• Journal of Korean Foot and Ankle Society
• /
• v.18 no.4
• /
• pp.189-194
• /
• 2014

Purpose: The purpose of this study was to compare the clinical and radiologic results of arthrodesis between anterior approach and transfibular approach arthrodesis in ankle arthritis. Materials and Methods: There were 61 cases of ankle arthritis treated by anterior or transfibular ankle arthrodesis in our hospital from April 2008 to March 2012. We investigated 29 cases (27 patients) who underwent ankle arthrodesis with an anterior approach (15 cases) and transfibular approach (14 cases), and were followed for over two years. Clinically, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, pain visual analogue scale (VAS), and subjective satisfaction degrees were evaluated. In addition, ankle coronal and sagittal alignments were evaluated using plain radiographs at 6 and 24 months, postoperatively. Results: Clinically, preoperative mean AOFAS score and VAS was 41.3 and 6.4, and were changed to 58.9 and 3.3 postoperatively in the anterior approach group. In the transfibular approach group, preoperative mean AOFAS score was 36.6 and VAS was 7.1, and they were changed to 54.9 and 3.4 postoperatively. However, no significant differences in the clinical results were observed between the two groups (p=0.297). Duration of attaining union was 8.1 weeks in the anterior approach group and 10.4 weeks in the transfibular approach group. Complications were delayed union in one case, nonunion in three cases, cancellous screw breakage in three cases, and complex regional reflex syndrome in one case. Conclusion: After transfibular ankle arthrodesis as treatment of ankle osteoarthritis, the tendency for valgus angulation of the ankle at the final follow-up was observed and 6.5 mm cancellous screw breakage occurred frequently. Therefore, in order to achieve better stability, it is necessary to use 6.5 mm cannulated screws rather than 6.5 mm cancellous screws for ankle arthrodesis.

• Journal of the Korean Orthopaedic Association
• /
• v.53 no.6
• /
• pp.522-529
• /
• 2018

Purpose: To compare the clinical outcomes of ultrasound-guided percutaneous repair (USPR) and open repair in a ruptured Achilles tendon. Materials and Methods: The outcomes of 12 patients with USPR (group A) and 18 patients with open repair (group B) from January 2015 to February 2017 were analyzed retrospectively. The postoperative clinical evaluations were performed using the Arner-Lindholm scale, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Achilles tendon total rupture score (ATRS), and visual analogue scale for the overall satisfaction and cosmetic satisfaction with the scar, and the starting time of single heel raises. The complications were also evaluated. Results: The Arner-Lindholm scale, AOFAS ankle-hindfoot score, ATRS, starting time of single heel raises were similar in both groups (all p>0.05). Group A showed a significantly higher overall patient's satisfaction and cosmetic satisfaction in than group B (all p<0.05). Two cases of Achilles tendon elongation were encountered in group A, and 1 case of re-rupture with deep infection and 1 case of superficial infection were experienced in group B. Conclusion: USPR showed good clinical outcomes and high satisfaction as well as a low rate of complications, such as sural nerve injury. Therefore, USPR can be considered as an effective surgical treatment option for Achilles tendon ruptures.

• Journal of the Korean Arthroscopy Society
• /
• v.11 no.1
• /
• pp.39-44
• /
• 2007

Purpose: To evaluate the results of subtalar arthroscopy and to define the indications for the procedure. Materials and Methods: Fifty-four patients were followed up for more than 1 year after subtalar arthroscopy. The mean age was 40 years, and the mean follow-up period was 18 months. Preoperative diagnoses included sinus tarsi syndrome in 19 cases, degenerative arthritis in 13 cases, calcaneal fracture in 10 cases, arthrofibrosis in 5 cases, os trigonum syndrome in 3 cases, talar fracture in 3 cases, talocalcaneal coalition in 3 cases and calcaneal tumor in 1 case. Clinically AOFAS ankle-hindfoot scale and satisfaction of the patients were evaluated. Results: There were 23 synovectomies, 13 subtalar fusions, 11 diagnostic arthroscopies, 5 adhesiolyses, 4 loose body removals, 3 excisions of os trigonum and 1 arthroscopic reduction of fracture. Twenty-five ankle arthroscopies and 11 modified Brostrom's operations were performed for the accompaning 17 ankle impingment syndromes, 11 chronic ankle instabilities and 7 osteochondral lesions of talus. AOFAS ankle-hindfoot scale was increased from 33 points preoperatively to 77 points postoperatively in subtalar fusion group, and was increased from 69 points preoperatively to 89 points postoperatively in other-than-fusion group. Ninety one percent of patients were satisfied with the procedures. There were no serious complications related to the subtalar arthroscopy. Conclusion: Subtalar arthroscopy appears to be safe and highly accurate procedure for subtalar pathology, although it requires technical expertise.

• Journal of Korean Foot and Ankle Society
• /
• v.10 no.2
• /
• pp.190-195
• /
• 2006

Purpose: To evaluate the results of open reduction and internal fixation for displaced talar neck fracture. Materials and Methods: Fourteen patients were followed for more than 1 year after open reduction and internal fixation of displaced talar neck fracture. The mean age was 41.5 years, and the mean follow-up period was 3.8 years. There were 10 type II, 3 type III and 1 type IV fractures per Hawkins. There were 3 open fractures. Clinically AOFAS ankle-hindfoot scale and Hawkins criteria were utilized. Radiologically quality of reduction, duration of bony union, avascular necrosis and posttraumatic arthritis were evaluated. Results: At last follow-up, AOFAS scale was mean 89.1 points. There were 8 excellent, 4 good, and 2 fair results according to Hawkins criteria. Radiologically anatomical reduction was obtained in 13 cases. Mean duration of bony union was 11.8 weeks. There were 3 avascular necrosis and 2 post-traumatic arthritis. There was no significant difference in the incidence of avascular necrosis between early operation group and surgically delayed group. Conclusion: Accurate open reduction and rigid internal fixation seem to be prerequisites for satisfactory treatment of a displaced talar neck fracture.

• Journal of Korean Foot and Ankle Society
• /
• v.6 no.2
• /
• pp.156-160
• /
• 2002

Purpose: To analyze the clinical outcome of triple arthrodesis for the posttraumatic arthritis after calcaneal fractures. Materials and Methods: We retrospectively reviewed 22 posttraumatic arthritis patients who underwent a triple arthrodesis from March 1991 to May 1998. The mean duration of follow up was 74 months(range, 36-123 months). The pain, function and alignment were evaluated by the modified ankle-hindfoot scale of the American Orthopaedic Foot and Ankle Society(AOFAS) clinically and the union rate, the duration of union and the degenerative change of adjacent joints radiographically were evaluated. Results: The mean duration from injury to arthrodesis was 33 months (range, 12-132 months). The AOFAS score improved from 36.4 points(range, 14-64) preoperatively to 67.6(range, 25-90) postoperatively. The union rate was 90.1% radiographically, the mean duration of union was 14.3 weeks(range, 12-21 weeks) and the degenerative change in the adjacent joint was showed in 12 patients(54.5%). There were 2 cases of talonavicular nonunion, one superficial wound infection and one partial skin necrosis. Conclusion: Triple arthrodesis for posttraumatic arthritis after calcaneal fractures is a useful method for relief of pain and correction of posttraumatic hindfoot deformity, as an evidenced by the satisfactory clinical outcome. Although a high prevalence of subsequent arthritis of the ankle and midtarsal joint was noted radiographically, we found that it was not clinically relevant.

• Journal of Korean Foot and Ankle Society
• /
• v.11 no.2
• /
• pp.204-208
• /
• 2007

Purpose: To evaluate the results of surgical reconstruction of lateral capsule-ligament complex with reinforcement by periosteal flap of distal fibula and inferior extensor retinaculum for chronic lateral ankle instability. Materials and Methods: From April 2003 to August 2006, 62 patients with chronic lateral ankle instability were operated. There were 38 males and 24 females with a mean age of 39.6 years (range, $18{\sim}61$ years). Mean follow-up period was 32 months (range, $10{\sim}48$ months). All patients were checked with preoperative ankle anteroposterior and lateral view, stress anterior drawer and varus test using Telos device. The clinical results were graded according to the VAS and AOFAS scale. Results: VAS score improved from preoperative 8.2 points to 3.1 points. There were 38 patients who were excellent (above 90 points), 18 who were good (between 76 and 90 points), 5 who were fair (between 60 and 75 points), and 1 who was poor (below 60 points) according to the AOFAS ankle and hindfoot scale. The excellent and good results amounted to 90.3%. Conclusion: Surgical reconstruction of lateral capsule-ligament complex with reinforcement by periosteal flap of distal fibula and inferior extensor retinaculum is believed to be a effective method for chronic lateral ankle instability.

• Journal of Korean Foot and Ankle Society
• /
• v.9 no.1
• /
• pp.52-58
• /
• 2005

Purpose: To analyze the overall clinical outcome, overall assessment, and patient's satisfaction rate of subtalar arthrodesis using the cannulated compression screw. Materials and Methods: This study is based on 17 patients, 17 feet who underwent subtalar arthrodesis using the cannulated compression screw from March, 1997 to March, 2004 with at least 1 year follow-up. The average follow-up period was 33.0 months (12 to 72 months). Functional results were assessed using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot (AOFAS) score, and Visual Analysis Scale (VAS) pain score, patients' returning to previous occupation and patients' satisfaction rate were also evaluated. Results: The mean AOFAS scores at final follow-up were 80.4 points (range $66{\sim}92$). The satisfactory rates were as follow. Thirteen patients (76.4%) were at least satisfied with surgical result at final follow-up. Patients' VAS pain score was average 2.8 points ($1{\sim}6$). Fourteen (82.3%) patients returned to previous job at mean postoperative period of 11.3 months (range 3-18 months). Patients' work efficiency after returning to previous occupation was 68.7% (range $33{\sim}100%$). There were 9 complications which were 3 cases of sural nerve injury, 1 case of valgus malunion, and 5 cases of the hindfoot residual pain. Conclusion: We obtained the satisfactory functional results with relatively high patient satisfaction rate of 76%. So we conclude that subtalar arthrodesis using the cannulated compression screw is a reliable method for addressing the painful end-stage subtalar osteoarthritis and unreconstructible comminuted calcaneal fractures. However we also found out that average 11 months were necessary for patients to return to their job.

• Journal of the Korean Orthopaedic Association
• /
• v.56 no.2
• /
• pp.157-163
• /
• 2021

Purpose: Xanthomatosis of the Achilles tendons is rare. In some patients, however, the lesions in the Achilles tendon need to be removed, which may be painful and disfiguring. While studies of successful surgical outcomes for the total resection and reconstruction of the Achilles tendon have been reported, reconstruction surgery has a technical challenge, and extended surgical exposures are required. This study analyzed five cases of bilateral xanthoma of the Achilles tendon, which was treated surgically using a wedge-shaped tendon-sparing approach to eliminate the need for tendon reconstruction. Materials and Methods: From July 2010 to May 2018, five patients with xanthomatosis in both Achilles tendons underwent wedge-shaped tendon preserving surgery. The average age was 49 years (range, 40-55 years), and the follow-up period was 21.4 months (range, 12-31 months). The patients consisted of three males and two females. Complications related to surgery were recorded. The outcome measures included the range of motion of the ankle joint, American Orthopaedic Foot and ankle Society (AOFAS) ankle/hindfoot score, and visual analogue scale (VAS) for overall satisfaction at the last follow-up. The availability of a single-limb heel raise and returning time to work were also measured. Results: Wound dehiscence that did not require secondary surgery was noted in one patient. At the last follow-up, the range of motion of the ankle joint was normal in all patients. The mean AOFAS ankle/hindfoot score was 91 (range, 85-96) and the VAS for the overall satisfaction ranged from 8 to 10. The average time between surgery and return to work was 27.6 days (range, 17-58 days) and all patients could perform a single-limb heel raise test. Conclusion: The tendon-sparing technique, which can preserve the anatomical functioning of the Achilles tendon, could be an excellent surgical approach because it has very promising functional and cosmetic surgical outcomes in patients with Achilles tendon xanthomatosis.

• Journal of Korean Foot and Ankle Society
• /
• v.14 no.2
• /
• pp.123-129
• /
• 2010

Purpose: To evaluate the efficacy of the arthroscopic exploration combined with modified Brostrom operation (MBO) for the treatment of chronic lateral ankle instability (CAI). Materials and Methods: Sixty patients who diagnosed a CAI were performed MBO. We divided to 2 groups, whether simultaneously inspected by arthroscopy (group B) or not (group A). The both group's results were compared according to American Orthopedic Foot and Ankle Society Ankle-hindfoot score (AOFAS), functional ankle score and visual analog scale (VAS) at preoperative and final follow-up period. Results: There were no significant differences of AOFAS, functional ankle score and VAS between both groups at final follow-up. However, in group A, 2 cases associated with medial ankle instability and syndesmotic injuries were did not diagnosed preoperatively, showed poor prognosis. In group B, one case had a permanent peroneal nerve symptom. The match rate of intra-articular lesions between preoperative diagnosis and postoperative arthroscopic diagnosis was 30% in group B. Conclusion: Combination of arthroscopic exploration and MBO is effective strategy for intra-operatively discrimination of intra-articular associated lesions for CAI.

• Journal of Korean Foot and Ankle Society
• /
• v.27 no.3
• /
• pp.87-92
• /
• 2023

Purpose: Concomitant ankle injuries associated with tibial shaft fractures can affect postoperative ankle joint pain and various postoperative ankle complications. This study compared the clinical outcomes between surgical treatment and conservative treatment of concomitant ankle injuries associated with tibial shaft fractures. Materials and Methods: From January 2015 to June 2020, a retrospective study was conducted on 118 tibia shaft fractures at the orthopedics department of the hospital. Associated ankle injuries were analyzed using plain radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and intraoperative stress exams. The clinical outcomes were compared using the pain visual analog scale (pain VAS), American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score (AOFAS score), and Karlsson-Peterson ankle score (KP score). Results: Seventy-two (61.02%) of the 118 cases were diagnosed with associated ankle injuries. Fifty-six cases underwent surgery for the ankle injury, and 16 cases underwent conservative treatment. The clinical results (according to the pain VAS score, AOFAS score, the KP score) were 1.79±1.26, 94.48±4.03, and 94.57±3.60, respectively, in the surgical treatment group, and 3.00±1.03, 91.06±3.02, and 91.25±3.31, respectively, in the conservative treatment group. Conclusion: Surgical treatment showed better clinical outcomes than conservative treatment in concomitant ankle injury in tibia fractures. Therefore, surgical treatment produces better clinical outcomes than conservative treatment in concomitant ankle injuries in tibia fractures. Hence to improve the clinical outcomes, more attention is needed on ankle joint injury in tibial shaft fractures for selecting suitable surgical treatments for those patients.