56±18 vs. 33±25; p=0.003), with a further, non-significant decrease between the one-, five-, and ten-year follow-up (33±25 vs. 24±21 vs. 15±12; p=0.457). Similar results were found for the other scores. The FFI subscale of sports activity did not significantly change compared to the preoperative situation with limitations, especially in running and jumping. Age, BMI, and lesion size significantly correlated to the FFI and its subscales.
Conclusion: PROMS after AMIC are stable for at least 10 years. The detailed analysis of the FFI and EFAS Score showed constant limitations in sports activities.
Markus WALTHER (München, Germany), Lukas DEISS, Anke RÖSER, Oliver GOTTSCHALK
14:48 - 14:54
#42753 - OP04 Open reduction of the posterior malleolus: Do we need additional syndesmotic stabilization? A biomechanical study.
Open reduction of the posterior malleolus: Do we need additional syndesmotic stabilization? A biomechanical study.
The treatment of ankle fractures involving the posterior malleolus (PM) has changed in favor of open reduction and internal fixation (ORIF). The need for additional syndesmotic stabilization has decreased. However, there are still doubts about the diagnosis and treatment of residual syndesmosis instability.
The aim was to evaluate the effect of fixation of the PM and to assess the need for additional stabilization methods. It was hypothesized that ORIF of the PM would not sufficiently stabilize the syndesmosis, but that additional syndesmotic reconstruction would restore kinematics.
Eight unpaired fresh-frozen lower legs were tested in a six-degree-of-freedom robotic arm with constant loading (200N) in neutral position, 10° dorsiflexion, 15° plantarflexion and 30° plantarflexion. The specimens were evaluated in the following order: intact state; osteotomy of the PM; transection of the anterior inferior tibiofibular ligament (AITFL) and interosseous tibiofibular ligament (IOL); ORIF of PM; additional syndesmotic screw; combination of syndesmotic screw and AITFL augmentation; AITFL augmentation.
A complete simulated rupture of the syndesmosis caused a translational (6.9mm posterior and 1.8mm medial displacement) and rotational instability (5.5° external rotation) of the distal fibula. This could be restored with ORIF of the PM in neutral ankle position, whereas sagittal and rotational instability remained in dorsi- and plantarflexion.
In complex ankle fractures, ORIF of the PM is essential to restore syndesmotic stability. However, residual syndesmotic instability can be detected by a specific posterior shift of the fibula on stress testing. In these cases, an anatomical AITFL augmentation is biomechanically equivalent to a syndesmotic screw.
Alexander MILSTREY (Muenster, Germany), Stella GARTUNG, Jens WERMERS, Matthias KLIMEK, Michael RASCHKE, Sabine OCHMAN
14:54 - 15:00
#42917 - OP05 Deep posterior tibiotalar ligament in unstable Weber B ankle fractures: Cross-sectional study correlating arthroscopic and stress radiographic findings.
Deep posterior tibiotalar ligament in unstable Weber B ankle fractures: Cross-sectional study correlating arthroscopic and stress radiographic findings.
Background
Weber B fractures often show unstable gravity stress tests but stable weightbearing radiographs (classified SER4a), suggesting partial deltoid ligament injury with an intact deep posterior tibiotalar ligament (dPTTL). Conversely, a dPTTL rupture is assumed if both radiographs are unstable (classified SER4b). However, the state of the dPTTL in SER4a vs. SER4b has yet to be studied. This study assessed the prevalence of dPTTL injury using direct visualization during arthroscopy of SER4a and SER4b fractures.
Methods
We conducted a prospective study on 20 adult patients with Weber B/SER4a-b ankle fractures having unstable gravity stress tests or unstable weightbearing radiographs (medial clear space 4.0 millimeters or larger). Blinded assessors evaluated the dPTTL using minimally invasive arthroscopy under local anesthesia. Intact dPTTL was defined by normal ligament visualization with tensioning and medial joint space closing with ankle dorsiflexion.
Results
Based on radiographic criteria, 15 patients were classified as SER4a and five as SER4b. Arthroscopy showed an intact dPTTL in 14 out of 15 SER4a injuries. In one SER4a patient, arthroscopy revealed dPTTL disruption despite a weightbearing radiograph with 3.9 millimeters of medial clear space. All SER4b injuries revealed dPTTL disruptions with arthroscopic assessment.
Conclusions
In Weber B fractures evaluated arthroscopically, the dPTTL is typically intact in cases where weightbearing radiographs are stable despite unstable gravity stress tests. Conversely, complete dPTTL disruption was consistently observed in cases where both tests were unstable. These findings support the hypothesis that a stable weightbearing radiograph indicates an intact dPTTL.
Martin GREGERSEN (Sarpsborg, Norway), Fredrik NILSEN, Mikaela HAMRE, Marius MOLUND
15:00 - 15:30
Discussion (1-5).
15:30 - 15:36
#43084 - OP06 Advantages of ultrasound identification of the distal insertion of the calcaneaofibular ligament during ligament reconstruction.
Advantages of ultrasound identification of the distal insertion of the calcaneaofibular ligament during ligament reconstruction.
Introduction: In lateral ankle instability, anatomical ligament reconstructions are generally performed using arthroscopy. The graft reconstructs the anterior talofibular and calcaneofibular (CFL) bundles. As the CFL calcaneal insertion is extra-articular, it makes it difficult to locate. Some techniques use radiography or surface anatomy. However, they can only offer an approximate identification of the actual CFL footprint, and they do not protect the sural nerve (SN). In contrast, an ultrasound technique allows direct visualisation of the insertion point and, of the sural nerve. Our study aimed to assess the reliability, accuracy and safety of ultrasound visualisation while performing calcaneal insertion of the CFL.
Materials and methods: This anatomical study was carried out on 15 ankles. Ultrasound identification and dye injection of the sural nerve were performed. Then, a needle was positioned at the level of the CFL calcaneal insertion. After dissection, the dye was found in contact with the SN and, the needle, in the CFL calcaneal insertion area, in every ankle The mean distance between the SN and the needle was 4.8 mm (range 3-7 mm).
Discussion and conclusion: A pre- or intra-operative ultrasound technique is a simple and reliable procedure to locate the CFL calcaneal footprint and drill the tunnel in a lateral ligament reconstruction safely. The tunnel should preferably be performed obliquely from the heel towards the subtalar joint (1 h-3 h direction on an ultrasound cross section), which preserves a maximum distance from the sural nerve, while allowing an accurate anatomical positioning of the calcaneal tunnel.
Julien BELDAME, Christel CHARPAIL (Bordeaux), Matthieu LALEVÉE, Riccardo SACCO, Fabrice DUPARC
15:36 - 15:42
#43141 - OP07 Three-Dimensional Mapping of Chaput Tubercle Fractures: Evaluation of Morphologic Characteristics and Anterior Inferior Tibiofibular Ligament Involvement.
Three-Dimensional Mapping of Chaput Tubercle Fractures: Evaluation of Morphologic Characteristics and Anterior Inferior Tibiofibular Ligament Involvement.
Introduction:
The literature on the classification and optimal management of Chaput fractures is evolving. Hence, we performed a CT-based 3D fracture mapping study to identify these fractures' morphological characteristics.
Methods:
This study included adult patients who had an ankle fracture with a Chaput component. CT scans were obtained, 3D models were generated and superimposed over a statistical shape model of the right tibia, and fracture lines were marked. The footprints of proximal and main bands of the AITFL and Basset’s ligament were also marked on the template tibia. An automated script was used to determine the fragment size, fracture surface area, and involvement of the tibial plafond, tibial incisura, AITFL, and Basset’s ligament.
Results:
76 patients, 21 males and 55 females were included in this study. Cluster analysis identified two distinct groups of fractures, each with two unique subgroups. We present this as a modification of the existing classification system. The first group consisted of sub-centimetric extra-articular avulsion fractures, n=47. Of these, 19% (n=9) did not involve the AITFL, which we termed as Type 1a, and 91% (n=48) involved the AITFL, which we termed Type 1b. The second group consisted of large intra-articular fractures. Of these 23% (n=6) involved only the incisura, which we termed as Type 2a; 77 % involved both the incisura and the tibial plafond and were termed as Type 2b.
Conclusion:
We propose a modification of the existing classification of Chaput fractures based on quantitative fracture mapping which may prove beneficial in surgical decision making.
Siddhartha SHARMA, Matthias PEIFFER, Bedri KARAISMAILOGLU (Istanbul, Turkey), Noopur RANGANATHAN, Soheil ASHKANI-ESFAHANI, Emmanuel AUDENAERT, Christopher DIGIOVANNI, Gregory WARYASZ
15:42 - 15:48
#42527 - OP08 A Step-by-Step Examination of Ankle Impingement Syndrome: An Evaluation of the Effectiveness and Quality of YouTube Videos.
A Step-by-Step Examination of Ankle Impingement Syndrome: An Evaluation of the Effectiveness and Quality of YouTube Videos.
Abstract
Introduction
YouTube is frequently used by patients and physicians for information. To our knowledge, there is no study evaluating the quality of YouTube videos in ankle impingement syndrome (AIS). The aim of this study was to evaluate and compare the quality of YouTube videos in anterior and posterior AIS.
Methods
YouTube videos on anterior and posterior AIS were evaluated and compared by two European Foot and Ankle Society (EFAS) member orthopedic surgeons using The Journal of American Medical Association (JAMA), DISCERN (Quality Criteria for Consumer Health Information), Global Quality Score (GQS) and Ankle Impingement Syndrome Specific Score (AISSS).
Results
50 videos about anterior ankle impingement syndrome and 43 videos about posterior ankle impingement syndrome were evaluated. The mean duration of videos related to anterior ankle impingement syndrome was 354.70 seconds (± 314.28) and the mean number of views was 27,166.08 (± 54,898.69). The mean duration of videos related to posterior ankle impingement syndrome was 1594 seconds (± 424.94) and the mean number of views was 15,309.89 (± 47,916.02). When evaluating the quality of video content using scoring systems, videos related to anterior AIS have higher average JAMA, GQS, and DISCERN scores than those related to posterior AIS. However, this difference is only statistically significant for the DISCERN score (p= 0.045).
Conclusions
The quality of YouTube videos in anterior and posterior ankle impingement syndrome is not sufficient.
Semih YAŞ (Sarıkaya, Turkey), Mehmet Ali TOKGÖZ, Secdegül COSKUN YAŞ, Ahmet YILDIRIM, Tayfun ÖZEL
15:48 - 15:54
#43028 - OP09 The peroneal artery in anterolateral approach to the distal tibia: an anatomic study.
The peroneal artery in anterolateral approach to the distal tibia: an anatomic study.
The anterolateral approach to the distal tibia, used in lateral supramalleolar osteotomies, fibula osteotomies or pilon fractures, provides extensive exposure of the distal tibia and fibula. To avoid bleeding, care must be taken with the peroneal artery and its perforating branches (PBPA) that emerge through the interosseous membrane. Scarce literature is available describing its distribution.
The objective of this study is to provide anatomical description of the PBPA at the anterolateral approach to the distal tibia and to determine safe zones.
Fourteen fresh-frozen lower extremities were injected with red-colored latex at the popliteal artery. The mean age was 84.2 years-old (SD:75.8-92.6), and 8/14 were females. An anterolateral approach was performed systematically with careful dissection to identify all PBPA. The number of branches and its distance to the tip of the lateral malleolus were recorded.
Thirteen (92.8%) of the specimens had three branches or fewer, ranging from 6.2-12.8cm to the tip of the lateral malleolus.
Three areas were considered based on the risk of PBPA injury: “high risk” between 9.6-10.6 cm, where 10/14 specimens (71.4%) had a branch; “low risk” between 11.4-12.6 cm, with only 1/14 specimens (7.2%) presenting a branch; and “no risk” in three ranges (<6.2cm, 7.3-8.5 cm, and >12.8cm), where no branches were found in any of the specimens.
According to our anatomical study, the area located 9.6-10.6cm from the tip of the lateral malleolus should be avoided when performing osteotomies and placing retractors while the regions of <6.2 cm, 7.3-8.5cm, <12.8cm present no risk of vascular injury.
Jan MARTINEZ-LOZANO (Barcelona, Spain), Tiago MOTA GOMES, Alberto GINÉS-CESPEDOSA, Xavier MARTIN OLIVA
15:54 - 16:00
#43138 - OP10 Evaluating fibular station changes with leg rotation in lateral ankle radiographs: a cross-sectional analysis.
Evaluating fibular station changes with leg rotation in lateral ankle radiographs: a cross-sectional analysis.
Introduction
Syndesmotic reduction and instability are typically assessed using anteroposterior (AP) radiographs. These assessments are influenced by foot rotation, but little is known about their accuracy in the lateral view. This study hypothesizes that fibular station in the sagittal plane changes significantly with leg rotation.
Methodology
This cross-sectional, retrospective study analyzed digital lateral ankle X-ray images from CT scans of 15 ankles. Images were imported into 3D modeling software (3D Slicer), where neutral position and varying degrees of internal and external rotation were digitally reconstructed. Anterior and posterior fibular stations were measured across these rotations, yielding a total of 135 measurements. Correlations between fibular station and leg rotation were assessed using Pearson correlation coefficients and linear regression.
Results
Of the 15 CT scans, 13 were from male patients and 2 from female patients. The anterior fibular (AF) station showed a decreasing trend with internal rotation and an increasing trend with external rotation. The posterior fibular (PF) station exhibited the opposite trend. Anterior fibular ratios (AF/TW and AF/PW) decreased with internal rotation and increased with external rotation. Posterior fibular ratios (PF/TW and PF/PW) showed no significant changes with rotation. The correlation coefficients for AF and PF stations with rotation were -0.28 (p=0.001) and 0.19 (p=0.03), respectively.
Conclusion
Leg rotation significantly affects lateral fibular station parameters, necessitating neutral leg positioning for accurate syndesmosis reduction assessment. Posterior ratios, being less impacted by rotation, may serve as more reliable indicators. Accurate standardization of leg rotation during radiographic assessment is crucial for reliable measurements.
Kamal BENIWAL, Ankit DADRA (CHANDIGARH, India), Sandeep PATEL, Siddhartha SHARMA, Mandeep DHILLON, Mahesh PRAKASH
16:00 - 16:30
Discussion (6-10).
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"Thursday 17 October"
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FP2
14:30 - 16:30
FREE PAPERS 2: Ankle & Miscellanea
Moderators:
Jan Willem LOUWERENS (orthopaedic surgeon) (Nijmegen, The Netherlands), Yves TOURNÉ (Chirurgien) (Grenoble, France)
14:30 - 14:36
#43098 - OP11 Development and validation of a fully automated tool to quantify 3D foot and ankle alignment using weight-bearing CT.
Development and validation of a fully automated tool to quantify 3D foot and ankle alignment using weight-bearing CT.
Introduction
Foot and ankle alignment plays a pivotal role in human gait and posture. Traditional assessment methods, relying on 2D standing radiographs, present limitations in capturing the dynamic 3D nature of foot alignment during weight-bearing and are prone to observer error. This study aims to integrate weight-bearing CT (WBCT) imaging and advanced deep learning (DL) techniques to automate and enhance quantification of the 3D foot and ankle alignment.
Methods
Thirty-two patients who underwent a WBCT of the foot and ankle were retrospectively included. After training and validation of a 3D nnU-Net model on 45 cases to automate the segmentation into bony models, 35 clinically relevant 3D measurements were automatically computed using a custom-made tool. Automated measurements were assessed for accuracy against manual measurements, while the latter were analyzed for inter-observer reliability.
Results
DL-segmentation results showed a mean dice coefficient of 0.95 and mean Hausdorff distance of 1.41 mm. A good to excellent reliability and mean prediction error of under 2 degrees was found for all angles except the talonavicular coverage angle and distal metatarsal articular angle.
Conclusion
In summary, this study introduces a fully automated framework for quantifying foot and ankle alignment, showcasing reliability comparable to current clinical practice measurements. This operator-friendly and time-efficient tool holds promise for implementation in clinical settings, benefiting both radiologists and surgeons. Future studies are encouraged to assess the tool's impact on streamlining image assessment workflows in a clinical environment.
Ide VAN DEN BORRE, Matthias PEIFFER (Ghent, Belgium), Jean VERVELGHE, Manu HUYGHE, Roel HUYSENTRUYT, Aleksandra PIZURICA, Emmanuel AUDENAERT, Arne BURSSENS
14:36 - 14:42
#43134 - OP12 Anterior tibial tendon transfer in idiopathic clubfoot: does the outcome differ with the initial treatment? Proposed classification to surgical indication.
Anterior tibial tendon transfer in idiopathic clubfoot: does the outcome differ with the initial treatment? Proposed classification to surgical indication.
Purpose To establish parameters and propose a radiographic classification for foota dduction/supination deformities to assist the indication of Garceau procedure. Secondly, to investigate whether the outcome of Garceau surgery depends on the initial treatment used, peritalar release, or the Ponseti method, and verify the maintenance of correction until skeletal maturity. Methods Prospective cohort study, with follow-up evaluations in 2009 and 2019. Fifty-three consecutive patients (71 feet) with idiopathic congenital clubfoot were divided into two groups according to the initial treatment used: peritalar release (group I) or Ponseti method (group II). All patients underwent Garceau procedure. The patients were evaluated clinically and radiographically using the American Orthopedic Foot Association (AOFAS) score for ankle and hindfoot.
Results In the first clinical evaluation, the mean score on the AOFAS was 87 points in group I and 86 points in group II. In the second evaluation, group I had mean AOFAS of 92 points and group II of 94 points. No statistical differences were found between the two groups. In the radiographic evaluation, the adduction deformity obtained an average correction of 4° in group I and 3.6° in group II; in supination deformity, the average depression of the first metatarsal head in relation to the ground was 6.7 mm in group I and 7.5 mm in group II, indicating the correction was maintained until skeletal maturity.
Conclusion Garceau transfer is capable of correcting residual deformities in adduction/supination of mild and moderate degrees, regardless of the initial treatment, and maintaining the correction until skeletal maturity.
Jordanna BERGAMASCO, Jordanna BERGAMASCO (São Paulo, Brazil), Marco Tulio COSTA, Ricardo FERREIRA, Patricia Maria FUCS
14:42 - 14:48
#42914 - OP13 Supramalleolar Osteotomy for ankle arthritis; Single Tertiary Referral Centre 12 year Overview comparing standard and custom Implant.
Supramalleolar Osteotomy for ankle arthritis; Single Tertiary Referral Centre 12 year Overview comparing standard and custom Implant.
The aim was to demonstrate that Supramalleolar osteotomy is a valuable treatment method in eccentric ankle arthritis in young and middle aged since it is an under-utilised procedure. We retrospectively analysed the outcome of it performed over 12 year period. We also compared the results of recently introduced computer-assisted PSI Integrated custom-made implants with standard implant.
Data was analysed from 47 patients over a period of 12 years of which 40 were by standard implant and 7 by computer assisted custom implant. 29 varus, 18 valgus deformity. The mean age was 57 (26-79 y/o), male:female ratio was 27:19. Mean follow-up was 15.25 months for standard implants; For the computer-assisted procedures the follow up range is 24 to 2 months. TAS, TTS and TT angels were measured pre and post-operatively. Fixation using a plate with/without bone graft or custom-made implant was performed by a single surgeon. MOXFQ and AOFAS questionnaires were completed pre and post-operatively. All followed similar rehabilitation programme.
Average radiological healing time was 24.3 weeks. MOXFQ score improved from 55.17 to 25.11 and AOFAS from 20.16 to 56.21. Complications were 2 non-unions, 1 stress fracture. 8 patients require fusion/replacement between 3-5 years. The PSI Integrated computer-assisted case gave improved accuracy than standard method with better scores but with a smoother approach for the surgeon.
Our results are comparable to similar studies. Being a joint preserving technique, Supra Malleolar Osteotomy should be considered either as an interim or definitive procedure especially with the development of computer assisted technologies.
Seyed ALI (Sutton Coldfield, United Kingdom), Mubark ISLAM
14:48 - 14:54
#42962 - OP14 The Hounsfield Units Algorithm demonstrates changes in bone density of the distal tibia in patients with Talus Osteochondral Defect.
The Hounsfield Units Algorithm demonstrates changes in bone density of the distal tibia in patients with Talus Osteochondral Defect.
INTRODUCTION: Changes in bone density (BD), particularly sclerosis, around Osteochondral Defects (OCD) of the talus have been described. However, data on distal tibia BD near these defects are lacking. Weightbearing computed tomography (WBCT) quantifies BD using Hounsfield units (HU). This study aimed to analyze mechanical stress distribution in the distal tibia and talus through BD distribution using HU.
METHODS: Retrospective comparative study including patients with talar OCD as primary diagnosis or incidental finding. In WBCT images, the VOI matched the OCD width and depth, extending 5mm below and 5mm above the tibial plafond. HU distribution was obtained along three perpendicular lines (anterior, central, posterior), dividing values into four segments: talus, osteochondral lesion, joint space, and tibia. The process was repeated on the opposite non-lesion side as a control.
RESULTS: Thirty-two talar OCD patients were included. Fifty-two percent were symptomatic, and 48% with an incidental finding. There was not significant difference in mean HU between symptomatic and incidental OCD patients. In controls, the talus had higher HU average than the tibia, but in OCD patients the tibia demonstrated higher HU than the talus. When comparing the HU in the tibia between OCD and controls, the OCD patients demonstrated significantly increased BD (474.34 vs 382.32)(p<.0001).
DISCUSSION AND CONCLUSION: Our results show significantly increased BD compared to controls, even among asymptomatic cases. This finding could potentially explain the pain symptoms, as well as the subsequent occurrence of mirror OCD in the tibia (kissing lesion). Future studies are necessary to further elucidate this issue.
Erik HUANUCO CASAS, Antoine ACKER (Geneva, Switzerland), Francois LINTZ, Kepler CARVALHO, Tommaso FORIN VALVECCHI, Emily LUO, Grayson TALASKI, Samuel ADAMS, Mark EASLEY, Cesar DE CESAR NETTO
14:54 - 15:00
#42831 - OP15 High body mass index is not a contraindication for an arthroscopic ligament repair with biological augmentation in case of chronic ankle instability.
High body mass index is not a contraindication for an arthroscopic ligament repair with biological augmentation in case of chronic ankle instability.
Purpose: To compare the clinical results of an arthroscopic lateral ligament repair with biological augmentation between patients with a BMI ≥ or < 30.
Methods: Sixty-nine patients with an isolated lateral ankle instability were treated with an arthroscopic anterior talofibular ligament (ATFL) repair with biological augmentation using the inferior extensor retinaculum (IER). Patients were divided into two groups according to their BMI: ≥ 30 (Group A; n=26) and <30 (Group B; n=43). Patients were pre-and post-operatively evaluated, with a minimum of 2 years follow-up, using the Karlsson Score. Characteristics of the patients, complications, ankle instability symptoms recurrence, and satisfaction score were recorded.
Results: In group A, median Karlsson Score increased from 43.5 (Range 22-72) to 85 (Range 37-100) at follow-up. Complications were observed in 7 patients (27%). Nineteen patients (73%) reported that they were “very satisfied”.
In group B, median Karlsson Score increased from 65 (Range 42-80) to 95 (Range 50-100) at follow-up. Complications were observed in 4 patients (9%). Thirty-three patients (77%) reported that they were “very satisfied”.
Pre-operative and at last follow-up Karlsson Score, results were significantly different between the two groups. There was no significant statistical difference in favour of satisfaction score, complications between the two groups.
Conclusion: ATFL repair with biological augmentation using IER gives excellent results for patients with BMI ≥ 30. Compared to patients with BMI <30, they present a slightly lower preoperative and postoperative Karlsson score, however, with a similar satisfaction rate, but are at higher risk of transient superficial peroneal nerve dysesthesia.
Kevin GUIRAUD, Kevin GUIRAUD (Villeneuve-sur-Lot), Guillaume CORDIER, Jordi VEGA, Gustavo ARAUJO NUNES
15:00 - 15:30
Discussion.
15:30 - 15:36
#42773 - OP16 Comparative study of outcome measures of arthroscopic versus mini arthrotomy ankle fusion: Is there any difference?
Comparative study of outcome measures of arthroscopic versus mini arthrotomy ankle fusion: Is there any difference?
Background: Ankle fusion is the benchmark procedure in refractory cases of ankle arthritis. Aim: The aim of this work was to
compare different outcome measures of arthroscopically assisted ankle fusion and mini-arthrotomy ankle fusions.
Methods: This prospective study included 30 patients with post-traumatic ankle OA, who were treated by ankle fusion.
Patients were divided regarding the adopted procedure into two groups, 15 patients in each group. Group A was treated
using arthroscopic assisted ankle fusion and Group B using single incision mini arthrotomy ankle fusion. They were
evaluated clinically with AFOAS, visual analogue scale of pain pre and post operatively, time of union, complications and
satisfaction. Results: The results were satisfactory in 12 patients in group A and 11 patients in group B. While three
patients (20%) in group A and four patients (26.6%) in group B had unsatisfactory results according to AFOAS and VAS.
Sound solid ankle fusion was achieved in 13 (86.6%) ankles in group A with a mean fusion time of 14.4 weeks (range
from 12-18 weeks) and 11 (73.3%) ankles in group B with a mean fusion time of 14.5 weeks. Two ankles in group A
(13.3%) and four ankles in group B (26.6%) had non-union. Conclusion: No difference was found between single-incision mini-arthrotomy and arthroscopic assisted ankle fusion. Minimally invasive ankle arthrodesis (particularly arthroscopic assisted
technique) offers a good option for the minimally deformed arthritic ankle.
Islam SARHAN (UK, United Kingdom), Mohamed NAGY, Saed SHEKEDF
15:36 - 15:42
#43097 - OP17 Articular Contact Mechanics in Osteochondral Lesions of the Talus: A Weightbearing-CT study.
Articular Contact Mechanics in Osteochondral Lesions of the Talus: A Weightbearing-CT study.
Introduction: Osteochondral Lesions of the Talus (OLT) may progress into a cascade of cartilage degeneration. While edge-loading on the surrounding tibiotalar articular surfaces has been proposed as principal determinant of cartilage degeneration, the pathophysiological pathways have not yet been clarified. The present study aims to evaluate the patient-specific influence of OLTs on the mechanical behaviour of the surrounding cartilage of the talus and tibia.
Methods
Patient-specific 3D models from 36 patients with an OLT, derived from weightbearing CT, were used to analyse the contact stress on the tibiotalar articulation using Discrete Element Analysis (DEA). A matched, virtual healthy control group was developed for each talus. Mean- , peak contact-stress and contact area were calculated during simulated ankle flexion.
Results
The mean talar contact-stress was elevated in the OLT cases, with a notable correlation between ankle flexion and OLT location. Edge loading occurred predominantly in anteromedial lesions during dorsiflexion (2.9 MPa (IQR: 1.3) for OLT versus 2.4 MPa (IQR: 0.9) for the controls), while posteromedial lesions were mostly loaded during plantarflexion (3.5 MPa (IQR: 1.7) for the OLT versus 2.9 MPa (IQR: 1.1) for the controls).
Conclusion
OLTs influence the whole-joint articular contact mechanics of the ankle, leading to increased stress on both the talus and the opposing tibia. More specifically, a clear pattern of edge-loading on the surrounding OLT cartilage was found. Anterior lesions had the highest stresses in neutral and dorsiflexion, while posterior lesions experienced higher stress during plantarflexion.
Matthias PEIFFER (Ghent, Belgium), Julian HOLLANDER, Arne BURSSENS, Sjoerd STUFKENS, Soheil ASHKANI-ESFAHANI, Emmanuel AUDENAERT, Gino KERKHOFFS, John KWON, Christopher DIGIOVANNI
15:42 - 15:48
#43089 - OP18 Sex Differences in Trace Element Zinc and Magnesium Levels After Fracture in a Rat Model.
Sex Differences in Trace Element Zinc and Magnesium Levels After Fracture in a Rat Model.
Introduction:
Zinc and magnesium are crucial for bone health, with deficiencies potentially impairing bone metabolism and repair. This study is the first to examine sex-related differences in trace element levels during the initial stages of fracture healing. Understanding these differences may lead to more effective treatments or supplementation strategies.
Methods:
After inducing a closed mid-diaphyseal femur fracture in male and female BB Wistar rats, fractured and intact contralateral femurs were collected at 1-, 3-, and 7-days post-injury. 10 mm segments were resected from the center of the callus, and similar regions were taken from contralateral femurs. Control femurs were harvested from non-fractured rats. Samples were analyzed via inductively coupled mass spectrometry, and t-tests compared fractured femurs to control and contralateral femurs, with p-values adjusted for multiple comparisons.
Results:
Zinc levels were significantly lower at the fracture site for 1-, and 3-day male groups compared to controls (p<0.01). In females, zinc levels remained relatively stable across time points, with a notable non-significant decrease at the fracture site for the 7-day group.
Magnesium levels were significantly lower at the fracture site for 1-day and 3-day male groups compared to controls (p<0.01). In females, magnesium levels showed minor fluctuations, with a slight non-significant decrease at the fracture site for the 7-day group.
Conclusion:
This study highlights sex differences in early fracture healing, with distinct temporal patterns in zinc and magnesium levels. These findings enhance our understanding of the roles of these trace elements in fracture healing and may inform future therapeutic approaches.
Jonathan LOPEZ (Newark, NJ, USA), David AHN, Mark FISHER, Jason DANIELS, James THORNTON, Darian NAPOLEON, Laura KUKLO, Ruey Horng CHEE, Sheldon LIN, J. Patrick O'CONNOR
15:48 - 15:54
#43107 - OP19 Midterm Outcomes of Transfibular Total Ankle Arthroplasty: Clinical and Radiographic Analysis of 130 Cases with Minimum 5-Year Follow-up.
Midterm Outcomes of Transfibular Total Ankle Arthroplasty: Clinical and Radiographic Analysis of 130 Cases with Minimum 5-Year Follow-up.
While most total ankle arthroplasty (TAA) utilize an anterior approach for implantation, the Zimmer Trabecular Metal implant is unique in that it utilizes a transfibular approach. This allows for a shallow resection depth and insertion of a curved prosthesis design, mimicking the native tibiotalar joint. We present the largest midterm study to date analyzing the survivorship, clinical, and radiographic outcomes of transfibular TAA at a minimum of 5-years follow-up.
A total of 130 ankles (122 patients, average age 60.8 years-old, 50.8% females) with average 5.9 years (range, 5.0-10.1) follow-up were included. PROMs included SF-12 physical (PCS) and mental (MCS) component scores, Ankle Osteoarthritis Scale (OAS), pain Visual Analog Scale (VAS). Radiographic outcomes included ROM, coronal/sagittal alignment, and periprosthetic lucency using a 12-zone system. Adverse events were reported using the Canadian Orthopedic Foot and Ankle Society Reoperation Coding System (CROCS).
Postoperative PROMs included SF-12 PCS: 41.5; SF-12 MCS: 54.9; VAS: 2.3; AOS Pain: 19.1; AOS Disability: 28.5. Postoperative tibiotalar ROM was 7.4° dorsiflexion, 17.3° plantarflexion. 26 (20%) ankles had a single zone of radiolucency; none had more than 7 zones. There were 3 (2.3%) cases of cysts, no cases of subsidence, septic/aseptic loosening, or fibular non-union. Reoperation rate was 36.2% (n=47) at average 26.7 months, most commonly removal of fibula hardware (n=28, 21.5%), medial gutter debridement (n=18, 13.8%). There were 5 (3.8%) cases of acute infection treated with I&D and metal component retention. Overall implant survival, defined by retention of the metal components, was 100% at final follow-up.
Jonathan DAY (Baltimore, USA), Amanda FLETCHER, Morgan MOTSAY, Maggie MANCHESTER, Zijun ZHANG, Lew SCHON
15:54 - 16:00
#43090 - OP20 Poetry in Motion: Ankle Biomechanics in Ballet Dance.
Poetry in Motion: Ankle Biomechanics in Ballet Dance.
Introduction/Purpose:
Ankle sprains are one of the most common injuries amongst ballet dancers and may lead to chronic ankle instability. Certain ballet positions can further increase the risk of bone and soft tissue injuries. While injuries occur frequently, there is little understanding of the biomechanics of the foot/ankle in ballet. This study used weightbearing computed tomography (WBCT) and distance mapping to describe ankle joint mechanics in various ballet positions.
Methods:
Bilateral WBCT scans were taken of five healthy professional ballerinas in five different positions: control/neutral, first position, fifth position, plié, and relevé (en pointe). A semi-automatic software was used to segment models of all bones proximal to the first distal phalanx. Talar dome and gutter articulations were selected manually, and distances along the entire tibiofibular interface and gutter articulations were calculated.
Results:
Syndesmotic widening was greatest in first position at 5 cm above the tibiotalar joint (Mean: 9.39 mm). The relevé position consistently had the greatest syndesmotic narrowing. The anteromedial gutter had the largest range in regard to distance, with greatest joint space width in fifth position (Mean: 4.99 mm) and narrowest in plié (Mean: 2.68 mm). More specifically, in fifth position the anteromedial gutter space was 71% wider than the control position.
Conclusion:
This study is the first of its kind to mechanistically describe the ankle as it relates to ballet dancing. Future research with larger cohorts and more WBCT stress positions is needed to comprehensively understand the foot and ankle joint mechanics in this demanding sport.
Emily LUO (Durham, NC, USA), Katherine KUTZER, Kepler CARVALHO, Grayson TALASKI, Madeline UNGS, Zirbes CHRISTIAN, Erik HUANUCO CASAS, Antoine ACKER, Cesar DE CESAR NETTO
16:00 - 16:30
Discussion.
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AQUARIUM |
16:30 |
"Thursday 17 October"
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CB2
16:30 - 17:00
Coffee Break, Exhibition, and Poster Walks
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17:00 |
"Thursday 17 October"
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DF1
17:00 - 18:25
DISCUSSION FORUM – Stress Fractures and Sport
17:00 - 18:25
Moderators.
Mostafa BENYAHIA (Surgeon) (Moderator, Copenhagen, Denmark), James RITCHIE (orthopaedic Foot and Ankle Surgeon) (Moderator, Tunbridge Wells, United Kingdom)
17:00 - 17:10
General considerations and how to address.
Ezequiel PALMANOVICH (ezepalm@gmail.com) (Speaker, Kfar Saba, Israel)
17:10 - 17:20
Any role for conservative treatment?
Bruno PEREIRA (Surgeon) (Speaker, Braga, Portugal)
17:20 - 17:30
Second metatarsal.
Paolo CECCARINI (Ortopaedic Surgeon) (Speaker, Perugia, Italy)
17:30 - 17:40
Calcaneus.
Fabian KRAUSE (Head Foot & Ankle surgery) (Speaker, Berne, Switzerland)
17:40 - 17:50
Navicular stress fracture.
Antonio VILADOT (orthopaedic Surgeon) (Speaker, Barcelona, Spain)
17:50 - 18:00
Fifth metatarsal.
Henryk LISZKA (senior assistant) (Speaker, Krakow, Poland)
18:00 - 18:25
Discussion.
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DF2
17:00 - 18:25
DISCUSSION FORUM – Midfoot Trauma
17:00 - 18:25
Moderators.
Daniele MARCOLLI (Foot and Ankle Surgeon) (Moderator, Milano, Italy), Fabian KRAUSE (Head Foot & Ankle surgery) (Moderator, Berne, Switzerland)
17:00 - 17:10
Navicular displaced fracture.
Markus WALTHER (Medical Director) (Speaker, München, Germany)
17:10 - 17:20
Cuboid displaced (and comminuted) fracture.
Antonio DALMAU (Head of Department) (Speaker, Barcelona, Spain)
17:20 - 17:30
The Jones fracture in the young athlete.
Maneesh BHATIA (Virtual Film Festival videos) (Speaker, Leicester, United Kingdom)
17:30 - 17:40
The subtle Lisfranc.
Mark Bowen DAVIES (Consultant Orthopaedic Surgeon) (Speaker, Sheffield, United Kingdom)
17:40 - 17:50
The not-so-subtle Lisfranc – fixation and how.
Manuel SOUSA (Foot and Ankle Surgeon) (Speaker, Lisbon, Portugal)
17:50 - 18:00
The comminuted Lisfranc – primary arthrodesis and how.
Joris HERMUS (Orthopedic surgeon) (Speaker, Maastricht, The Netherlands)
18:00 - 18:25
Discussion.
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AQUARIUM |
18:25 |
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WR
18:25 - 18:30
Adjourn and Welcome Reception
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AUDITORIUM |