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<jats:sec><jats:title>Background:</jats:title><jats:p> Historically, talectomy has been predominantly performed to operatively treat severely rigid equinovarus feet. A limited number of investigators have studied functional outcomes in pediatric patients posttalectomy. We aimed to assess the outcomes of pediatric patients undergoing talectomy using the American Orthopaedic Foot &amp; Ankle Society (AOFAS) score and a subjective survey of patients’ and their caregivers’ satisfaction. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> We performed a retrospective cohort study that included 31 patients with nonidiopathic severely rigid talipes equinovarus, in a single center, using consecutive sampling. All medical records of those patients were reviewed, and relative data were extracted. The AOFAS score was used to measure the outcomes during the last visit (April 2020). Satisfaction was evaluated in a binary manner by questioning the patients and their caregivers if they would undergo the same surgery again for the same result. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Thirty-one patients were included. Myelomeningocele was the primary diagnosis in 13 patients (41.9%), and arthrogryposis was diagnosed in 11 patients (35.5%). Twenty-two patients had bilateral procedures. The mean age at the time of surgery was 6.0 ± 3.0 years, and the mean follow-up was 6.0 ± 1.0 years. Plantigrade feet following the primary surgery were achieved in 88.5% of cases. Postoperatively, braces were well tolerated in 86.5% of patients. Deformity recurrence was observed in 21.2% of patients, and 17.3% of patients required subsequent surgeries. Patients with arthrogryposis had significantly higher AOFAS scores than those with myelomeningocele and other diagnoses ( P = .017). Further, patients who tolerated braces had higher AOFAS scores than those who did not tolerate braces ( P = .006). However, patients who developed hindfoot varus and dorsal bunion postoperatively had lower AOFAS scores ( P = .054 and P = .006, respectively). Patients who had recurrent deformities or required further surgeries also had lower AOFAS scores ( P = .025 and P = .015, respectively). Although 17.3% of patients were not able to comment about their satisfaction due to their general medical condition, 63.5% of patients reported that they were satisfied. Furthermore, 75.0% of caregivers were satisfied with the outcomes and their children’s functional status posttalectomy. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> The observed outcomes of primary and salvage talectomies demonstrate the general overall effectiveness of this operative intervention as an end-stage treatment for pediatric patients with severely rigid talipes equinovarus. </jats:p></jats:sec><jats:sec><jats:title>Level of Evidence:</jats:title><jats:p> Level III; retrospective cohort study. </jats:p></jats:sec>

<jats:sec><jats:title>Background:</jats:title><jats:p> Coronal plane ankle joint alignment is typically assessed using the tibiotalar angle (TTA), which relies on the anatomical axis of the tibia (AAT) and the articular surface of the talus as landmarks. Often, the AAT differs from the mechanical axis of the lower limb (MAL). We set out to test our hypothesis that the TTA using the MAL would differ from the TTA measured using the AAT in patients with ankle osteoarthritis. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Standardized standing long leg radiographs of 61 ankles with end-stage osteoarthritis were analyzed. We measured the MAL and the AAT. A line was drawn along the talar articular surface (TA) and the TTA was calculated using both the MAL (MAL-TA) and the AAT (AAT-TA). The mechanical axis of the tibia (MAT) was also recorded and the MAL-MAT angle calculated. The difference between MAL-TA and AAT-TA and its correlation with the MAL-MAT angle were assessed. Intra- and interobserver agreement were measured for MAL-TA and AAT-TA. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> The mean MAL-TA was 91.4 degrees (95% CI, 88.5-94.4) and the mean AAT-TA was 91.2 degrees (95% CI, 88.6-93.9). The difference ranged from −8.1 to 7.8 degrees, and was greater than 2 and 3 degrees in 42% and 18% of the patients, respectively. The difference, as an absolute value, also strongly correlated with the MAL-MAT angle ( r = 0.91, P &lt; .001). Intra- and interobserver reliability were excellent for both MAL-TA (intraclass correlation coefficient [ICC], 0.93 and 0.91, respectively) and AAT-TA (ICC, 0.91 and 0.89, respectively). </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> We recommend that surgeons consider using the MAL-TA, which relies on long leg radiographs, especially with proximal deformity, to more accurately measure coronal plane ankle joint alignment. </jats:p></jats:sec><jats:sec><jats:title>Level of Evidence:</jats:title><jats:p> Level III, retrospective comparative study. </jats:p></jats:sec>

<jats:sec><jats:title>Background:</jats:title><jats:p> Ankle replacement and ankle arthrodesis are standard treatments for treating end-stage ankle arthritis when conservative treatment fails. Comparing patient-reported outcome scores to the instrument’s minimal important difference (MID) helps physicians and researchers infer whether a meaningful change in health from the patient’s perspective has occurred following treatment. The objective of this study was to estimate the MID of the Ankle Osteoarthritis Scale among a cohort of operatively treated end-stage ankle arthritis patients undergoing ankle replacement or arthrodesis. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> A survey package including the Ankle Osteoarthritis Scale was completed by participants preoperatively and 2 years postoperatively. Distribution and anchor-based approaches to calculating the MID were used to estimate the MID of the Ankle Osteoarthritis Scale and its 2 domains. The distribution-based approaches used were the small and medium effect size methods, while the mean absolute change method and linear regression method were the anchor-based approaches. Bootstrap sampling was used to obtain the variance of MID estimates. The MID was estimated for sex, age, operative, and baseline health subgroups. The cohort comprised 283 participants, totaling 298 ankles. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> The MID did not vary with sex or operative procedure. Age-based differences in MID values may exist for the Ankle Osteoarthritis Scale total score, and MID values were generally smallest among the oldest patients. Patients with the best and worst ankle-related health preoperatively had higher MID values than patients reporting mid-range Ankle Osteoarthritis Scale values preoperatively. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> The best estimate of the MID of the Ankle Osteoarthritis Scale total score is 5.81. Our findings indicate that the MID of the Ankle Osteoarthritis Scale may not vary by sex or operative subgroups but likely varies by age and preoperative Ankle Osteoarthritis Scale score. </jats:p></jats:sec><jats:sec><jats:title>Level of Evidence:</jats:title><jats:p> Level II, prospective comparative study. </jats:p></jats:sec>

<jats:sec><jats:title>Background:</jats:title><jats:p> The purpose of this study was to report on the radiographic outcomes, clinical outcomes, and implant survivorship following extramedullary-referenced (EMr) vs intramedullary-referenced (IMr) total ankle replacement (TAR). </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> From May 2007 to February 2018, a consecutive series of patients with end-stage tibiotalar osteoarthritis undergoing TAR was enrolled in this study. Analyses were performed comparing IMr vs EMr components for patient-reported outcomes data, pre- and postoperative radiographic ankle alignment, concomitant procedures, and complications. Kaplan-Meier survivorship analyses served to determine implant reoperation and revision surgery. A total of 340 TARs were included with 105 IMr TAR and 235 EMr TAR. The mean follow-up was 5.3 years (±2.5, range 2-12). </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> The absolute value for preoperative coronal alignment was significantly greater for IMr compared to EMr TAR (13.0 vs 6.4 degrees; P &lt; .0001), but both groups achieved near neutral alignment postoperatively (1.4 vs 1.5 degrees; P = .6655). The odds of having a concomitant procedure was 2.7 times higher in patients with an IMr TAR (OR 2.7, CI 1.7-4.4; P &lt; .0001). There were similar improvements in patient-reported outcome scores at 1 year and final follow-up (all P &gt; .05). The 5-year implant survivorship was 98.6% for IMr vs 97.5% for EMr at final follow-up. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> The IMr and EMr TAR components had comparable postoperative alignment, patient-reported outcome scores, and complications. The 5-year implant survivorship was similar between the IMr and EMr groups. </jats:p></jats:sec><jats:sec><jats:title>Level of Evidence:</jats:title><jats:p> Level III, retrospective comparative study. </jats:p></jats:sec>

<jats:sec><jats:title>Background:</jats:title><jats:p> Total ankle arthroplasty (TAA) is successful by both subjective patient-reported outcome measures (PROMs) and objective functional improvements of gait. Each is reproducible and valid, but they are entirely distinct methods. This study investigated the correlation between subjective and objective outcomes of TAA. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Seventy patients underwent gait analysis preoperatively and 1 year after TAA. The 36-Item Short-Form Health Survey (SF-36) and visual analog score (VAS) for pain and American Orthopaedic Foot &amp; Ankle Society (AOFAS) Ankle-Hindfoot Scores were recorded at each interval. A Student t test, a multivariate regression, and a Pearson correlation coefficient were used to measure the correlation between parameters of gait and PROMs. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Patients had statistically significant improvements in gait velocity, total range of motion (ROM), maximum plantarflexion, ankle power, and SF-36 Physical, VAS, and AOFAS scores. The SF-36 Physical score had a moderate positive correlation with preoperative walking speed, step length, and ankle power and postoperative walking speed and ankle power. No correlation between VAS score and function was detected. The AOFAS score had a moderate positive correlation with postoperative walking speed, step length, and ankle power, and improvement in walking speed, cadence, and ankle power. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> Statistically significant correlations were found between numerous preoperative and postoperative comparisons of PROMs and the AOFAS score with the objective biomechanical outcomes of gait. Walking speed and ankle push-off power correlated most with patient perceptions of function and improvement, while pain and ROM did not. Subjective PROMs and objective biomechanical outcomes were complementary in the assessment of surgical outcomes and, combined, helped to address the dilemma of the confounding effect of other lower extremity pathologies on PROMs. </jats:p></jats:sec><jats:sec><jats:title>Level of Evidence:</jats:title><jats:p> Level III, comparative series. </jats:p></jats:sec>

<jats:p> Level of Evidence: Level V. </jats:p>

<jats:p> Dislocation of the native knee represents a challenging injury, further complicated by the high rate of concurrent injury to the common peroneal nerve (CPN). Initial management of this injury requires a thorough neurovascular examination, given the prevalence of popliteal artery injury and limb-threatening ischemia. Further management of a knee dislocation with associated CPN palsy requires coordinated care involving the sports surgeon for ligamentous knee reconstruction and the peripheral nerve surgeon for staged or concurrent peroneal nerve decompression and/or reconstruction. Finally, the foot and ankle surgeon is often required to manage a foot drop with a distal tendon transfer to restore foot dorsiflexion. For instance, the Bridle Procedure—a modification of the anterior transfer of the posterior tibialis muscle, under the extensor retinaculum, with tri-tendon anastomosis to the anterior tibial and peroneus longus tendons at the anterior ankle—can successfully return patients to brace-free ambulation and athletic function following CPN palsy. Cross-discipline coordination and collaboration is essential to ensure appropriate timing of operative interventions and ensure maintenance of passive dorsiflexion prior to tendon transfer. </jats:p>