Ha-Yong Kim

Reconstruction of the Lateral Ankle Ligament With a Long Extensor Tendon Graft of the Fourth Toe

Background: The treatment of lateral ankle instability is challenging when the remaining ligamentous tissue is insufficient. Anatomic reconstruction with a tendon graft is a good option that can produce a stable ankle and avoid the complications of a nonanatomic tenodesis procedure. Hypothesis: A new technique for anatomically reconstructing the lateral ligaments of the ankle using an extensor digitorum longus tendon graft of the fourth toe will be effective for treating lateral ankle instability with chronic ligamentous insufficiency. Study Design: Case series; Level of evidence, 4. Methods: Twenty-four patients were treated with anatomic reconstruction of the ligaments using the long extensor tendon of the fourth toe. The mean age was 35.7 years (range, 16-53 years). The minimum follow-up was 24 months (range, 24-57 months; mean, 37 months). There were 17 cases of chronic ligamentous insufficiency, 3 failed Brostrom operations, and 4 others. Preoperative and postoperative Karlsson scales were used to analyze the functional results. The anterior displacement and the talar tilt angle on standard stress radiography of the talocrural joint were measured preoperatively and at the time of last follow-up for comparison. Results: The results on the Karlsson scale increased from 48.0 ± 4.2 points preoperatively to 92.2 ± 3.8 points at the latest follow-up (P < .01). Radiographically, the mean anterior displacement was 6.7 ± 1.2 mm before operation and 3.4 ± 0.6 mm at the latest follow-up (P < .01). The mean talar tilt angle was 12.3° ± 1.1° before the operation and 4.3° ± 0.8° at the latest follow-up (P < .01). Conclusion: Anatomic reconstruction of the lateral ankle ligaments using the long extensor tendon of the fourth toe appears to be an effective surgical option for chronic insufficiency of the lateral ankle ligament.

Arthroscopic Versus Posterior Endoscopic Excision of a Symptomatic Os Trigonum A Retrospective Cohort Study

Background: Both subtalar arthroscopic and posterior endoscopic techniques are used to treat posterior ankle impingement syndrome (PAIS). However, there have been no studies comparing the 2 procedures. Hypothesis: Both arthroscopic and endoscopic excisions of the os trigonum are safe and effective in treating PAIS. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-eight patients were treated with excision of the os trigonum either by an arthroscopic (16 patients) or endoscopic (12 patients) technique. The mean patient age was 29.8 years (range, 17-55 years), and the mean follow-up period was 30 months (range, 18-58 months). Preoperative and postoperative visual analog scale (VAS) score for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Maryland Foot Score (MFS) were used to analyze the functional results. Duration of surgery, time to return to sports (RTS), and patient satisfaction were evaluated as well. The size of the os trigonum was measured using T1-weighted sagittal magnetic resonance imaging (MRI). The clinical and MRI results were compared between the 2 groups. Results: The VAS score, AOFAS score, and MFS for both the arthroscopic group (preoperative: 6.3, 63.8, and 61.5, respectively; postoperative: 1.2, 89.9, and 89.6, respectively) and endoscopic group (preoperative: 6.7, 64.8, and 62.5, respectively; postoperative: 1.2, 89.9, and 88.4, respectively) improved significantly (P < .01). The mean surgery and RTS times were 39.4 minutes and 7.5 weeks in the arthroscopic group and 34.8 minutes and 8.0 weeks in the endoscopic group, respectively (P > .05). All patients were satisfied with the results. There were no significant differences between the 2 groups in the preoperative and postoperative VAS score, AOFAS score, or MFS (P > .05). The mean size of the os trigonum was 11.1 × 8.8 mm2 in the arthroscopic group and 12.6 × 10.4 mm2 in the endoscopic group, and the difference was significant (P < .05). Two patients underwent both arthroscopic and endoscopic procedures because of technical difficulty in removing the large os trigonum arthroscopically. Conclusion: Both arthroscopic and posterior endoscopic excisions of the os trigonum were safe and effective in treating PAIS. The arthroscopic procedure was more demanding, especially in cases of a large os trigonum. The posterior endoscopic approach had the advantage of addressing problems in the posterior ankle joint and allowed a more extensive release of the flexor hallucis longus.

Operative Treatment for Ganglion Cysts of the Foot and Ankle

The authors analyzed the clinical results of surgical excision for symptomatic or recurrent ganglion cysts of the foot and ankle, and tried to elucidate the prognostic factors. Fifty-three cases of ganglions in the foot and ankle were followed for more than 24 months after excision. The mean duration of follow-up was 3.7 years. As a preceding treatment, 17 cases received a mean of 1.3 aspirations, and 16 cases recurred after a mean of 1.7 operations. The cyst was most common in the dorsum of the foot and ankle, where 35 cases were found. Thirty cases originated from the tendon sheath, 19 cases from the joint, and 4 cases from others. Preoperative mean AOFAS foot scores were low in the cysts associated with the tarsal tunnel syndrome, and in the cysts of the plantar aspect of the first toe. Postoperative mean AOFAS foot scores were significantly increased in the preceding 2 groups. There were 3 (5.7%) cases of recurrence, all of which originated from the tendon sheath. In the case of ganglion cysts originating from the tendon sheath, careful attention should be paid to locate satellite masses to avoid recurrence.

Midfoot Reconstruction for a Large, Aggressive Giant-Cell Tumor

The occurrence of a giant-cell tumor (GCT) in the small bones of the foot is rare. Two studies have shown incidences of 1% and 2%1,2. The younger age of patients with a GCT in the foot, compared with those with tumor in the long bones, as well as a multifocal trend and a higher recurrence rate have been stressed in the literature3. In one study, eighteen of twenty-one GCTs that involved the foot were distributed in the tarsal bones, with a noteworthy number of cases in the talus4. Although metatarsal lesions were rare in that series, several cases of single or double metatarsal reconstruction in patients with GCT have been reported in the literature5-7.nnThe proposed treatments for GCT of the foot are curettage and bone-grafting as well as marginal or wide excision; however, wide excision is usually impossible to achieve without performing an amputation8. Some authors have recommended that en bloc resection and bone-grafting be used as the first line of treatment for GCT in suitable sites5. The reconstruction techniques include the use of allografts or large autogenous grafts with fusion6,7,9.nnWe present a case of a large, aggressive GCT that originated in the medial cuneiform. It destroyed the adjacent cuneiforms as well as the first, second, and third metatarsal bases. We treated the patient with a marginal en bloc resection of the medial two cuneiforms and the proximal two-thirds of the first and second metatarsals combined with a partial excision of the medial halves of the lateral cuneiform and the third metatarsal base. The resultant osseous defect was reconstructed with a large iliac strut graft and fixation with multiple plates and screws. The midterm clinical results …

A Minimum Ten Years of Follow-Up of Alumina Head on Delta Liner Total Hip Arthroplasty

BACKGROUNDnIn the early days when delta ceramics were developed, there was a period of using delta ceramic liner and alumina ceramic head. Therefore, the purpose of this study is to investigate the clinical and radiological outcomes of total hip arthroplasty using delta ceramic liner on alumina ceramic head after a minimum of 10 years of follow-up and to evaluate problems of early delta ceramic liner.nnnMETHODSnAlumina on delta cementless total hip arthroplasty was performed in 92 hips (85 patients) from August 2005 to March 2007 at our hospital. Bilateral total hip arthroplasty were performed in 7 patients, 30 patients on the left side and 48 patients on the right side. Preoperative diagnosis was osteonecrosis of the femoral head in 34 hips (37%), degenerative arthritis in 31 hips (33.7%), femur neck fracture in 21 hips (22.8%), and rheumatoid arthritis in 6 hips (6.5%). All surgeries were carried out with anterolateral approach. For the clinical evaluation, Harris hip score (HHS), pain, and range of motion were assessed. Radiographs were reviewed by the authors to search for any signs of osteolysis, loosening of implants, and heterotopic ossification.nnnRESULTSnHHS was compared between preoperative and final follow-ups. The mean HHS improved from preoperative 58.3 points (range 27-76) to 92.7 points (range 78-98) on the final follow-up (Pxa0= .02). The mean range of hip motion at the final follow-up was flexion 116.9°, adduction 23.8°, abduction 34.6°, internal rotation 16.3°, and external rotation 39.2°. As for the postoperative pain, 1 patient complained of inguinal pain and 4 patients complained of thigh pain. Because of trauma, 3 cases of dislocation were observed in all cases. There are 3 cases with dislocation and 2 cases were treated with conservative treatment without recurrence, but 1 case was required for surgical treatment due to eccentric rim wear of delta liner. The aseptic loosening of acetabular cup and femoral stem was each 1 hip.nnnCONCLUSIONnAlumina head-on-delta liner cementless THA, using a large femoral head 32-36 mm in diameter, demonstrated satisfactory clinical and radiological results in the minimum 10 years of follow-up. Eccentric rim wear can occur even in delta ceramic liners that are known to have high strength, and this can lead to dislocation which can, in turn, increase the possibility of linear fracture.