Jae Hoon Ahn

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.

Subtalar Arthroscopic Procedures for the Treatment of Subtalar Pathologic Conditions: 115 Consecutive Cases

Arthroscopic procedures of subtalar pathology has shown promising results in previous studies, but the number of patients was relatively small. This article describes our experience and evaluated the clinical outcomes of 115 patients treated with subtalar arthroscopy for a range of subtalar pathologies. One hundred fifteen patients were followed up for >1 year after undergoing a subtalar arthroscopic procedure. Mean patient age was 40 years, and mean follow-up period was 42 months. Preoperative diagnosis included sinus tarsi syndrome in 31 patients, degenerative arthritis in 30, calcaneal fracture in 15, arthrofibrosis in 10, os trigonum syndrome in 8, talar fracture in 5, talocalcaneal coalition in 7, and calcaneal tumor in 1. The clinically modified American Orthopaedic Foot and Ankle Society (AOFAS) and AOFAS ankle-hindfoot scales and patient satisfaction were evaluated. Thirty-one patients had subtalar synovitis and underwent synovectomy; 9 had mild degenerative disease and underwent debridement and chondroplasty; 6 had chondromalacia and underwent intra-articular shaving; 11 had a loose body removed; 10 underwent arthroscopic resection for arthrofibrosis; 8 had symptomatic os trigonum and underwent arthroscopic excision; 6 underwent excision and multiple drilling for an osteochondral lesion of the talus; and 26 had severe degenerative joint disease and underwent arthroscopic subtalar arthrodesis. The mean modified AOFAS ankle-hindfoot scale in the subtalar fusion group was increased from 33 points preoperatively to 84 points postoperatively (P< .005), and the mean AOFAS ankle-hindfoot scale in the other-than-fusion group increased from 69 points preoperatively to 89 points postoperatively (P<.005). Ninety-seven percent of patients were satisfied with the procedure, and there were no serious complications.

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.

Cementless Bipolar Hemiarthroplasty for Unstable Intertrochanteric Fractures in Elderly Patients

Background Bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients is a viable option that can prevent the complications of an open reduction, such as nonunion and metal failure. This study evaluated the clinicoradiological results of cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in elderly patients. Methods Forty hips were followed for more than 2 years after cementless bipolar hemiarthroplasty using a Porocoat® AML Hip System. The mean age was 78.8 years and the mean follow-up period was 40.5 months. The Harris hip score and postoperative hip pain were analyzed clinically. The radiological results were assessed using a range of indices. Results At the last follow-up, the mean Harris hip score was 80.6 points. There were one case of hip pain and one case of thigh pain. Twenty-four cases (60%) showed no decrease in ambulation capacity postoperatively. Radiologically, there were 23 cases (57.5%) of fixation by bone ingrowth and 17 cases (42.5%) of stable fibrous fixation. There were no cases of osteolysis. Eleven cases (27.5%) of new bone formation were found around the stem. All stems were stable without significant changes in alignment or progressive subsidence. Conclusions The short-term results of cementless bipolar hemiarthroplasty in elderly patients with unstable intertrochanteric fractures were satisfactory.

Tendon adhesion after percutaneous repair of the Achilles tendon: a case report.

Percutaneous repair of the Achilles tendon is known to minimize tendon adhesions and wound complication through a minimally invasive technique. The usually reported complications are sural nerve injury and inadequate contact of the tendon stumps, which can lead to rerupture or tendon lengthening. We experienced an interesting case of Achilles tendon adhesion after percutaneous repair, which had been initially misdiagnosed as a rerupture. To our knowledge, this is the only report of Achilles tendon adhesion as a complication after percutaneous repair, which stresses the importance of functional postoperative rehabilitation.