• Journal of Korean Orthopaedic Sports Medicine
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• v.10 no.2
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• pp.69-77
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• 2011

Purpose: This study was retrospectively performed to compare the clinical outcomes of modified Brostrom procedures using the single suture anchor and the double suture anchor for chronic lateral ankle instability. Materials and Methods: Thirty-seven patients were followed up for more than 1 year after the modified Brostrom procedures using suture anchor. Single surgeon treated seventeen cases with single suture anchor and 20 cases with double suture anchor. The clinical evaluation was performed according to the Karlsson scale and Sefton grading system. Radiologic measurement of the talar tilt and anterior talar translation was performed through anterior and varus stress radiographs using Telos device. Results: The Karlsson scale had improved significantly from preoperative average of 45.2 points to 89.4 points in single suture anchor group, and from 46.4 points to 90.5 points in double suture anchor group. According to the Sefton grading system, 15 cases (88.2%) in single suture anchor group and 18 cases (90%) in double suture anchor group achieved satisfactory results. The talar tilt angle and anterior talar translation had improved significantly from preoperative average of $13.6^{\circ}$ and 8.6 mm to $5.4^{\circ}$ and 4.1 mm in single suture anchor group, from $14.1^{\circ}$ and 8.4mm to $3.9^{\circ}$ and 4 mm in double suture anchor group. Double suture anchor technique was significantly superior in postoperative talar tilt. Conclusion: Single and double suture anchor techniques produced similar clinical and functional outcomes except for talar tilt, which was significantly superior in double suture anchor group. Both modified Brostrom procedures using the single and double suture anchor appear to be effective treatment methods for chronic lateral ankle instability. Further evaluation of clinical outcomes and biomechanical studies in athletes are needed.

• Journal of the Korean Orthopaedic Association
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• v.54 no.1
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• pp.59-66
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• 2019

Purpose: Several radiologic reference lines have been used to evaluate individuals with a clubfoot but there is no consensus as to which is most reliable. The aim of this study was to identify which radiologic parameters have relevance to the predictability of additional surgery after Ponseti casting on clubfoot and the effect of clubfoot treatments that contain Ponseti casting and additional surgery. Materials and Methods: A total of 102 clubfeet (65 patients, 37 bilateral) were reviewed from 2005 to 2013. The patients were divided into two groups (Group A, those for whom the result of the Ponseti method was successful and did not require additional surgery; and Group B, those for whom the result of the Ponseti method was unsuccessful and required additional surgery), and the following parameters were measured on the plain radiographs: i) talo-calcaneal angle on the anteroposterior and lateral view, ii) talo-1st metatarsal angle on the anteroposterior view, and iii) Tibio-calcaneal angle on the lateral view with the ankle full-dorsiflexion state. Each radiograph was reviewed on two separate occasions by one orthopedic doctor to characterize the intra-observer reliability, and the averages were analyzed. Next, 20 cases were chosen using a random number table, and two orthopedic doctors measured the angle separately to characterize the interobserver reliability. Results: Groups A and B included 73 clubfeet (71.6%) and 29 clubfeet (28.4%), respectively. The initial talo-calcaneal angle and tibiocalcaneal angle in the lateral view were significantly different among the groups. In addition, inter- and intra-observer biases were not detected. The talo-1st metatarsal angle on the anteroposterior view and tibio-calcaneal angle on the lateral view were significantly different after treatment in both groups. Conclusion: Congenital clubfeet treated with the Ponseti method showed successful results in more than 70% of patients. The initial talocalcaneal angle and tibio-calcaneal angle on the lateral view were the radiologic parameters that could predict the need for additional surgical treatments. The talo-1st metatarsal angle on the anteroposterior view and tibio-calcaneal angle on the lateral view could effectively evaluate the changes in clubfoot after treatment.

• Investigative Magnetic Resonance Imaging
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• v.12 no.2
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• pp.148-152
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• 2008

Purpose : To find the MR findings and evaluate the usefulness of MR in flexor hallucis longus(FHL) dysfunction. Materials and Methods : From 1992 to 2003, fourty patients were found to have surgically confirmed FHL dysfunction. 24 cases of 22 patients who had performed MR were included in this study. We analyzed the signal intensity of FHL tendon and muscle, tendon sheath, sheath effusion, and bone lesions, retrospectively. Results : Non-specific, increased sheath effusion of FHL tendon was seen in 12 cases (50%). Large amount of sheath effusion(grade 3) was observed in 5 cases (21%). The signal intensity of FHL tendon was normal in all cases. High signal intensity at the FHL muscle, proximal to musculotendinous junction was seen in 1 case (4%). One case (4%) of marrow edema of the talus and another one case (4%) of osteochondritis dissecans of the talus was seen. Conclusion : Non-specific, increased sheath effusion of FHL tendon was observed on MR in FHL dysfunction patients. Therefore, MR has a limited role in diagnosis of FHL dysfunction and is useful to exclude other bone and tendon diseases causing medial ankle pain.

• Journal of Korean Foot and Ankle Society
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• v.4 no.2
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• pp.83-86
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• 2000

A vascular necrosis of the talus has frequently been reported following trauma because talus has no muscle insertions, sixty percent of the surface of the talus is covered by hyaline cartilage, takes only a small area for entrance of a blood supply. Osteonecrosis is also associated with a variety of nontraumatic disorders. There are many indications for steroid usage, patient with rheumatoid arthritis, systemic lupus erythematosus, chronic obstructive pulmonary disease, and status- post renal or cardiac transplantation may be on long- term steroid usage, osteonecrosis may develop. A vascular necrosis of the talus secondary to chronic steroid usage is an unusual case. Delay in detection of osteonecrosis may lead to fragmentation and collapse of the talar body. When pain on range of motion is present and conservative treatment have been exhausted, surgical treatment is indicated, that is, fusion of the ankle joint. However it is important that conservative treatment may prevent its various sequelae with early diagnosis because steroid - treated patients have a more operative risk and increased risk for postoperative infection. We report a rare case of corticosteroid induced avascular necrosis of talus after cardiac transplantation.

• Journal of Korean Foot and Ankle Society
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• v.10 no.1
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• pp.113-116
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• 2006

Benign and malignant tumors are found in the foot, although the incidence is low. The most common bone tumor in the foot is osteochondroma, which is thought to develop in bones that form through the process of enchondral ossification. In particularly, osteochondromas in the foot mostly occur in metatarsal bones and phalanges. It is seldom found in talus. It is usually confused with osteophyte or enthesis. We report an osteochondroma case confirmed by roentgenographical and pathological investigation, after removing the masses form bilateral tali of a 19-year-old male patient presented with bilateral ankle joint pain for three years.

• Journal of Korean Foot and Ankle Society
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• v.10 no.1
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• pp.66-70
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• 2006

Purpose: To analyze the clinical and radiological outcome of subtalar arthrodesis using cannulated screws and morselized bone graft. Materials and Methods: Twenty one patients with follow-up of more than 1 year after subtalar arthrodesis were included in this study. Mean age was 40.8 years, and mean follow-up duration was 38 months. Underlying diseases were 19 cases of posttraumatic arthritis (18 calcaneal fractures and 1 talar fracture) and 2 cases of tarsal coalition. Clinically AOFAS ankle-hindfoot score, operation time, complication and satisfaction of patients were analyzed. Radiologically time to union, arthritis of surrounding joints, preoperative and postoperative talar declination angle were analyzed. Results: AOFAS ankle-hindfoot score was improved from preoperative 33 points to postooperative 79 points. Eighteen patients (86%) were satisfied with the results. Mean operation time was 91 minutes. All cases were fixed with 1-2 cannulated screws and morselized bone graft. Mean time to radiologic union was 12.1 weeks. There was 1 case of delayed union. There was no significant perioperative changes in talar declination angles. Conclusion: Subtalar arthrodesis using cannulated screws and morselized bone graft seems to be relatively simple and effective treatment method for subtalar arthritis.

• Journal of Korean Foot and Ankle Society
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• v.11 no.1
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• pp.91-96
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• 2007

Purpose: To evaluate the clinical results and determine appropriate methods of surgical treatment about type II talar neck fracture. Materials and Methods: Among nineteen patients who received surgical treatment for type II talar neck fracture from May 2000 to May 2005. Fourteen patients with a follow-up period of more than 1 year were divided into two groups. Six patients reduced by closed reduction (Group A) with screw fixation and eight patients reduced by open reduction with screw fixation. We analyzed preoperative, postoperative and follow-up simple radiographs and reviewed patient hospital records retrospectively. Clinical results were evaluated by Hawkins scoring system. We analyzed pain, limp, range of motion of ankle and subtalar joint. Results: Five patients (83.3%) in group A and seven patients (87.7%) in group B had excellent and good clinical results. There were no complications including avascular necrosis, delayed union, nonunion. Conclusion: Closed reduction with screw fixation of talar neck fracture shows correct reduction and satisfactory results. But because of short term period of follow-up, we need long term results.

• Archives of Reconstructive Microsurgery
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• v.8 no.1
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• pp.50-55
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• 1999

Avascular necrosis is a significant late complication of talar neck fracture. However, treatment for early stage avascular necrosis has been not established. Two patients with post-traumatic avascular necrosis of talus treated with vascular pedicle graft using lateral tarsal artery were reviewed to determine the efficacy of procedure. The procedure involved grafting the lateral tarsal artery and vein into a hole made in the talus through a anterolateral approach. Follow-up was 12 and 24 months respectively. Two patients had significant pain relief, improved function, no worsening of their radiologic staging. The results are promising enough to recommend consideration of this procedure in early stages of avascular necrosis.

• Journal of Korean Foot and Ankle Society
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• v.19 no.2
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• pp.43-46
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• 2015

Arthroscopic treatment has been reported to provide effective improvement of ankle function when used in treatment of small osteochondral lesion of talus; however, favorable long-term results have been less predictable for large osteochondral lesion of talus. In cases in which primary arthroscopic treatment fails, the decision regarding which subsequent technique to choose has become increasingly difficult, as good clinical outcomes may be unlikely for such patients irrespective of the surgical technique used. Redomicrofracture should be used judiciously for treatment of osteochondral lesion of talus in which arthroscopic treatment has failed.

• Journal of Korean Foot and Ankle Society
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• v.24 no.2
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• pp.48-54
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• 2020

Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. Various terms are used to describe this clinical entity, including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Several treatment options are available; the choice of treatment is based on the type and size of the defect and the treating clinician's preference. Arthroscopic microfracture (a bone marrow stimulation technique) is a common and effective surgical strategy in patients with small lesions or in those in whom non-operative treatment has failed. This study had the following aims: 1) to review the historical background, etiology, and classification systems of OLT; 2) to describe a systematic approach to arthroscopic bone marrow stimulation for OLT; and 3) to determine the characteristics that are useful for assessing osteochondral lesions, including age, size, type (chondral, subchondral, cystic), stability, displacement, location, and containment of the lesion.