advances in foot and ankle arthroscopy - asps · advances in foot and ankle arthroscopy ryan l....
TRANSCRIPT
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UPMC Surgical ConferenceSeptember 23, 2016
Advances in Foot and Ankle Arthroscopy
Ryan L. McMillen DPM, FASPS
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Consultant: Wright Medical
Financial Disclosure
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Direct Ligament Repair
• Brostrom 1966, Gould modification 1980
• Avoids sacrificing tendons
• 87-95% good to excellent results, large review
• Less postoperative pain, instability, and loss of inversion/eversion strength
• ligament repair only 15-35% of patients continued to have pain and symptoms post op– Only 20% of intraarticular pathology seen with open
lateral repairFerkel & Cham, FAI 2007
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Technique – Primary ligament repair
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Brostrom
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Brostrom
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Brostrom Gould
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Modified Brostrom Gould
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Complications – Primary repair
• Poorer results if patients >250lbs
• CFL should be restored to prevent STJ laxity
• Must address underlying foot deformities
• Arthroscopy
– 9% complications overall• 49% neurologic injury, distraction may increase risk
– Peroneal nerve traction, skin necrosis from straps
• Most resolve by 6mo postop
• Infection: 1.4% ankle scopes
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Disadvantages
Long term non weight bearing: 6 weeks
Extensive physical therapy recovery period
Larger surgical incision
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Arthroscopic Repair Advantages
Smaller Surgical incisions
Faster Recovery?
Less Pain
Less Scar Tissue
Faster return to full activities?
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Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Internal Internal Brace
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Post Operative
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Advantages
Smaller Incision
Direct visualization for repair
Faster mobilization
Earlier Weightbearing
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Post Operative Protocol
• NWB 2 weeks
• Sutures removed
• CAM Boot
• WBAT
• Physical Therapy
•
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Demographics and Results
Age: 40 (24-61)
Pre Operative Pain score: 7.8 (7-9)
Post Operative Pain Score: 0.667(0-1)
Average Return to Activites: 52 Days (33-65)
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AOFAS Score 1 year follow up
N=12
Pre Op AOFAS: 42
Post Op 1 year post op: 93
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8 weeks post op
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Questions?
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Thank You
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ASPS Surgical Conference
Sept 22, 2018
Management of Failed 1st Ray Surgery
Ryan L. McMillen DPM, FASPS