| Wednesday 16 October |
| Time |
AQUARIUM |
WELCOME DESK |
AUDITORIUM |
STUDIO |
EXHIBITION AREA |
EPOSTERS ZONE |
CINEMA |
R1 |
| 13:30 |
13:30-16:30
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BFAS-presymp
BFAS-EFAS pre-meeting (15 mins each + 5 mins Q&A)
BFAS-EFAS pre-meeting (15 mins each + 5 mins Q&A)
13:30 - 16:30
Moderators.
Laurent GOUBAU (Foot and Ankle Surgeon) (Moderator, Ghent and Brussels, Belgium), Geoffroy VANDEPUTTE (MD) (Moderator, Lier, Belgium)
13:30 - 13:40
Welcome and Introduction.
Kristian BUEDTS (Md) (Speaker, Brussels, Belgium), Laurent GOUBAU (Foot and Ankle Surgeon) (Speaker, Ghent and Brussels, Belgium)
13:40 - 14:00
How innovation in Materials and Techniques in Forefoot Surgery has changed my practice in the last 10 years, or not?
Manfred THOMAS (Speaker, Augsburg, Germany)
14:00 - 14:20
How innovation in understanding the sagittal plane has changed my practice in the last 10 years, or not?
Manuel MONTEAGUDO (CONSULTANT ORTHOPAEDIC SURGEON) (Speaker, Madrid, Spain)
14:20 - 14:40
How innovation in distal tibia osteotomy has changed my practice in the last 10 years, or not?
Jean BRILHAULT (Speaker, Trelaze, France)
14:40 - 15:00
How innovation in TAR has changed my practice in the last 10 years, or not?
Timothy DANIELS (Delegate, Canada)
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| 16:30 |
16:30-17:00
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BFAS-presym
BFAS-EFAS pre-meeting
BFAS-EFAS pre-meeting
16:30 - 17:00
Contributions of the international fellows.
17:00 - 17:00
End of BFAS Pre-Congress.
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| Thursday 17 October |
| Time |
AQUARIUM |
WELCOME DESK |
AUDITORIUM |
STUDIO |
EXHIBITION AREA |
EPOSTERS ZONE |
CINEMA |
R1 |
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| 08:00 |
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08:00-08:30
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| 08:30 |
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08:30-08:40
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OC
Opening Ceremony
Opening Ceremony
Speakers:
Kristian BUEDTS (Md) (Speaker, Brussels, Belgium), Manuel MONTEAGUDO (CONSULTANT ORTHOPAEDIC SURGEON) (Speaker, Madrid, Spain), Manfred THOMAS (Speaker, Augsburg, Germany)
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| 08:40 |
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08:40-10:00
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PS1
PLENARY SESSION 1: NEUROFOOT/ANKLE
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 (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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| 10:30 |
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10:30-11:30
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SY1
SYMPOSIUM: Most relevant EFAS publications (2022-2024)
SYMPOSIUM: Most relevant EFAS publications (2022-2024)
Moderators:
Daniele MARCOLLI (Foot and Ankle Surgeon) (Milano, Italy), Martinus RICHTER (Director) (Rummelsberg, Germany)
10:30 - 10:42
EFAS in depth: our journal, your journal.
Martinus RICHTER (Director) (Speaker, Rummelsberg, Germany)
10:42 - 10:54
Most relevant 1 - Distraction arthroplasty in the management of osteoarthritis of the ankle: A systematic review.
Arshad ZAKI (Student) (Speaker, Cambridge, United Kingdom)
10:54 - 11:00
Most relevant 2 - Diagnostic applications and benefits of weightbearing CT in the foot and ankle: A systematic review of clinical studies.
Arne BURSSENS (Foot and ankle surgeon) (Speaker, Ghent, Belgium)
11:00 - 11:06
EFAS Best Paper Award.
11:06 - 11:30
Discussion.
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10:30-11:30
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SY2
SYMPOSIUM: Removal of Metalwork in the Foot and Ankle
SYMPOSIUM: Removal of Metalwork in the Foot and Ankle
Moderators:
Norman ESPINOSA (Owner / Member) (Moderator, Zurich, Switzerland), James RITCHIE (orthopaedic Foot and Ankle Surgeon) (Moderator, Tunbridge Wells, United Kingdom)
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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| 11:35 |
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11:35-12:30
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BSFFAF
BSFFAF: Brussels Short Film Foot and Ankle Festival
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
Retrograde nail for ankle fracture in a fragile patient.
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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11:35-12:30
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F1
Paediatric Foot and Ankle FORUM:
Paediatric Foot and Ankle FORUM:
11:35 - 12:30
Moderators.
Anja HELMERS (Speaker, Germany), Christina STUKENBORG-COLSMAN (XXX) (Speaker, Hannover, Germany)
11:35 - 11:45
What is a symptomatic flatfoot?
Maurizio DE PELLEGRIN (Speaker, Italy)
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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| 12:15 |
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12:15-14:30
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| 12:30 |
12:30-13:30
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SYI01
SYMPOSIUM - CONMED FOOT
SYMPOSIUM - CONMED FOOT
12:30 - 13:30
My experience with Quantum® TAR: a journey through innovation.
Thibaut LEEMRIJSE (Chirurgien) (Keynote Speaker, Bruxelles, Belgium)
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12:30-13:30
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SYI02
SYMPOSIUM - PLANMED / AMES MEDICAL
Lateral column lengthening, when? Cotton, when?
Planning for Progressive Collapsing Foot: Weight-Bearing CT Scans Guiding Successful Osteotomies.
SYMPOSIUM - PLANMED / AMES MEDICAL
Lateral column lengthening, when? Cotton, when?
Planning for Progressive Collapsing Foot: Weight-Bearing CT Scans Guiding Successful Osteotomies.
12:30 - 12:45
Progressive Collapsing Foot: how to plan successful osteotomies. Avoid fusions as long as you can!
Federico USUELLI (Keynote Speaker, Italy)
12:45 - 13:00
Keep it simple: Medial calcaneal displacement and Cotton Osteotomy.
Agustin BARBERO (Foot and Ankle Surgeon) (Keynote Speaker, Milan, Italy)
13:00 - 13:15
Lateral column lengthening: Evans, Hinterman. Planning and surgical technique.
Federico USUELLI (Keynote Speaker, Italy)
13:15 - 13:30
Bring your cases and discuss together.
Federico USUELLI (Keynote Speaker, Italy), Agustin BARBERO (Foot and Ankle Surgeon) (Keynote Speaker, Milan, Italy)
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| 12:40 |
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12:40-13:00
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PWK1
Poster Walks presentations 1
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
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
#40837 - PWK21 Automatic software-based 3D-angular measurement for Weight-Bearing CT (WBCT) is valid.
Automatic software-based 3D-angular measurement for Weight-Bearing CT (WBCT) is valid.
Background
The purpose of this study was to compare automatic software-based angular measurement (AM, Autometrics 2.0, Curvebeam, Warrington, PA, USA) with validated measurement by hand (MBH) regarding angle values and time spent for Weight-Bearing CT (WBCT) scans.
Methods
Five-hundred bilateral WBCT scans (PedCAT, Curvebeam, Warrington, PA, USA) were included in the study. Five angles (1st - 2nd intermetatarsal angle, talo-metatarsal 1-angle (TMT) dorsoplantar and lateral projection, hindfoot angle, calcaneal pitch angle) were measured with MBH and AM on the foot/ankle (side with pathology). Angles and time spent of MBH and AM were compared (t-test, homoscedatic).
Results
Mean age of the patients was 49 years (range, 18-85), 214 (43%) were male. 243 (49%) right and 257 (51%) left feet were analyzed with the following specific pathologies: osteoarthritis/instability, n=147 (29%); Haglund deformity/Achillodynia, n=41 (8%); forefoot deformity, n=108 (22%); Hallux rigidus, n=37 (7%); flatfoot, n=35 (7%); cavus foot, n=10 (2%); osteoarthritis except ankle, n=82 (16%). The angles did not differ between MBH and AM (each p>0.36, table 1). The null hypothesis was rejected. The power was 0.92. The time spent for MBH / AM was 44.5 / 1s on average per angle (p<.001).
Conclusions
AM provided angles which were not different from validated MBH and can be considered as a validated angle measurement method. The time spent was 97% lower for AM than for MBH. The investigator time spent is 97% lower for AM (1s per angle) than for MBH (44.5s per angle).
Martinus RICHTER (Rummelsberg, Germany), Stefan ZECH, Issam NAEF, Stefan A MEISSNER, Regina SCHILKE, Fabian DUERR
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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| 13:00 |
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| 13:10 |
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13:10-13:30
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PKW2
Poster Walks presentation 2
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
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
#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
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, Alberto ARCERI, Simone Ottavio ZIELLI, Laura LANGONE (Bologna, Italy), Cesare FALDINI
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13:30-14:30
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SYI04
SYMPOSIUM - PARAGON 28
SYMPOSIUM - PARAGON 28
13:30 - 14:30
From Fracture to Fusion: Complex Ankle Reconstruction.
Mark Bowen DAVIES (Consultant Orthopaedic Surgeon) (Keynote Speaker, Sheffield, United Kingdom), Ezequiel PALMANOVICH (ezepalm@gmail.com) (Keynote Speaker, Kfar Saba, Israel)
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13:30-14:30
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SYI03
SYMPOSIUM - NEWCLIP TECHNICS
SYMPOSIUM - NEWCLIP TECHNICS
13:30 - 14:30
Ankle arthrosis management with SMOT and associated PSI.
Kristian BUEDTS (Md) (Keynote Speaker, Brussels, Belgium), Jean BRILHAULT (Keynote Speaker, Trelaze, France)
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| 13:35 |
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13:35-13:55
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PKW3
Poster Walks presentations 3
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
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
#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
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PWP4
Poster Walks presentations 4
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
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 (Ghent, 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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FP1
FREE PAPERS 1: Ankle & Sports
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, Mehmet Ali TOKGÖZ (Ankara, Turkey), 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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14:30-16:30
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FP2
FREE PAPERS 2: Ankle & Miscellanea
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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DF1
DISCUSSION FORUM – Stress Fractures and Sport
DISCUSSION FORUM – Stress Fractures and Sport
17:00 - 18:25
Moderators.
Roman TOTKOVIČ (chief) (Moderator, košice, Slovakia), James RITCHIE (orthopaedic Foot and Ankle Surgeon) (Moderator, Tunbridge Wells, United Kingdom)
17:00 - 17:10
General considerations and how to address.
Helka KOIVU (Consultant) (Speaker, Turku, Finland)
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
DISCUSSION FORUM – Midfoot Trauma
DISCUSSION FORUM – Midfoot Trauma
17:00 - 18:25
Moderators.
Nuno CORTE REAL (Clinical Director) (Moderator, Cascais, Portugal), Elena SAMAILA (Associated Professor) (Moderator, Verona, Italy)
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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WELCOME DESK |
AUDITORIUM |
STUDIO |
EXHIBITION AREA |
EPOSTERS ZONE |
CINEMA |
R1 |
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PL1
PRESIDENTIAL INVITED LECTURE
PRESIDENTIAL INVITED LECTURE
08:00 - 08:30
Moderator.
Kristian BUEDTS (Md) (Moderator, Brussels, Belgium), Jente WAGEMANS (Speaker, Schoten, Belgium)
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PS2
PLENARY SESSION 2:
TIBIAL MALALIGNEMENT AFFECTING THE FOOT AND ANKLE
PLENARY SESSION 2:
TIBIAL MALALIGNEMENT AFFECTING THE FOOT AND ANKLE
08:40 - 10:00
Moderators.
Markus WALTHER (Medical Director) (Moderator, München, Germany), Mark Bowen DAVIES (Consultant Orthopaedic Surgeon) (Moderator, Sheffield, United Kingdom)
08:40 - 08:50
Proximal tibia – varus or valgus knee.
Aleksas MAKULAVICIUS (Team leader) (Speaker, Vilnius, Lithuania)
08:50 - 09:00
Diaphyseal / torsional deformities.
Christian PLAASS (Consultant) (Speaker, Hannover, Germany)
09:00 - 09:10
Supramalleolar – varus/valgus.
Victor VALDERRABANO (Chairman) (Speaker, Basel, Switzerland)
09:10 - 09:20
Supramalleolar – multiplanar and sagittal plane.
Matthias WALCHER (Orthopaedic Surgeon) (Speaker, Würzburg, Germany)
09:20 - 09:30
Progressive correction with circular external fixation.
Antti YLITALO
09:30 - 10:00
Discussion.
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PWP5
Poster Walks presentations 5
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
Poster Walks presentations 5
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
Speakers:
Stefan CLOCKAERTS (Foot and ankle Surgeon) (Speaker, Mechelen, Belgium), Antti YLITALO
10:05 - 10:25
#42587 - PKW17 Three-Dimensional Distance Mapping to Identify Safe Zones for Lateral Column Lengthening.
Three-Dimensional Distance Mapping to Identify Safe Zones for Lateral Column Lengthening.
Background: Evans (E-LCL) and Hintermann LCL (H-LCL) lateral column lengthening osteotomies are standard surgical solutions for flexible, progressive collapsing feet. E-LCL is performed between the anterior and middle facets, posing risks to certain os calcis subtalar joint (OCST) subtypes. H-LCL is performed between the posterior and middle facets, potentially suitable for all OCSTs. Both osteotomies can lead to increased subtalar osteoarthritis, suggesting iatrogenic damage. Distance mapping (DM) visualizes the relative distance between two articular surfaces using color patterns. This study aims to measure the safe zones for LCL using 3D models and DM, hypothesizing high reproducibility.
Methods: Two raters categorized 200 feet across 134 patients into OCSTs based on the Bruckner classification. They independently measured four angles. The proximal and distal extents of the posterior safe zone (PSZ) angles were determined for H-LCL osteotomies, while the anterior safe zone (ASZ) angles were identified for E-LCL osteotomies. The surface area available for safe osteotomies was calculated. Interclass correlation assessed rater agreement, with analysis of variance and Mann-Whitney U tests comparing safe zones between OCSTs.
Results: The mean proximal and distal extents of the PSZ angles were 68 ± 7 and 75 ± 5 degrees, respectively. The ASZ angles were 89 ± 6 and 95 ± 5 degrees, respectively. No significant differences were found between OCSTs. The raters showed good to excellent agreement. In 18 cases, planning for H-LCL or E-LCL osteotomies was not feasible
Efrima BEN, Agustin BARBERO (Milan, Italy), Kuharajan RAMALINGAM, Cristian INDINO, Camilla MACCARIO, Federico USUELLI
10:05 - 10:25
#42589 - PKW18 Abnormal axial rotation of the talus on weight-bearing computed tomography in patients with osteochondral lesion of the talus and functional instability of the ankle.
Abnormal axial rotation of the talus on weight-bearing computed tomography in patients with osteochondral lesion of the talus and functional instability of the ankle.
Introduction:
Osteochondral lesions of the talus (OLT) are commonly associated with ankle sprains, often leading to chronic ankle instability (CAI), both mechanical and functional. While diagnosing mechanical CAI is straightforward, identifying functional CAI presents challenges. Microinstability, attributed to superior anterior talofibular ligament (S-ATFL) tear, is proposed as a factor in functional CAI, resulting in anterior translation and internal rotation of the talus. Weight-bearing computed tomography (WBCT) provides valuable insights into hindfoot alignment, particularly under load-induced deformation, making it a promising tool for evaluating patients with functional instability. This study aims to compare talus axial rotation in symptomatic OLT patients with subjective signs of functional CAI to asymptomatic volunteers and assesses the reliability of these measurements.
Materials and Methods:
Forty ankles with symptomatic OLT and micro-instability signs were compared to a control group of asymptomatic individuals. Three-dimensional models were generated using WBCT and image analysis software, allowing for semi-automatic hindfoot alignment measurements. Additional analysis was conducted to assess the agreement between measurements.
Results:
Symptomatic OLT patients displayed significantly increased external talus rotation compared to controls, with a mean difference of -4.5 ± 4.5 degrees (P < 0.001). Intraobserver reliability showed good to excellent correlation (ICC 0.88, ICC 0.92), while interobserver agreement was excellent (ICC 0.93, ICC 0.90).
Conclusion:
Patients with symptomatic OLT and functional CAI exhibit abnormal external rather than internal talus rotation. Preoperative WBCT reliably identifies abnormal external rotation, suggesting caution regarding procedures like lateral ligament surgeries that may exacerbate joint incongruence.
Efrima BEN, Agustin BARBERO (Milan, Italy), Cristian INDINO, Camilla MACCARIO, Amit BENADY, Federico USUELLI
10:05 - 10:25
#42627 - PKW19 Are large language models efficient as triage tools for surgical management of foot and ankle patients?
Are large language models efficient as triage tools for surgical management of foot and ankle patients?
Large Language Models (LLMs) like ChatGPT and Bard have emerged as potential but not risk-less tools, offering specialized answers based on context and prior knowledge. In Foot and Ankle (FA) surgery, efficient triage is crucial due to the variety of conditions and limited surgical time. This study evaluates LLMs' ability to guide patients towards appropriate medical or surgical management compared to board-certified FA surgeons.
Forty-four fictitious clinical scenarios were created, incorporating chronicity, onset, and anatomic localization. Outcomes were assessed on a Likert scale (1-5) for the likelihood of needing surgical management, and the primary outcome was a binary decision towards surgical (1,2,3 for certain, probable or uncertain) or medical follow up (4,5 for improbable and not required). Four FA surgeons and ChatGPT and Bard were evaluated, with agreement analyzed using Fleiss' and Cohen's Kappas.
Overall Likert scale agreement was -0.003, indicating no concordance. Agreement on the decision (surgical versus medical orientation of patients) improved to low (0.17). Pairwise comparison showed slight agreement among surgeons (0.02) and moderate between LLMs (0.52), with ChatGPT aligning slightly with surgeons (0.13), and Bard poorly (0.09). Strikingly, agreement between surgeons was even worse (0.067).
LLMs require refinement for clinical reliability. Moderate agreement between them suggests a common knowledge base which could be promising regarding their reliability, although ChatGPT's higher surgeon agreement suggests some models may better capture clinical judgment nuances. Future research should enhance LLMs interpretive algorithms based on a common nomenclature of conditions and explore their supportive role in medical decision-making.
François LINTZ, Antoine ACKER, Kepler (Alencar Mendes) CARVALHO, May LABIDI, Gianluca GONZI (, United Kingdom), Marie-Aude MUNOZ, Alessio BERNASCONI, Cesar DE CESAR DE NETTO
10:05 - 10:25
#42987 - PKW20 Ankle fracture with well-repaired syndesmotic injury versus ankle fracture with no syndesmotic injury: a prospective cohort study of surgical outcomes.
Ankle fracture with well-repaired syndesmotic injury versus ankle fracture with no syndesmotic injury: a prospective cohort study of surgical outcomes.
Introduction
This prospective cohort study was to compare treatment outcomes between ankle fractures with well-repaired syndesmotic injury and with no syndesmotic injury following standard fixations.
Methods
All 34 patients were divided into group-1: ankle fracture with well-repaired syndesmotic injury (n = 21) and group-2: ankle fracture with no syndesmotic injury (n = 13). In group-1, syndesmotic evaluations before/after syndesmotic repairs were done via hook tests/external rotation stress tests under fluoroscopic control and/or open syndesmotic viewing. Syndesmotic articulation was reduced and fixed/repaired to be close to anatomic alignment as possible under fine-tune confirmation as mentioned. Other fractures at ankle area were fixed as standard manners. Tibiofibular (TF) clear space was measured as a main parameter to determine quality of syndesmotic repair. Validated Visual analogue scale foot and ankle (VASFA) scores and Short Form-36 (SF-36) were postoperatively recorded.
Results
There were no significant differences between the two groups in terms of postoperative VASFA scores (group-1: mean-value = 82.26 +/- 17.20 vs group-2: mean-value = 74.53 +/- 22.16, P-value = 0.269) and quality of syndesmotic repair via postoperative TF clear space distances (group-1: mean-value = 3.84 +/- 1.78 mm vs group-2: mean-value = 3.84 +/- 1.06 mm, P-value = 1). VASFA moderately correlated with SF-36 scores via Pearson Correlation Coefficient (r): 0.5016.
Conclusions
Ankle fracture patients with well-repaired syndesmotic injury were able to demonstrate similar outcomes to a cohort with no syndesmotic injury following surgery. Syndesmotic injury did not always produce negative outcome provided that it was well repaired under proper treatment.
Angthong CHAYANIN (Bangkok, Thailand)
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EDI
EDI (Equality, Diversity, Inclusion) FORUM:
EDI (Equality, Diversity, Inclusion) FORUM:
10:30 - 11:30
Moderators.
Elena SAMAILA (Associated Professor) (Moderator, Verona, Italy), Rick BROWN (Clinical lead) (Moderator, Oxford, United Kingdom)
10:30 - 10:40
Ethnicity in Foot & Ankle surgery.
Mostafa BENYAHIA (Surgeon) (Speaker, Copenhagen, Denmark)
10:40 - 10:50
LGTBQ+ in Foot & Ankle Surgery.
Kristian BUEDTS (Md) (Speaker, Brussels, Belgium)
10:50 - 11:00
EDI in Orthopaedics in Eastern Europe.
Iozefina BOTEZATU (MDPhD) (Speaker, bucharest, Romania)
11:00 - 11:10
“Briser le plafond de glace”- Breaking the glass ceiling. How can institutions make it easier for future women to progress in F&A surgery?
Barbara PICLET (chirurgien) (Speaker, La Ciotat, France)
11:10 - 11:20
Establishing a mentorship Programme for Foot & Ankle Surgeons.
Anna CHAPMAN (Speaker, United Kingdom)
11:20 - 11:30
Discussion.
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10:30-11:30
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F2
Foot and Ankle Trauma FORUM
Foot and Ankle Trauma FORUM
10:30 - 11:30
Moderators.
Stefan RAMMELT (Head, Foot & Ankle Center) (Moderator, Dresden, Germany), Nikolaos GOUGOULIAS (Consultant Orthopaedic Surgeon) (Moderator, Katerini, Greece)
10:30 - 10:40
Operative versus non-operative treatment of ankle fractures – What do we know?
Nikolaos GOUGOULIAS (Consultant Orthopaedic Surgeon) (Speaker, Katerini, Greece)
10:40 - 10:50
When and how to treat deltoid ligament ruptures in ankle fractures?
Hans POLZER (Speaker, Germany)
10:50 - 11:00
When and how to treat anterior and posterior malleolar fractures?
Andrzej BOSZCZYK (consultant) (Speaker, Warsaw, Poland)
11:00 - 11:10
What to do differently in patients with relevant comorbidities?
Stefan RAMMELT (Head, Foot & Ankle Center) (Speaker, Dresden, Germany)
11:10 - 11:30
Discussion.
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11:30-13:00
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SYI05
SYMPOSIUM - ARTHREX
Advances in Orthopedics and Sports Medicine - Cases Discussions
SYMPOSIUM - ARTHREX
Advances in Orthopedics and Sports Medicine - Cases Discussions
13:00 - 13:20
Short-term Results of AutoCart for the Treatment of Osteochondral Defects of the Talus.
Tomas BUCHHORN (Keynote Speaker, Germany)
13:20 - 13:40
Ankle instability - from injury to performance.
Urszula ZDANOWIC (Keynote Speaker, Warsaw, Poland)
13:40 - 14:00
Return to Sports After Percutaneous Treatment of Achilles Ruptures.
Manuel SOUSA (Foot and Ankle Surgeon) (Keynote Speaker, Lisbon, Portugal)
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13:00-15:00
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13:00-14:00
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SYI06
SYMPOSIUM - GEISTLICH
SYMPOSIUM - GEISTLICH
13:00 - 14:00
AMIC® Chondro-Gide® for Osteochondral Lesions of the Ankle & MTP Joint: Evidence, Guidelines and Personal Experience.
Martinus RICHTER (Director) (Keynote Speaker, Rummelsberg, Germany), Bom Soo KIM (Professor) (Keynote Speaker, Incheon, Republic of Korea), Markus WALTHER (Medical Director) (Keynote Speaker, München, Germany)
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SYI07
SYMPOSIUM - INTERNATIONAL WBCT
Time to Capture the Full Picture with Weightbearing CT!
SYMPOSIUM - INTERNATIONAL WBCT
Time to Capture the Full Picture with Weightbearing CT!
13:00 - 13:06
Opening remarks.
Arne BURSSENS (Foot and ankle surgeon) (Keynote Speaker, Ghent, Belgium)
13:06 - 13:18
Capture your foot and ankle alignment fully automated on WBCT.
Martinus RICHTER (Director) (Keynote Speaker, Rummelsberg, Germany)
13:18 - 13:30
Rotational alignment of the lower limb determined by automated measurements on WBCT.
Andy GOLDBERG (Keynote Speaker, United Kingdom)
13:30 - 13:42
Understand the foot and ankle alignment after total ankle arthroplasty using WBCT.
Federico USUELLI (Keynote Speaker, Italy)
13:42 - 13:54
Reveal the foot and ankle alignment after supramalleolar ankle osteotomy using WBCT.
Kristian BUEDTS (Md) (Keynote Speaker, Brussels, Belgium)
13:54 - 14:00
Closing remarks.
Alessio BERNASCONI (Foot and Ankle - Orthopaedic Surgeon) (Keynote Speaker, Napoli, Italy)
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13:10-13:30
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PWP6
Poster Walks presentations 6
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
Poster Walks presentations 6
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
Moderators:
Laurens DE COCK (Md) (Moderator, Dendermonde, Belgium), Matthias WALCHER (Orthopaedic Surgeon) (Moderator, Würzburg, Germany)
13:10 - 13:30
#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
13:10 - 13:30
#41204 - PWK22 Delayed Wound Healing in Complex Hindfoot Surgery – An underappreciated problem?
Delayed Wound Healing in Complex Hindfoot Surgery – An underappreciated problem?
Delayed wound healing results in increased costs, repeated appointments, and unsatisfactory patient experience. We conducted an audit assessing incidence of delayed wound healing and causative factors.
This was a prospective audit of 109 patients undergoing foot and ankle surgery in a tertiary unit over four months. The standard was for 90% of wounds to heal by two weeks. Patients were seen by clinical nurse specialists at two weeks for wound review and management as required. We examined demographics, co-morbidity, type of surgery, and wound closure. Procedures included Forefoot (43%), Midfoot (13%), Non-fusion Ankle (14%) Hind foot/Ankle Fusion (14.5%), and Cavus /Planus correction (15.5%). Multinomial logistic regression was used to identify factors associated with delayed healing.
18 patients (16.5%) had delayed wound healing, requiring an additional 4 weeks to heal (2-20 extra weeks). All patients wounds healed with dressings and only 2 required antibiotics. Delays were seen in 32% of patients with multiple co-morbidity versus 12% in those without (p=0.03). The strongest predictive factor was type of surgery, with complex cases (hindfoot/ankle fusion; cavus/planus correction) associated with a delayed healing rate of 42.4% versus 5.3% for others (p<0.001, Odd’s Ratio 19.6). When considering complexity of surgery, co-morbidity did not independently predict wound healing delays.
Healing rates for simple cases met our audit standard. However, complex ankle/hindfoot cases had a 20-fold increase in delayed healing. Units undertaking complex work should be cognisant of the increased burden to patients and clinic time. Patients should be counselled, and complications monitored within a governance framework.
Angelica GHEORGHE, Karen ALLIGAN, Karan MALHOTRA, Cullen NICHOLAS, Shelain PATEL, Wilthelmino RONGAVILLA, Matthew WELCK (london, United Kingdom)
13:10 - 13:30
#42546 - PWK23 Radiological Posterior Medial Safe Zone of the Ankle. Protecting the Posterior Tibial Tendon During Ankle or Pilon Fracture Fixation.
Radiological Posterior Medial Safe Zone of the Ankle. Protecting the Posterior Tibial Tendon During Ankle or Pilon Fracture Fixation.
Background: The surgical treatment of pilon and posterior malleolar fractures can risk damage to the posterior tibial tendon (PTT). Our aim in this study was to identify the medial fluoroscopic safe zone, to prevent inadvertent injury to PTT during both direct and indirect fixation.
Methods: A cadaveric study was performed using 9 fresh frozen cadavers. A medial posteromedial approach was performed on each specimen to expose the PTT sheath. A flexible wire was placed down the lateral aspect of PTT sheath as a radio opaque marker. Fluoroscopic imaging was performed in the anteroposterior and lateral position to identify a medial safe zone.
Results: In all specimens, the wire was located medial to a vertical line corresponding to the articular surface (the medial safe zone line) of the medial malleolus on anteroposterior imaging. On lateral imaging, the marker followed the medial malleolus obliquity and continued to correspond to 30% of the posterior plafond.
Conclusion: This study demonstrated that a medial safe zone fluoroscopic landmark is unambiguous in localizing the PTT sheath and that any metal work medial to this line is likely to be at risk of damaging the tibialis posterior tendon. The lateral radiograph showed that any anteroposterior screw could involve the PTT sheath even if the penetration is only 70% across the tibial width.
Clinical relevance: We described a radiographic and clinical safe zone to protect PTT during fixation and hardware placement. This information will assist surgeons in avoiding hardware placement that can damage PTT.
Vasileios LAMPRIDIS (UK, United Kingdom), Ben JONES, Junaid AAMIR, William HARRISON, Kyle ROUGHNEEN, Alastair BOND, Lyndon MASON
13:10 - 13:30
#42585 - PWK24 Distance mapping patterns analysis of tibiotalar joint in ankle osteoarthritis: The battleship technique.
Distance mapping patterns analysis of tibiotalar joint in ankle osteoarthritis: The battleship technique.
Background: Weightbearing computed tomography (WBCT) enables the creation of intraarticular distance mapping (DM), an algorithm which assesses the distance between articular surfaces and assigns predetermined colors to generate a visual representation of the joint interaction. Similar foot and ankle (FA) alignments have demonstrated to share DM patterns. This study aims to create predictable DM patterns in patients with OA of the tibiotalar joint, using a novel method created by the authors coined the "battleship technique," and evaluate whether these patterns correspond to FA alignment.
Methods: Forty OA ankles were included. We calculated the DM weighted sum of the tibiotalar joint using the battleship technique (BTT) to obtain a single coordinate representing the deformity's apex on the X- and Y-axis. Patients were divided into two coronal groups (valgus and varus) and two sagittal groups (anterior translation and posterior translation) and compared.
Results: There was a statistically significant difference between the coronal group in α,
talar surface, hindfoot alignment, and talar tilt angles and β angle and tibiotalar ratio in the sagittal groups. A statistically significant correlation was found between the talar surface and talar tilt angle to the location of the X-coordinate and between the β angle and the tibiotalar ratio to the location of the Y-coordinate.
Conclusion: The battleship technique can create predictable DM patterns in patients with advanced OA changes in the tibiotalar joint. This pattern corresponds to the ankle alignment in the coronal and sagittal plane, indicating that this technique could locate the intraarticular deformity's apex.
Efrima BEN, Agustin BARBERO (Milan, Italy), Cristian INDINO, Camilla MACCARIO, Federico USUELLI
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13:35-13:55
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PWK7
Poster Walks presentations 7
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
Poster Walks presentations 7
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
Moderators:
Nick CULLEN (Consultant foot and ankle surgeon) (Stanmore uk, United Kingdom), Sabine OCHMAN (Consultant) (Muenster, Germany)
13:35 - 13:55
#42577 - PKW25 The influence of pre-operative reduction quality on post-operative wound complications in ankle fractures: a review of 247 cases.
The influence of pre-operative reduction quality on post-operative wound complications in ankle fractures: a review of 247 cases.
The initial management for unstable ankle fractures involves urgent fracture reduction and immobilisation. However, opinions vary on the definition of an adequate pre-operative reduction. We hypothesised that residual tibiotalar subluxation may limit the resolution of soft tissue swelling and impair post-operative wound healing. This study aimed to evaluate the rate of wound complications following ankle fracture fixation according to the quality of pre-operative reduction. We conducted a retrospective case series of all ankle fractures in adults (> 18 years old) treated with surgical fixation at a district general hospital from January 2020 until July 2023. Pre-operative reduction was categorised as adequate or inadequate according to the absence or presence of residual tibiotalar joint subluxation on post-manipulation radiographs, respectively. Wound complication was defined as any wound problem requiring dressing care, antibiotics, or a return to theatre. 247 patients were included in this study, with a mean follow-up duration of 21.6 weeks. 98 (39.7%) patients had an inadequate pre-operative reduction with residual subluxation of the tibiotalar joint. There were 29 (11.7%) cases of post-operative wound complications, of which 7 (24.1%) required surgical interventions. The rate of wound complications was higher in patients with an inadequate pre-operative reduction compared to those in whom adequate reduction was achieved (17.3% versus 8.1% respectively, p = 0.026). Inadequate pre-operative reduction with residual tibiotalar subluxation is a risk factor for post-operative wound complications in ankle fractures. Urgent intervention is warranted in cases with persistent subluxation despite multiple attempts at closed reduction.
Rye Yern YAP (Hereford, United Kingdom), Peter LOGAN, Mohammad IQBAL, Vishwajeet KUMAR, Zaid AL-WATTAR
13:35 - 13:55
#42578 - PKW26 Comparison of the measurement of the Calcaneal X/Y ratio on plain radiographs and CT scan.
Comparison of the measurement of the Calcaneal X/Y ratio on plain radiographs and CT scan.
Background:
In 2018, Tourne et al introduced the X/Y ratio as a novel radiological parameter to assess relative calcaneal length. Their research concluded that any calcaneum showing a ratio less than 2.5 can be considered “long” predisposing for the Haglund's syndrome.
The aim of our study was to evaluate the accuracy of the XY ratio measurement on the plain radiographs reflecting the morphology of the calcaneum.
Methods:
Two assessors measured the X/Y ratio of fifty patients on the plain radiograph using the Tourne et al’s technique. The X/Y ratio was also assessed on sagittal cuts of the CT scan of the ankle joint, with the axis of the CT scan image adjusted on the axial cut to run parallel to the long axis of the calcaneum.
Results:
The mean X/Y ratio measurements of the two assessors on X-ray (2.71±0.43 and 2.69±0.41) were lower than those measured on CT (3.14±0.44 and 3.10±0.44). The intra-observer agreement for X-ray and CT scan ratios was poor for both assessors (ICC = .487 and .476). Interobserver reliability of the X/Y ratio measured on plain radiographs was good, and it was excellent when measured on CT scans (ICC = .808 and .956).
Conclusions:
The poor agreement between the measurement on X-ray and CT scan indicates that the X/Y ratio on X-ray doesn’t necessarily reflect the true morphology of the Calcaneum. Our study is the first to assess the X/Y ratio on CT scan. the excellent interobserver agreement shows that it is a reliable method.
Hesham OSHBA (Crowthorne, United Kingdom), Kate NICHOLLS, Togay KOC, Neeraj PUROHIT, Raghda SHAABAN
13:35 - 13:55
#42590 - PKW27 Enhancing precision in osteochondral lesion of the talus measurements and improving agreement in surgical decision-making: A comprehensive evaluation using weight-bearing computed tomography and distance mapping for preoperative planning.
Enhancing precision in osteochondral lesion of the talus measurements and improving agreement in surgical decision-making: A comprehensive evaluation using weight-bearing computed tomography and distance mapping for preoperative planning.
Purpose: Weight-bearing CT (WBCT) enables three-dimensional modeling of ankle morphology, while distance mapping (DM) provides color-coded representation of intraarticular distance, particularly beneficial for delineating osteochondral lesions of the talus (OLT). This study aims to assess DM's reliability in measuring OLT surface, depth, and volume and its role in achieving consensus among surgeons regarding optimal surgical intervention.
Methods: Thirty-six patients with 40 OLTs underwent WBCT and DM evaluation. Two raters utilized DM to define lesion boundary (LB) and lesion fundus (LF) and calculate lesion depth, surface, and volume. Treatment options were selected based on measurements, and inter-rater and intra-rater agreement were assessed.
Results: Interrater and intrareader agreement for lesion depth surface showed excellent correlation (0.90 - 0.94, p < 0.001). Cohen's Kappa analysis indicated near-perfect agreement (Kappa = 0.834, p < 0.001) for preferred preoperative plans. The study demonstrated that WBCT and DM together offer reliable measurements of OLT parameters, facilitating accurate treatment planning and enhancing interrater consensus among surgeons.
Conclusion: WBCT-based 3D modeling and DM prove to be valuable tools for evaluating OLTs, providing precise measurements of surface, depth, and volume with excellent reliability. Integration of these techniques into preoperative planning enhances surgical decision-making, ensuring optimal outcomes for patients with OLTs. Further research may explore the broader applicability of WBCT and DM in orthopedic practice to improve treatment strategies and patient care.
Efrima BEN, Agustin BARBERO (Milan, Italy), Jari DAHMEN, Amit BENADY, Cristian INDINO, Camilla MACCARIO, Gino KERKHOFFS, Federico USUELLI
13:35 - 13:55
#42592 - PKW28 Comparison of hindfoot preoperative alignments and postoperative total ankle arthroplasty positioning using weight-bearing computed tomography-generated 3 dimensional models.
Comparison of hindfoot preoperative alignments and postoperative total ankle arthroplasty positioning using weight-bearing computed tomography-generated 3 dimensional models.
Background: Traditional imaging methods for total ankle arthroplasty (TAA) suffer from rotational bias and bone superimposition, necessitating more precise assessment techniques. Weight-bearing computed tomography (WBCT) and 3D models from WBCT have revolutionized foot and ankle alignment visualization, offering unparalleled detail. This study aims to compare preoperative hindfoot alignment with postoperative outcomes in TAA across three planes and assess measurement reliability.
Methods: Eighty-one TAA patients underwent preoperative and postoperative WBCT, measuring five coronal angles (Alpha, TSA, TT, SA, TCA), three sagittal angles (Beta, Gamma, TTR), and one axial angle (PTARA). Two raters evaluated measurements pre- and post-surgery in separate sessions. Pre- and postoperative measurements were compared, and inter-rater and intra-rater reliability were calculated.
Results: Significant changes were observed in three coronal (TSA, TT, SA) and two sagittal angles (Beta, Gamma) (P < 0.001). Alpha, TCA, TTR, and PTARA showed no significant changes (P > 0.05). Intra- and inter-rater reliability scores ranged from 0.885 to 0.97, indicating good to excellent correlation.
Conclusion: WBCT-based 3D modeling facilitates detailed comparison of preoperative alignment and postoperative TAA positioning across coronal, sagittal, and axial planes, highlighting significant adjustments in coronal and sagittal alignments. The high reliability underscores the value of WBCT and 3D modeling in preoperative planning, enhancing surgical intervention accuracy.
Efrima BEN, Agustin BARBERO (Milan, Italy), Amit BENADY, Cristian INDINO, Camilla MACCARIO, Federico USUELLI
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SYI10
SYMPOSIUM - STRYKER
SYMPOSIUM - STRYKER
14:00 - 15:00
Another step forward together - Innovation & Survivorship in Total Ankle Replacement.
David TOWNSHEND (Keynote Speaker, North Shields, United Kingdom), Andy GOLDBERG (Keynote Speaker, United Kingdom), Jean BRILHAULT (Keynote Speaker, Trelaze, France)
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14:00-15:00
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SYI08
SYMPOSIUM - ACUMED
SYMPOSIUM - ACUMED
14:00 - 15:00
Treating Trimalleolar Ankle Fractures.
Kristian BUEDTS (Md) (Keynote Speaker, Brussels, Belgium), Jan MARTINEZ LOZANO (Resident) (Keynote Speaker, Barcelona, Spain)
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14:00-14:20
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PWK8
Poster Walks presentations 8
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
Poster Walks presentations 8
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
Moderators:
Elisabeth ELLINGSEN HUSEBYE (Senior consultant) (Oslo, Norway), Anja HELMERS (Germany)
14:00 - 14:20
#42593 - PWK29 Reliability of cone beam weightbearing computed tomography analysis of total ankle arthroplasty positioning and comparison to weightbearing x-ray measurements.
Reliability of cone beam weightbearing computed tomography analysis of total ankle arthroplasty positioning and comparison to weightbearing x-ray measurements.
Background:
The current reference standard for postoperative evaluation of total ankle arthroplasty (TAA) positioning, weightbearing radiography (WBXR), is subject to technical bias. Weightbearing cone beam computed tomography (WBCT) enables visualization of the foot's complex 3-dimensional (3D) structure under standing load. To date, no WBCT-based system for TAA positioning has been validated. The purpose of this study was to (1) assess TAA positioning using WBCT 3D models and (2) evaluate the agreement levels between 2 raters and thus evaluate the intermethod reliability with respect to WBXR.
Methods:
Fifty-five consecutive patients were retrospectively reviewed. Two raters independently created a 3D WBCT model using dedicated software and recorded the following measurements: α angle, tibiotalar surface angle (TSA), hindfoot angle (HFA), tibiotalar ratio (TTR), β angle, γ angle, and Φ angle. Measurements were repeated 2 months apart in similar, independent fashion and compared to WBXR. Interobserver, intraobserver, and intermethod agreements were calculated.
Results:
All 7 measurements showed good to excellent intraobserver and interobserver reliability (ICC 0.85-0.95). The intermethod (WBCT vs WBXR) agreement showed good agreement for the γ angle (ICC 0.79); moderate agreement levels for the α angle, TSA angle, β angle, and TTR (ICC 0.68, 0.69, 0.70, and 0.69, respectively); poor agreement for the HFA (ICC 0.25); and negative agreement for the φ angle (ICC −0.2).
Conclusion:
Position analysis of TAA using WBCT demonstrated good to excellent interobserver and intraobserver agreement and can be reliably used. Additionally, a negative to moderate agreement between standard WBCT and standard
WBXR was found.
Efrima BEN, Agustin BARBERO (Milan, Italy), Cristian INDINO, Camilla MACCARIO, Federico USUELLI
14:00 - 14:20
#42602 - PWK30 Anterior Translation of the Talus Post Anterior Pilon Fixation. Are we Missing Something?
Anterior Translation of the Talus Post Anterior Pilon Fixation. Are we Missing Something?
Background: Anterior Pilon fractures are uncommon injuries to the ankle. Fixation of the fracture is commonly undertaken, however concomitant injury to the anterior talofibular ligament (ATFL) is not commonly addressed. There are no current studies assessing talus translation in anterior Pilon fractures.
Objective: To assess incidence of persistent talus anterior translation in Pilon fractures affecting the anterior plafond.
Methods: A retrospective analysis of a prospectively collected database in a major trauma centre was undertaken to establish eligible patients. All patients with Pilon fractures with anterior components undergoing reduction and fixation were included. Intraoperative and weightbearing postoperative radiographs were assessed for fracture reduction and anterior talus translation. The Topliss Classification was used for pilon type characterisation.
Results: A total of 57 patients were identified who could be included in the study. The mean age of patients was 43.60 years (95% CI 39.87, 47.33). Out of the full cohort, 80.70% (46/57) were judged to be anatomically reduced. There were 39 patients (68.42%) with persistent anterior talus translation. There was no significant difference between types of Pilon fractures (p=.581). There was a higher rate of persistent anterior translation with coronal fracture types 72.73% (32/44) as compared to sagittal fracture types 53.85% (7/13).
Conclusion: Over half the patients in this study had persistent anterior talus translation post fixation despite being anatomically reduced. The fracture mechanism to sustain an anterior Pilon is likely to injure the ATFL, which if unrepaired, may remain unstable. Cartilage loss and over compression of the fracture are other possible aetiologies.
Vasileios LAMPRIDIS (UK, United Kingdom), James MCEVOY, William HARRISON, Lyndon MASON
14:00 - 14:20
#42612 - PWK31 Impact of Initial Tendon Gap Size on Outcomes of Functional Rehabilitation in Achilles Tendon Rupture.
Impact of Initial Tendon Gap Size on Outcomes of Functional Rehabilitation in Achilles Tendon Rupture.
This study investigates the relationship between the initial gap size of a ruptured Achilles tendon and patient outcomes following a functional rehabilitation program. Factors like age and activity level typically influence treatment decisions, but the gap size between tendon ends remains debated. The research focuses on defining any correlation between the initial tendon gap and outcomes in patients treated non-surgically with functional rehabilitation.
Method:
A prospective case series study was conducted on patients with acute Achilles tendon rupture treated non-surgically with a functional rehabilitation program from 2016 to 2018. The tendon gap was measured via ultrasound at the initial presentation. Patients were followed for at least 12 months and evaluated using the Achilles Tendon Rupture Score (ATRS), plantarflexion strength, and re-rupture rate.
Results:
Out of 56 patients who completed the one-year follow-up, 2 experienced re-ruptures. The average plantarflexion gap was 13.7 mm. The mean ATRS at 12 months was 85.12. No statistically significant correlation was found between the final ATRS and the initial rupture gap.
Conclusion:
The outcome following non-operative functional rehabilitation treatment of ruptured Achilles tendon did not correlate with the size of the tendon gap, and the authors recommend that the decision on functional rehabilitation should not be based on these criteria.
Amr ABOUELELA (England, United Kingdom), Islam MUBARK
14:00 - 14:20
#42652 - PWK32 Digital monitoring of weight-bearing improves success rates and reduces complications in lower extremity surgeries.
Digital monitoring of weight-bearing improves success rates and reduces complications in lower extremity surgeries.
The aim of this study is to develop a digital monitoring system to track weight and evaluate its impact on postoperative outcomes after lower extremity surgeries (LES). This parallel randomized controlled trial enrolled 266 patients who underwent LES (fracture or joint replacement) at our medical center between March 11, 2022, and January 10, 2023. Patients were randomly assigned to the intervention and control groups in a 1:1 ratio. The intervention group (n=116) used a cane and shoes equipped with a weight-bearing system after lower limb surgery, while the control group (n=116) used a simple cane and shoes without a weight-bearing system. The primary outcomes included callus formation, duration of union, and success rate of union in the two groups. The intervention group had a significantly higher rate of complete surgical success than the control group (93.9% vs. 79.3%, p=0.001). The intervention group also had a significantly lower risk of non-union than the control group (OR: 2.33, 95% CI: 1.14, 3.48, p=0.001). The mean duration of surgery until the time of union and the meantime of callus formation was significantly lower in the intervention group (p=0.01). The use of a digital monitoring system for weighing in LES significantly increased the success rate and reduced post-operative complications. Therefore, incorporating this system can enhance the rehabilitation process and prevent revision surgeries in patients with LES.
Babk OTOUKESH, Shayan AMIRI (Tehran, Islamic Republic of Iran)
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14:00-15:00
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SYI09
SYMPOSIUM - MEDARTIS
SYMPOSIUM - MEDARTIS
14:00 - 15:00
Remodelling the foot, unloading the ankle.
Alexandros ELEFTHEROPOULOS (Foot and Ankle specialist) (Keynote Speaker, Naousa, Greece), Christian PLAASS (Consultant) (Keynote Speaker, Hannover, Germany), Victor VALDERRABANO (Chairman) (Keynote Speaker, Basel, Switzerland)
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PWK9
Poster Walks presentations 9
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
Poster Walks presentations 9
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters
Moderators:
Hans-Jörg TRNKA (Director) (Vienna, Austria), Alistair WILSON (Consultant) (Belfast, United Kingdom), Emre BACA (assoc. prof) (istanbul, Turkey)
14:20 - 14:40
#42759 - PWP33 The kinematics of the distal tibiofibular joint in syndesmosis instability and its reconstruction - a biomechanical in vitro study.
The kinematics of the distal tibiofibular joint in syndesmosis instability and its reconstruction - a biomechanical in vitro study.
The aim of the present study was to investigate the stability of the syndesmosis after transection and the effect of stabilization with rigid and dynamic reconstruction techniques.
Syndesmosis stability was investigated using a six-axis industrial robotic arm on human lower leg specimens (n=14). In neutral position, dorsiflexion and plantar flexion, stability was examined using an external rotation stress test under an axial load of 200 Newtons. The examination was performed on the intact syndesmosis and the sequentially transected syndesmosis (1. transection of anterior inferior tibiofibular ligament (AITFL); 2. transection of interosseous ligament (IOL); 3. transection of posterior inferior tibiofibular ligament (PITFL). Reconstruction was then performed using either various screw techniques (n=7) or a dynamic suture button system (Arthrex Tightrope, n=7).
In the coronal plane, both rigid and dynamic reconstruction techniques led to an equivalent reduction in lateralization.
In the axial plane, transection of the AITFL did not lead to significant rotational instability, whereas transection of the IOL led to instability. Stability could be reconstructed by implantation of 2 tricortical set screws, whereas instability remained with dynamic reconstruction.
In the sagittal plane, a dorsal displacement of the AITFL already occurred when the AITFL was cut. This could be stabilized with all screw reconstructions, but not with the suture button procedures.
The results indicate instability of the fibula, particularly in the sagittal and axial plane. In addition, our model shows an equivalence of the different screw techniques and the reconstruction with two suture buttons.
Alexander MILSTREY (Muenster, Germany), Vivienne HOELL, Jens WERMERS, Stella GARTUNG, Michael RASCHKE, Julia EVERS, Sabine OCHMAN
14:20 - 14:40
#42886 - PWP34 Bio-integrative screws versus metallic screws for calcaneus osteotomies: a non-inferiority randomized clinical trial.
Bio-integrative screws versus metallic screws for calcaneus osteotomies: a non-inferiority randomized clinical trial.
Introduction
The use of bio-integrative implants in orthopedic surgery is growing. While many biomechanical and histological reports could sustain its structural and biological properties, few clinical studies support its use. This trial aims to determine the bio-integrative screws' capacity to reach non-inferior clinical and radiographical outcomes of current metallic screws in calcaneus osteotomies.
Methods
This was a single center, in parallel groups, randomized, non-inferiority clinical trial (NCT05018130) including patients undergoing open calcaneal sliding osteotomy. Surgeries were performed respecting the same technique, using 2 canulated 4mm screws, either titanium or fiber. Primary outcome was bone healing by weight-bearing computed tomography at the 6th postoperative week. Secondary outcomes included healing, minor and major assessed until 48 weeks of follow-up. Readings were performed by two assessors.
Results
24 feet were included in the study. Groups were similar demographically (ps>0.37), with 12 allocated to the bio-integrative and 12 to the metallic groups. The mean follow-up was 23.3 months (15-33) with no losses. Considering bone healing at six weeks, the bio (83.3%) and the metallic (66.7%) groups had similar rates (p=0.320), what was maintained at 12 weeks (100% vs. 91.7% respectively; p=0.500). Minor complications were similar between groups (16.7% vs. 16.7%; p=1), all resolved by six weeks. No major complications and no secondary surgeries were observed.
Conclusion
Bio-integrative screws presented non-inferior results to metallic screws when used in calcaneus osteotomies, considering bone healing and complications. Larger and longer trials are necessary to determine the superiority of any implant and its impact on orthopedic surgery.
Nacime Salomao BARBACHAN MANSUR, Eli SCHMIDT, Francois LINTZ, Chinelati ROGERIO, Matthieu LALEVEE, Cesar DE CESAR NETTO (Iowa City, USA)
14:20 - 14:40
#42888 - PWP35 Biomechanical evaluation of screw vs. k-wire reconstructions for instable Lisfranc injuries.
Biomechanical evaluation of screw vs. k-wire reconstructions for instable Lisfranc injuries.
There is currently no consensus regarding the choice of implant for instable Lisfranc injuries. The aim of this study was to investigate the effects of a transection of the Lisfranc ligaments on the height of the foot and the distance between the Os cuneiforme mediale (CM) and Os metatarsale 2 (MT2). In a second step, the stability of screw vs. K-wire reconstruction was investigated.
16 human specimens were loaded with 200N and 700N in a testing machine. Sequential measurements were performed in the native state and after cutting the dorsal, interosseous and plantar Lisfranc ligaments. In a final step, the entire tarsometatarsal (TMT) ligaments were transected.
Subsequently, in two groups of 8 paired specimens each, TMT joints 1-3 were addressed with 3.5mm screws or 2.0mm K-wires, TMT joints 4-5 were always addressed with 2.0mm K-wires. Biomechanical and radiological analysis was performed.
Already at 200N loading, there was a relevant loss of height of the CM (p=0.0005) and MT2 (p=0.002) after transection of the dorsal ligament. The screw reconstruction successfully restored the height and distance of both the CM (p=0.0101) and the MT2 (p=0.0088). The K-wire reconstruction did not achieve a significant improvement on both the CM (p=0.8358) and the MT2 (p=0.9981) under load.
Especially in unstable Lisfranc injuries, the screw versus K-wire reconstructions were superior. Vertical instability could be determined as a sensitive parameter that is not yet regularly used in diagnostics. An increase in the axial distance between CM and MT2 only occurs when all ligaments are injured.
Alexander MILSTREY (Muenster, Germany), Franziska WERMELING, Julia EVERS, Michael RASCHKE, Sabine OCHMAN
14:20 - 14:40
#42961 - PWP36 Research on Determining Bony Landmarks for Accurate Tibiofibular Syndesmotic Fixation: Cadaveric Validity and Safety Analysis of Angle Bisector Method.
Research on Determining Bony Landmarks for Accurate Tibiofibular Syndesmotic Fixation: Cadaveric Validity and Safety Analysis of Angle Bisector Method.
Introduction
Determining the optimal intraoperative fixation angle for syndesmosis remains uncertain and depends on the surgeon. This study aims to evaluate whether the angle bisector method can provide a patient- and level-specific syndesmotic fixation angle that is reproducible and safe in a cadaveric setting.
Methods
Funded by the AOFAS Research Grants Program, cadaveric leg specimens underwent fixation using the angle bisector method at two levels (2-cm and 3.5-cm proximal) parallel to the tibial plafond by two surgeons. The angle bisector method involved a drill and screw directed along the bisector of the angle, formed between two K-wires at the fixation level. Post-fixation CT images were analyzed to measure the angle between the true centroidal axis and the screw axis. Distances between the centroidal axis and screw entry points, as well as between K-wires and major neurovascular structures, were measured and documented.
Results
The average angle between the centroidal axis and screw trajectory was 2.7 degrees at the 2-cm level and 1.8 degrees at the 3.5-cm level. The distance between entry points averaged 1.7 mm at 2-cm and 1.2 mm at 3.5-cm. Results showed low inter-surgeon variability and high intra- and inter-observer reliability (ICC > 0.80). Trajectories differed significantly between levels. The distance between K-wires and neurovascular structures was always over 5 mm, with no damage noted, confirming the method's safety.
Conclusion
The angle bisector method provides an accurate and safe syndesmotic fixation trajectory. This technique can be easily implemented using K-wires or a specially designed jig.
Bedri KARAISMAILOGLU (Istanbul, Turkey), Julian HOLLANDER, Jiyong AHN, Siddhartha SHARMA, Matthias PEIFFER, Lorena BEJARANO-PINEDA, Daniel GUSS, John Y KWON, Christopher DIGIOVANNI, Soheil ASHKANI-ESFAHANI, Gregory WARYASZ
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FP3
FREE PAPERS 3: Forefoot
FREE PAPERS 3: Forefoot
Moderators:
Alberto GINÉS CESPEDOSA (Adjunto) (Moderator, Barcelona, Spain), Sabine OCHMAN (Consultant) (Moderator, Muenster, Germany)
15:00 - 15:06
#41114 - OP21 The surgical treatment of brachymetatarsia by one-stage lengthening of the metatarsal bone using an autograft from tubular bones of the foot.
The surgical treatment of brachymetatarsia by one-stage lengthening of the metatarsal bone using an autograft from tubular bones of the foot.
Introduction. Brachymetatarsia is a fairly rare pathology that is characterized by shortening of the metatarsal (or metatarsals) bones due to premature closure of the growth plate. However, most patients suffering from this pathology require surgical treatment.
Purpose of the study: to improve the results of treatment of patients with brachymetatarisis by introducing into surgical practice the method of simultaneous lengthening of the metatarsal bone using an autograft from the tubular bones of the foot.
Materials and methods. This article presents a comparison of treatment results between two groups of patients. The main group of patients (40 patients, 50 feet) underwent simultaneous lengthening of the shortened metatarsal bone using autografts from tubular bones of the foot. The control group of patients (25 patients, 33 feet) underwent distraction osteosynthesis of the metatarsal bone using an external fixation device.
Results. The results obtained during the study suggest the advantage of the method of one-step lengthening of the metatarsal bone using autografts from tubular bones of the foot over the distraction method. Patients in the main group had a shorter healing period compared to the control group (8.1±1.3 and 16.2±2.4 weeks, respectively), and fewer complications. Also, patients of the main group in the early postoperative period noted a high cosmetic result of the operation.
Conclusions. By using the developed method of surgical treatment, we were able to significantly reduce the treatment time for patients, as well as achieve high aesthetic results.
Levon MAKINYAN (Moscow, Russia), Albert MANNANOV, Vladislav APRESYAN
15:12 - 15:18
#43158 - OP23 Comparative Biomechanical Study of Different Screw Fixation Methods Following Minimally Invasive Chevron-Akin (MICA): A Finite Element Analysis.
Comparative Biomechanical Study of Different Screw Fixation Methods Following Minimally Invasive Chevron-Akin (MICA): A Finite Element Analysis.
Background: Minimally Invasive Chevron-Akin (MICA) hallux valgus (HV) deformity correction utilizes an extra-articular distal first metatarsal chevron osteotomy that is held with rigid fixation using two fully threaded screws, of which one is bicortical to provide stability. However, the necessity of two screws is debated, as is the necessity of bicortical fixation. Despite the clinical success of MICA, there is a lack of biomechanical studies assessing the stability and strength of different fixation constructs.
Methods: A 3D foot finite element model was developed from computed tomography images of a female patient with moderate HV deformity. Five different screw configurations were assessed using FEA, including fourth-generation MICA fixation with 2 screws (one bicortical and one intramedullary), 2 intramedullary screws, 2 bicortical screws, 1 intramedullary screw, and 1 bicortical screw. Loading conditions involved a vertical ground reaction force applied to the midfoot, with simulated 150N and 300N loads. Stress analysis considered osteotomy displacement, maximum and minimum principal stresses, and equivalent von Mises stress for both implants and bone.
Results: FEA indicated that MICA fixation with two screws (one bicortical and one intramedullary) demonstrated the lowest values for osteotomy displacement, minimum and maximum total stress, and equivalent von Mises stress on the bone and screws in both loading conditions.
Conclusion: This biomechanical analysis provides valuable insights into the strength of different MICA screw fixation configurations, highlighting the superiority of classical MICA fixation configurations with two screws in terms of stability and stress distribution.
Thomas LEWIS, Henrique MANSUR, Gabriel FERREIRA, Miguel VILHO, Leonardo BATTAGLION, Roberto ZAMBELI, Robbie RAY (London, United Kingdom), Gustavo NUNES
15:18 - 15:24
#42948 - OP24 Does decompressive chevron osteotomy decrease subchondral bone density of the 1st metatarsophalangeal joint in hallux rigidus?
Does decompressive chevron osteotomy decrease subchondral bone density of the 1st metatarsophalangeal joint in hallux rigidus?
Objective: To investigate the impact of decompressive chevron osteotomy on subchondral
bone density at the first MTP joint.
Methods: Sixteen feet (12 patients) with hallux rigidus underwent decompressive chevron
osteotomy. Pre- and post-operative standing cone beam 3DCT were assessed, and clinical
data was collected. Radiologic measurements, including bone density using Hounsfield units
(HU), were conducted. Statistical analyses were performed to evaluate changes and
correlations.
Results: Post-operative bone density significantly decreased in proximal (Pre, 650.9±149.1;
Post, 312.4±115.9; p<0.001) and distal (Pre, 910.4±143.3; Post, 639.0±167.1; p<0.001)
components of the first MTP (joint and the first TMT (Pre, 762.9±166.6; Post, 611.5±165.9;
p=0.015) joint. No significant difference was measured at the TT joint (Pre, 497.5±143.6;
Post, 534.3±130.7; p=0.463). Length of the first metatarsal (Pre, 60.4±3.4; Post, 54.3±3.0;
p<0.001) and metatarsal protrusion index (MPI) (Pre, -0.9±3.0; Post, -9.0±3.6; p<0.001)
significantly decreased post-operatively. Clinical assessments showed significant
improvements in AOFAS scores (36.1±14.5 points) and pain on VAS scale (- 5.3±1.9).
Conclusion: Decompressive chevron osteotomy leads to a significant decrease in
subchondral bone density of the first MTP joint. A decrease in bone density occurs also in the
first TMT joint.
Luca TANEL (Bolzano, Italy), Matthieu LALEVEE, Philippe BEAUDET
15:24 - 15:30
#42986 - OP25 The presence of an avulsion fracture of the 1st tarso-metatarsal joint in Lisfranc injuries is a useful adjunct in the detection of 1st TMTJ instability.
The presence of an avulsion fracture of the 1st tarso-metatarsal joint in Lisfranc injuries is a useful adjunct in the detection of 1st TMTJ instability.
Aims
Ligamentous Lisfranc injuries often feature avulsion fractures of the tarso-metatarsal joint (TMTJ). A proportion of these will have a congruent TMTJ joint on initial imaging, and many of these patients will have an unstable TMTJ which requires stabilisation.
The study aimed to determine the relationship between the presence of an avulsion fracture on initial imaging and instability of the first TMTJ.
Methods
A prospective database of Lisfranc fracture-dislocations was analysed for the presence of TMTJ1 avulsion fractures. All cases were managed with examination under anaesthesia (EUA) and stress testing under image intensification prior to fixation or arthrodesis surgery. The rate of TMTJ1 instability and the sensitivity and specificity of the presence of an avulsion in detecting instability was determined.
Results
153 patients with a mean age of 35.2 years were included. 99 injuries (64.7%) had an avulsion fracture of TMTJ1 on imaging. Of these, 76.7% had a congruent joint on XR or CT scan. 91.9% of patients with an avulsion fracture demonstrated instability on EUA stress testing. Amongst the 54 cases showing no avulsion, 23 (42.6%) were unstable on EUA. The presence of an avulsion had a sensitivity of 79.8% and a specificity of 79.5% in the detection of instability.
Conclusions
The presence of an avulsion fracture of TMTJ1 is highly suggestive of instability. This finding should lower the threshold to perform EUA stress testing. A high proportion of Lisfranc injuries without avulsion fractures have TMTJ1 instability, and therefore the absence of this finding does not reliably exclude instability.
Prashant SINGH (London, UK, United Kingdom), Neil JONES, Marco PES, Francesc MALAGELADA, Amit PATEL, Lucky JEYASEELAN
15:30 - 15:36
#41019 - OP26 Noninferiority of copper dressings compared to negative pressure wound therapy in diabetic foot – an RCT study.
Noninferiority of copper dressings compared to negative pressure wound therapy in diabetic foot – an RCT study.
Aim:
Compare the wound healing rate, cost, and convenience between Negative Pressure Wound Therapy (NPWT) and Copper Oxide Dressings (COD) in the management of diabetic foot wounds (DFW).
Method:
A Randomized controlled trial (RCT) with 46 DFW, in whom NPWT was indicated. Twenty-three patients were enrolled in the COD and NPWT arm for three months or wound closure. The primary endpoint was wound size reduction, assessed by "Tissue Analytic" program. Secondary endpoints were convenience, application time, pain, and cost.
Results:
The initial wound area was 19.9±4.36 and 14.1±2.32 cm2 in the COD and NPWT arms, respectively (p=0.25). Wound size reduction was statistically significant non-inferior of the COD Arm compared to the NPWT (p=0.04) and superior in the last visit (T-test, p=0.032). 11 (47.8%) and 8 (34.8%) wounds were closed during the study in the COD and NPWT arms respectively (P=0.37). COD therapy was more convenient for the patients (Visual Analog Score [VAS] was 8.44 vs. 5.33; p=0.002) and the medical personnel (8.29 vs. 6.0; p=0.007), and less painful (1.15 vs. 2.19; p=0.67) in the COD arm compared to NPWT. The COD's mean application time was shorter (8.5 vs. 13.25 minutes; p<0.001). The cost of COD is estimated to be 84% less than NPWT treatment.
Conclusion:
This RCT study indicates statistically significant non-inferiority of COD dressing therapy than NPWT in terms of wound healing rate of DFW. Better convenience and reduced costs in the COD arm justify initial copper dressing attempts in patients with diabetic foot wounds before NPWT treatment.
Eyal MELAMED (Haifa, Israel), Jihad DABBAH, Michael PINZUR
15:36 - 16:00
Discussion.
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FP4
FREE PAPERS 4: Midfoot & Hindfoot
FREE PAPERS 4: Midfoot & Hindfoot
Moderators:
Mostafa BENYAHIA (Surgeon) (Copenhagen, Denmark), Antonio VILADOT (orthopaedic Surgeon) (Barcelona, Spain)
15:00 - 15:06
#42939 - OP27 Middle Facet Subluxation in PCFD: Effects of Plane Orientation on WBCT Measurements.
Middle Facet Subluxation in PCFD: Effects of Plane Orientation on WBCT Measurements.
Introduction:
Middle facet subluxation (MFS) and middle facet incongruence angle (MFIA) are commonly reported as marker of peritalar subluxation (PTS) in Progressive Collapsing Foot Deformity (PCFD). In the literature MFS and MFIA are assessed a true coronal plane which differs from the plane of the middle facet. We hypothesized that changes in the plane’s of measurement would lead to changes in the MFS and MFIA and as well its “dysplastic” appearance.
Method:
retrospective case-control study, 89 patients with PCFD and 11 controls. Measurements of MFS, MFIA, and middle facet dysplasia were conducted using both the classical method (taking measurements in the coronal plane as described in the literature) and the new method ( taking measurements after rotation of the coronal plane until it was perpendicular to the middle facet plane). A p-value of <0.05 was considered statistically significant.
Results:
Significant differences were observed between the two methods across all parameters, the new method demonstrated lower MFS (25.4% vs. 40.3%, p<0.0001), lower MFIA (4.7 degrees vs. 13.1 degrees, p<0.0001), and fewer dysplastic joints (1% vs. 37%, p<0.0001)
For controls, only the MFIA was significantly different (p:0.0045) between methods.
Conclusion:
MFS is a complex deformity influenced by multiple parameters. The new method showed lower MFS, MFIA, and dysplasia measurements compared to current classical method. When assessing MFS, surgeons should be mindful that the plane of measurement relative to the structure is critical. We suggest using a plane of measurement perpendicular to the plane of the middle facet when assessing its subluxation.
Antoine ACKER (Geneva, Switzerland), Tommaso FLORIN VALECCHI, Emily LUO, Erik HUANUCO CASAS, Grayson TALASKI, Albert ANASTASIO, Samuel ADAMS, Cesar DE CESAR NETTO
15:06 - 15:12
#43152 - OP28 Medializing Calcaneal Osteotomy for progressive collapsing foot deformity alters the three-dimensional subtalar joint alignment.
Medializing Calcaneal Osteotomy for progressive collapsing foot deformity alters the three-dimensional subtalar joint alignment.
Background: While many studies were able to determine the hind- and midfoot alignment after a medializing calcaneal osteotomy (MCO), the subtalar joint alignment remained obscured by superposition on plain radiography. Therefore, we aimed to assess the hind-, midfoot- and subtalar joint alignment pre- compared to post-operatively using 3D weightbearing CT (WBCT).
Methods: Seventeen patients with a mean age of 42±17 years were retrospectively analyzed. Inclusion criteria consisted of PCFD deformity corrected by a MCO as main procedure and imaged by WBCT before and after surgery. Exclusion criteria were patients who had concomitant calcaneal lengthening osteotomies, mid-/hindfoot fusions, hindfoot coalitions, and supramalleolar procedures. Image data were used to generate 3D models and compute the hindfoot (HA), midfoot (MA) - and subtalar joint (STJ) alignment in the coronal, sagittal and axial plane, as well as distance maps.
Results: Pre-operative measurements of the HA and MA improved significantly relative to their post-operative equivalents p<0.05). The post-operative STJ alignment showed significant inversion (2.8°±1.7), abduction (1.5°±1.8), and dorsiflexion (2.3°±1.7) of the talus relative to the calcaneus (p<0.05) compared to the pre-operative alignment. The displacement between the talus and calcaneus relative to the sinus tarsi increased significantly (0.6 mm±0.5;p<0.05).
Conclusion: This study detected significant changes in the sagittal, coronal, and axial plane alignment of the subtalar joint, which corresponded to a decompression of the sinus tarsi. These findings contribute to our clinical practice by demonstrating the magnitude of alteration in the subtalar joint alignment that can be expected after PCFD correction with MCO as main procedure.
Loïc RAES, Matthias PEIFFER, Tim LEENDERS, Kvarda PETER, Ahn JIYONG, Emmanuel AUDENAERT, Arne BURSSENS (Ghent, Belgium)
15:12 - 15:18
#42935 - OP29 Distinct Weight-Bearing CT Parameters in Pediatric vs. Non-Pediatric PCFD: Less Forefoot Abduction and Less Middle Facet Subluxation in Pediatric Cases.
Distinct Weight-Bearing CT Parameters in Pediatric vs. Non-Pediatric PCFD: Less Forefoot Abduction and Less Middle Facet Subluxation in Pediatric Cases.
Introduction:
This study aims to evaluate differences with Weight-Bearing CT (WBCT) among a cohort of symptomatic Progressive Collapsing Foot Deformity (PCFD) patients with a history of pediatric flat foot (=pediatric PCFD), without (=non-pediatric PCFD), and a control group. We hypothesized that pediatric PCFD would display distinct WBCT parameters.
Method:
In this retrospective case-control study, pediatric PCFD was defined as flat feet since childhood, non-pediatric PCFD as foot shape changed in adulthood. 37 pediatric PCFD patients were compared to 52 non-pediatric PCFD patients and 11 control. Significance was set at a p-value < 0.05. A multivariate regression analysis was conducted to identify parameters associated with pediatric PCFD.
Results:
Compared to non-pediatric PCFD, the pediatric PCFD group showed a lower Foot and Ankle Offset (p<0.001), lower sagittal talus-first metatarsal angle (TFM) (p<0.001), lower axial TFM (p 0.0001), lower hindfoot moment arm (HMA)(p=0.0002), lower talonavicular uncoverage (p<0.0001), lower middle facet subluxation (p=0.0021), higher sinus tarsi (p<0.001), higher subfibular impingement (p<0.0001. Differences between the pediatric and control groups in (HMA) (p=0.053) and SF (p=0.07) were not statistically significant. When considering only WBCT parameters, multivariate regression analysis indicated that axial TFM (p:0.005), MFS (p:0.013), and ST (p:0.03) were the best predictors of pediatric PCFD. (R2 : 0.27).
Conclusion:
Pediatric PCFD is characterized by distinct WBCT parameters compared to non-pediatric PCFD, notably exhibiting less forefoot abduction, less middle facet subluxation a lower FAO and a hindfoot alignment closer to that of the control group. TFM, MFS, and ST stand out as parameters associated with pediatric PCFD.
Antoine ACKER (Geneva, Switzerland), Tommaso FLORIN VALECCHI, Emily LUO, Grayson TALASKI, Erik HUANUCO CASAS, Albert ANASTASIO, Cesar DE CESAR NETTO
15:18 - 15:24
#42931 - OP30 Comparable postoperative outcomes in obese and non-obese patients following surgery for insertional Achilles tendinopathy.
Comparable postoperative outcomes in obese and non-obese patients following surgery for insertional Achilles tendinopathy.
Introduction
Higher body mass index (BMI) levels can increase the risk of complications and poor outcomes following surgical interventions for various orthopaedic conditions, including insertional Achilles tendinopathy (IAT). However, the exact impact of BMI on postoperative outcomes for IAT is still unclear and warrants further investigation.
Methods
Prospectively collected registry data of 75 patients who underwent surgery for unilateral IAT were reviewed. Patients were separated into 2 groups based on BMI: normal (<30 kg/m2) and obese (≥30 kg/m2). Clinical assessment at preoperative, 6-month and 2-year follow-up was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, visual analog scale (VAS), 36-Item Short Form Health Survey (SF-36) physical (PCS) and mental (MCS) component summary scores, as well as assessment of postoperative satisfaction.
Results
There were 47 patients in the normal BMI and 28 patients in the obese group. Both groups showed significant improvement in AOFAS score, VAS score, SF-36 PCS and MCS at 6 months and 2 years postoperatively. However, there were no significant differences in these scores between the two groups and both groups achieved similar final postoperative scores at 2 years. Wound complications were more common in obese (n = 2, 7.1%) compared to normal BMI (n = 1, 2.1%) patients, but did not reach statistical significance (p =.284). Postoperative satisfaction (p = .394) were also similar between the two groups.
Conclusion
Obese patients undergoing surgery for IAT can achieve similar outcomes as those with normal BMI without the increased risk of complications.
Adriel You Wei TAY (Singapore, Singapore), Rui Xiang TOH, Kizher Shajahan MOHAMED BUHARY, Zongxian LI, Kae Sian TAY
15:24 - 15:30
#42989 - OP31 Objective diagnosis and evaluation of isolated gastrocnemius tightness in standing position: An Alternative to the Silfverskiöld Test.
Objective diagnosis and evaluation of isolated gastrocnemius tightness in standing position: An Alternative to the Silfverskiöld Test.
INTRODUCTION
Gastrocnemius-soleus complex (GSC) tightness leads to functional pseudoequinism in the gait cycle, which translates into increased forefoot pressure. One of the most used tests to diagnose it is the Silfverskiöld test. We propose a different test to objectively evaluate the GSC shortening: In a standing position, a goniometer is used to evaluate ankle dorsiflexion.
OBJECTIVES
The main objective is to compare the reliability of the Silfverskiöld test versus the standing test.
MATERIALS AND METHODS
A cross-sectional observational study was conducted with 2 independent observers. The Silfverskiöld test was performed with goniometric measurement. Then, in standing position with both feet parallel facing forward, patients move one leg backwards with the knee fully-extended, progressively bending the knee placed in front. When discomfort appears in the calf region, a goniometric measurement is performed. Next, patients bend the knee placed backwards and same measurement is taken maintaining the heel touching the floor. Interrater reliability was assessed using the intraclass correlation coefficient (ICC) Two-way-Random-effects, mean of 2 raters, Absolute agreement (ICC2k) statistical test.
RESULTS
We performed 50 measurements for each test. Higher ICC was observed in the standing test (ICC=0.75) than Silfverskiöld test (ICC=0.68), making it more reliable (p<0,001). Normal dorsiflexion values in standing test ranged from 110,49º with knee extension to 119,85º with knee flexion. Patients with positive Silfverkiöld test, increased 13º in ankle dorsiflexion with standing test.
CONCLUSION
The standing position test could be a reliable alternative to the Silfverskiöld test in the diagnosis of GSC tightness, but more studies are needed.
Saiz Modol CONRADO (Pamplona, Spain), Lopez Capdevila LAIA, Llombart-Blanco RAFAEL, Valverde Gestoso CARMEN, Jimenez-Villarejo FRANCISCO, Dominguez Sevilla ALEJANDRO
15:30 - 15:36
#42032 - OP32 The size of Haglund’s deformity does not matter to insertional Achilles tendinopathy: A matched case control study.
The size of Haglund’s deformity does not matter to insertional Achilles tendinopathy: A matched case control study.
Background
We aimed to investigate the effect of Haglund’s deformity size on insertional Achilles tendinopathy (IAT) using a new measurement system and identify independent risk factors of IAT with Haglund’s deformity.
Methods
We reviewed medical records of patients with IAT and age/sex-matched patients with diagnoses other than Achilles tendinopathy. Radiographs were reviewed to identify posterior/plantar heel spur, and intra-Achilles tendon calcification, and to measure Fowler-Philip angle, calcaneal-pitch angle, and Haglund’s deformity angle/height. Multivariate logistic regression analysis was performed to identify independent risk factors of IAT with Haglund’s deformity.
Results
50 patients were enrolled in the study group, equaling the size of the age/sex-matched control group. Our new Haglund’s deformity measurement system showed excellent intraobserver /interobserver reliability. No significant differences between the two groups were noted in Haglund’s deformity angle and height: 6.0° in both groups, and 3.3mm Vs.3.2mm in the study and control group, respectively. The study group had significantly higher calcaneal pitch angle, incidence of posterior heel spur, plantar heel spur, and intra-Achilles tendon calcification: 5.2° Vs.23.1°(P=.044); 81.8% Vs.36.4%(P<.001); 76.4% Vs.34.5%(P=.003); 67.3% Vs.5.5%(P<.001), respectively. Multivariate logistic regression analysis identified independent risk factors of IAT: posterior heel spur(OR=3.650), intra-Achilles tendon calcification(OR=55.671) and increased calcaneal pitch angle(OR=6.317).
Conclusion
Based on our results, the Haglund’s deformity size was not associated with IAT, suggesting a routine Haglund’s deformity resection may be unnecessary in the surgical treatment of IAT. If patients with Haglund’s deformity have posterior heel spur, intra-Achilles tendon calcification, or increased calcaneal pitch angle, a higher chance of IAT can be predicted.
Wonyong LEE (Sayre, PA, USA, USA), Colt CRYMES
15:36 - 16:00
Discussion.
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16:00-17:00
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DF6
DISCUSSION FORUM
State-of-the-art MP1 Arthrodesis Technique
DISCUSSION FORUM
State-of-the-art MP1 Arthrodesis Technique
16:00 - 17:00
Moderators.
Christian PLAASS (Consultant) (Moderator, Hannover, Germany), Maneesh BHATIA (Virtual Film Festival videos) (Moderator, Leicester, United Kingdom)
16:00 - 16:04
Open approach: Dorsal (4 mins).
Donald MC BRIDE (Consultant Orthopaedic Foot and Ankle Surgeon) (Speaker, Stoke on Trent, United Kingdom)
16:04 - 16:08
Open approach: Medial (4 mins).
Jean-Luc BESSE (Praticien Hospitalier) (Speaker, Lyon, France)
16:10 - 16:14
Joint preparation: Flat cuts (4 mins).
Oliver MICHELSSON (Consultant) (Speaker, Helsinki, Finland)
16:14 - 16:18
Joint preparation: Ball-cup reamers (4 mins).
Daniele MARCOLLI (Foot and Ankle Surgeon) (Speaker, Milano, Italy)
16:18 - 16:22
Joint preparation: Step-cut (4 mins).
Dimitrios HATZIEMMANUIL (Orthopaedic Surgeon) (Moderator, THessaloniki, Greece)
16:25 - 16:29
Implants: Plate and screws (4 mins).
Xavier OLIVA MARTIN (Speaker, Barcelona, Spain)
16:29 - 16:33
Implants: Staples/crossed screws (4 mins).
Elisabeth ELLINGSEN HUSEBYE (Senior consultant) (Speaker, Oslo, Norway)
16:33 - 16:37
Postop (weightbearing/return to work-sport) (4 mins) .
Alistair WILSON (Consultant) (Speaker, Belfast, United Kingdom)
16:37 - 17:00
Discussion.
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16:00-17:00
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DF5
DISCUSSION FORUM
Evidence for Controversies in Foot and Ankle
DISCUSSION FORUM
Evidence for Controversies in Foot and Ankle
16:00 - 17:00
Moderators.
Paolo CECCARINI (Ortopaedic Surgeon) (Moderator, Perugia, Italy), Antonio DALMAU (Head of Department) (Moderator, Barcelona, Spain)
16:00 - 16:10
Syndesmotic fixation – screw vs flexible.
Kristian BUEDTS (Md) (Speaker, Brussels, Belgium)
16:10 - 16:20
Plantar fasciopathy – gastroc lengthening vs proximal plantar fasciotomy.
Alberto GINÉS CESPEDOSA (Adjunto) (Speaker, Barcelona, Spain)
16:20 - 16:30
Metatarsalgia - plantar plate repair vs isolated osteotomy.
Nick CULLEN (Consultant foot and ankle surgeon) (Speaker, Stanmore uk, United Kingdom)
16:30 - 16:40
Ankle lateral instbility – Open vs all-inside-arthroscopic.
Nuno CORTE REAL (Clinical Director) (Speaker, Cascais, Portugal)
16:40 - 17:00
Discussion.
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17:05-17:25
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PWP10
Poster Walks presentations 10
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters:
Poster Walks presentations 10
Poster Walks presentations (3 mins each + 1 question from evaluators) of best scored posters:
Moderators:
Paulo AMADO (Director of Orthopedic Departement) (Porto, Portugal), Alessio BERNASCONI (Foot and Ankle - Orthopaedic Surgeon) (Napoli, Italy), Dimitrios HATZIEMMANUIL (Orthopaedic Surgeon) (THessaloniki, Greece)
17:05 - 17:25
#42977 - PWP37 Benefits of circular external fixation in superconstruct reconstruction for challenging deformities: a prospective cohort study.
Benefits of circular external fixation in superconstruct reconstruction for challenging deformities: a prospective cohort study.
Introduction
Unsatisfactory union of fusion sites is not uncommon following superconstruct fixation in challenge deformities. This study is to propose a new concept as the addition of circular external fixation to the conventional superconstruct for improving outcomes following the management of mentioned conditions at foot and ankle.
Methods
We prospectively introduce the circular external fixation to augment the internal fixation for the reconstruction of ankle-hindfoot, and forefoot-midfoot deformities in several conditions such as Charcot neuroarthropathy and severe equinocavovarus, etc. We divided all 24 patients who underwent corrective osteotomy and/or fusion into two groups as an advanced superconstruct group (combination of circular external fixation and internal fixation) and conventional superconstruct group (only internal fixation). The demographic characteristics were collected including union rate at 3-6 months postoperatively and union time of fusion.
Results
From the available data, union rates were 100% and 58.3% in advanced and conventional groups, respectively (p-value>0.05). Times to acceptable union were 69.3 and 107.4 days in advanced and conventional groups, respectively (p-value: 0.169). For the subgroup analysis in the Charcot neuroarthropathy patients (n=13), the union rate was also higher in the advanced group than the conventional group. For the non-Charcot patients (n=11), it seemed that there was no remarkable difference of union rates between the two groups.
Discussion and Conclusion
Advanced superconstruct using the addition of circular external fixation to the conventional fixation seems to provide additional benefits to increase union rate and reduce union time in the foot and ankle deformity corrections, especially in Charcot neuroarthropathy patients.
Angthong CHAYANIN (Bangkok, Thailand)
17:05 - 17:25
#42983 - PWP38 Minimally invasive surgery versus arthroscopic surgery for the first tarsometatarsal arthrodesis: a randomized comparative study.
Minimally invasive surgery versus arthroscopic surgery for the first tarsometatarsal arthrodesis: a randomized comparative study.
Introduction
Little is known about the different outcomes between the minimally invasive surgery (MIS) and arthroscopic surgery (AS) for the first tarsometatarsal (TMT) arthrodesis. This study was to compare the outcomes of this joint preparation for fusion regarding effectiveness and safety between MIS and AS in the cadaveric specimens.
Methods: All 16 cadaveric feet were randomly divided into two groups as 8 feet for MIS (under fluoroscopic control) group and 8 feet for AS group. They were operated by the fellowship-trained foot and ankle orthopaedic surgeons. Following complete procedures, all feet were dissected and recorded for areas of joint preparation on metatarsal and medial cuneiform sides via photographs and the ImageJ program. The injury of adjacent structure was noted in each specimen.
Results: Average areas of joint preparation on metatarsal and medial cuneiform sides were 130.92 and 119.65 mm2, respectively. Average areas of joint preparation on metatarsal sides were 162.13 and 99.72 mm2 in MIS and AS, respectively (P-value = 0.067). Average areas of joint preparation on medial cuneiform sides were 129.87 and 109.42 mm2 in the MIS and AS, respectively (P-value = 0.557). For safety profiles, rate of adjacent injury was insignificantly higher in MIS group (42.86%) than AS group (0%) (P-value = 0.192). All injuries were found at extensor hallucis longus tendon.
Conclusions: There were no significant differences of the effectiveness and safety profiles between MIS and AS groups. However, MIS seemed to provide more effectiveness on joint surface preparation but higher risk to adjacent structure than AS.
Angthong CHAYANIN (Bangkok, Thailand)
17:05 - 17:25
#42994 - PWP39 Effects of Medial Displacement Calcaneal Osteotomy and Lateral Column Lengthening Osteotomy Variations on Foot Alignment in Patients with Progressive Collapsing Foot Deformity.
Effects of Medial Displacement Calcaneal Osteotomy and Lateral Column Lengthening Osteotomy Variations on Foot Alignment in Patients with Progressive Collapsing Foot Deformity.
Background:
Progressive Collapsing Foot Deformity (PCFD) is a complex condition marked by collapse of the medial longitudinal arch, forefoot abduction, decreased talonavicular coverage, and hindfoot valgus alignment. This study aimed to assess changes in foot alignment using two surgical options: medial displacement calcaneal osteotomy (MDCO) and lateral column lengthening osteotomy (LCLO), as well as their combinations.
Method:
Weightbearing CT scans of six patients with stage I PCFD were converted into 3D models. For each patient, fifteen models were created: MDCO with 5mm,10mm and 15mm sliding, LCLO with 5mm,10mm and 15mm lengthening, and their combinations, totaling 90 models. Measurements were conducted using Mimics Innovation Suite (Materialise, Leuven, Belgium) software.
Results:
We evaluated talonavicular coverage, Meary’s angle, calcaneal pitch, talocalcaneal angle, talar-first metatarsal angle, and tibiocalcaneal angle across different osteotomy types and correction amounts. LCLO more effectively increased talonavicular coverage, while MDCO better corrected calcaneal valgus. Minor deformities required less adjustment, whereas severe deformities benefitted from greater adjustments and the combination of both osteotomies proved more effective in such cases.
Conclusion:
Deformities should be individually assessed, with surgical technique decisions tailored to each patient to avoid over- or under-correction. Preoperative 3D modeling can enhance surgical precision, providing critical data for osteotomy planning. This study supports the use of 3D models for precise surgical planning in treating PCFD, offering valuable reference values.
Ece DAVUTLUOGLU (istanbul, Turkey), Mete OZER, Yahya DENIZ, Soheil ASHKANI-ESFAHANI, Christopher DIGIOVANNI, Bedri KARAISMAILOGLU
17:05 - 17:25
#43093 - PWP40 Redefining hallux rigidus classification through an objective hounsfield unit algorithm via weightbearing computed tomography.
Redefining hallux rigidus classification through an objective hounsfield unit algorithm via weightbearing computed tomography.
Introduction/Purpose:
Hallux Rigidus (HR) is one of the most common conditions affecting the 1st metatarsophalangeal (MTP) joint. While the current Coughlin and Shurnas’ classification system is a more quantitative approach to diagnosing HR, 2D radiographic staging remains subjective. Weightbearing Computed Tomography (WBCT) may offer a more objective understanding of HR’s 3D pathology. The purpose of this study was to compare the Coughlin and Shurnas’ system with a novel WBCT based approach of classifying HR.
Methods:
WBCT scans of 31 cases of HR and 10 healthy controls were compared retrospectively to their Coughlin and Shurnas’ classification. Computational analysis using Hounsfield units [HU]) profiles was performed along five lines (central, inferolateral, inferomedial, superolateral, superomedial) within a volume of interest perpendicular to the 1st metatarsal head. HU distribution and joint space width (JSW) were calculated.
Results:
Average JSW was 1.28 mm for controls and 1.23 mm for HR group (p < 0.05). There was an increase in JSW from control (stage 0) to stage 1, a decrease from stage 1 to 2, and stage 3 consistently had the lowest JSW (p < 0.0001). The superomedial aspect of the joint had the most significant decrease in JSW (p < 0.05). Our model was most accurate in predicting stage 1 and 3 HR. For a JSW >=2.02 mm, there was an 89.4% probability the case was stage 1. JSW<1.09mm was more likely to be stage 2 or 3.
Conclusion:
In this study, we describe a novel quantitative approach to understanding and predicting HR deformity.
Emily LUO (Durham, NC, USA), Erik HUANUCO CASAS, Tommaso FORIN VALVECCHI, Hannah STEBRAL, Grayson TALASKI, Antoine ACKER, Kepler CARVALHO, James NUNLEY, Cesar DE CESAR NETTO
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17:30-18:40
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PS3
PLENARY SESSION 3
AOFAS at EFAS – Functional Hallux Limitus/Rigidus
PLENARY SESSION 3
AOFAS at EFAS – Functional Hallux Limitus/Rigidus
17:30 - 18:40
Moderators.
Kristian BUEDTS (Md) (Moderator, Brussels, Belgium), Michael ARONOW (not applicable) (Moderator, West Hartford, CT, USA, USA)
17:30 - 17:40
Pathomechanics.
Manuel MONTEAGUDO (CONSULTANT ORTHOPAEDIC SURGEON) (Speaker, Madrid, Spain)
17:40 - 17:50
Joint preserving surgery.
Michael ARONOW (not applicable) (Speaker, West Hartford, CT, USA, USA)
17:50 - 18:00
Arthrodesis.
Kristian BUEDTS (Md) (Speaker, Brussels, Belgium)
18:00 - 18:10
Arthroplasty/resurfacing (Cartiva).
David THORDARSON (Speaker, USA)
18:10 - 18:20
Hallux rigidus in the young athlete.
Eric GIZA (Speaker, USA)
18:20 - 18:40
Discussion.
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| 18:45 |
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18:45-18:50
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| Saturday 19 October |
| Time |
AQUARIUM |
WELCOME DESK |
AUDITORIUM |
STUDIO |
EXHIBITION AREA |
EPOSTERS ZONE |
CINEMA |
R1 |
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09:00-10:15
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PS4
PLENARY SESSION 4: Difficult Scenarios in the Adolescent
PLENARY SESSION 4: Difficult Scenarios in the Adolescent
09:00 - 10:15
Moderators.
Senthil KUMAR (Consultant Orthopaedic Surgeon) (Moderator, Glasgow, United Kingdom), Barbara PICLET (chirurgien) (Moderator, La Ciotat, France)
09:00 - 09:10
Hallux valgus in patient with generalized laxity.
Geoffroy VANDEPUTTE (MD) (Speaker, Lier, Belgium)
09:00 - 10:15
Residual equinovarus after previous surgeries.
Manuel MONTEAGUDO (CONSULTANT ORTHOPAEDIC SURGEON) (Speaker, Madrid, Spain)
09:20 - 09:30
Equinus gait and metatarsalgia.
Stephan WIRTH (Head of foot and ankle surgery) (Speaker, Zürich, Switzerland)
09:30 - 09:40
Symptomatic Frieberg’s disease.
Hans-Jörg TRNKA (Director) (Speaker, Vienna, Austria)
09:40 - 09:50
Painful flatfoot collapse with talocalcaneal bony coalition.
Christina STUKENBORG-COLSMAN (XXX) (Speaker, Hannover, Germany)
09:50 - 10:15
Discussion.
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10:45-12:00
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BFAS
BFAS FORUM:
Insertional tendinitis, conservative & operative treatment
BFAS FORUM:
Insertional tendinitis, conservative & operative treatment
10:45 - 12:00
Moderators.
Kristian BUEDTS (Md) (Moderator, Brussels, Belgium), Giovanni MATRICALI (professor in orthopaedic surgery) (Moderator, Leuven, Belgium)
10:45 - 10:55
Achilles tendon: debride or osteotomy?
Laurent GOUBAU (Foot and Ankle Surgeon) (Speaker, Ghent and Brussels, Belgium)
10:55 - 11:05
Accessory Navicular bone: remove or fix?
Kristian BUEDTS (Md) (Speaker, Brussels, Belgium)
11:05 - 11:15
Plantar fascia : including lateral band.
Geoffroy VANDEPUTTE (MD) (Speaker, Lier, Belgium)
11:15 - 11:25
Peroneus brevis tendon.
Stefan CLOCKAERTS (Foot and ankle Surgeon) (Speaker, Mechelen, Belgium)
11:25 - 11:35
Anterior tibial tendon.
Laurens DE COCK (Md) (Speaker, Dendermonde, Belgium)
11:35 - 12:00
Discussion.
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10:45-12:00
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AWARD
EFAS Award/Fellowships presentations
EFAS Award/Fellowships presentations
10:45 - 12:00
Moderators.
Nuno CORTE REAL (Clinical Director) (Moderator, Cascais, Portugal), Victor VALDERRABANO (Chairman) (Moderator, Basel, Switzerland)
10:45 - 10:51
EFAS Research Grant for "Foot & Ankle Arthrosis".
10:51 - 10:57
EFAS Research Grant for "Foot & Ankle Disorders".
10:57 - 11:03
EFAS Best Paper Award.
11:03 - 11:09
EFAS Best Poster Award.
11:09 - 11:15
EFAS Best Oral Presentation.
11:15 - 11:21
EFAS Travelling Fellowship Route1.
11:21 - 11:28
EFAS Travelling Fellowship Route2.
11:28 - 11:34
EFAS Research Fellowship.
11:34 - 11:40
EFAS-AOFAS Exchange Program - EFAS Group.
11:40 - 11:46
EFAS-AOFAS Exchange Program - AOFAS Group.
11:46 - 11:52
IFFAS Conference Travelling Award.
11:52 - 12:00
Q&A Discussion.
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12:05-13:25
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SY3
SYMPOSIUM: Imaging of the foot and ankle
SYMPOSIUM: Imaging of the foot and ankle
12:05 - 13:25
Moderators.
Donald MC BRIDE (Consultant Orthopaedic Foot and Ankle Surgeon) (Moderator, Stoke on Trent, United Kingdom), Aleksas MAKULAVICIUS (Team leader) (Moderator, Vilnius, Lithuania)
12:05 - 12:15
Weightbearing x-rays – importance and technique.
Peter BOCK (Speaker, Vienna, Austria)
12:15 - 12:25
How ultrasound imaging changed my practice?
Roman TOTKOVIČ (chief) (Speaker, košice, Slovakia)
12:25 - 12:35
MRI – false positives and negatives.
Emre BACA (assoc. prof) (Speaker, istanbul, Turkey)
12:35 - 12:45
Weightbearing CT – indications and clinical research.
Martinus RICHTER (Director) (Speaker, Rummelsberg, Germany)
12:45 - 12:55
SPECT-CT – trending topic and why?
Matthew WELCK (Efas youth committee) (Speaker, london, United Kingdom)
12:55 - 13:25
Discussion.
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12:05-13:00
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F4
Diabetic Foot and Ankle FORUM:
Diabetic Foot and Ankle FORUM:
12:05 - 13:00
Moderator.
Armin KOLLER (Lead Diabetic Foot Surgeon) (Moderator, Rheine, Germany), Manfred THOMAS (Moderator, Augsburg, Germany)
12:05 - 12:15
The role of the foot surgeon in diabetic foot care.
Armin KOLLER (Lead Diabetic Foot Surgeon) (Speaker, Rheine, Germany)
12:15 - 12:25
Special features and pitfalls in diabetic foot surgery.
Wilbert VAN LAAR (Orthopedic Surgeon) (Speaker, Leiden, The Netherlands)
12:25 - 12:35
Does the surgeon really know the Charcot Foot?
Alexander WEE (Speaker, United Kingdom)
12:35 - 12:45
Orthotic off-loading for ulcerated or neuroarthropathic feet.
Fredrik NILSEN (Consultant) (Speaker, Sarpsborg, Norway)
12:45 - 13:00
Discussion.
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13:05-13:25
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HC
EFAS Humanitarian Committee: presentation
EFAS Humanitarian Committee: presentation
Speakers:
Rick BROWN (Clinical lead) (Speaker, Oxford, United Kingdom), Manuel SOUSA (Foot and Ankle Surgeon) (Speaker, Lisbon, Portugal)
13:05 - 13:25
Discussion.
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| 13:30 |
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13:30-13:45
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CC2
CLOSING CEREMONY
CLOSING CEREMONY
13:30 - 13:45
Moderators.
Kristian BUEDTS (Md) (Speaker, Brussels, Belgium), Manfred THOMAS (Speaker, Augsburg, Germany), Manuel MONTEAGUDO (CONSULTANT ORTHOPAEDIC SURGEON) (Speaker, Madrid, Spain)
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