Adult acquired flatfoot deformity (AAFD) represents a spectrum of deformities affecting the foot and the ankle. The optimal management of AAFD remains controversial. We evaluated the efficacy of surgical treatments of AAFD using both direct and indirect evidences. We searched PubMed, EmBase, and the Cochrane Library to identify eligible studies conducted through November 2018. To compare different surgical strategies, we performed a network meta-analysis. A traditional meta-analysis using a random-effects model was used to evaluate the pooled outcome. A total of 21 studies including 498 patients were collected and analyzed. Network meta-analysis results based on lateral angle talocalcaneal-calcaneal pitch (LAT-CP) indicated that medial displacement calcaneal osteotomy (MDCO) has the highest probability to be the best course of AAFD treatment. However, analyses based on anteroposterior talo-first metatarsal (AP-TMT1) and lateral angle talocalcaneal talo-first metatarsal (LAT-TMT1) suggested that lateral column lengthening (LCL) was the best treatment, while those based on lateral angle talocalcaneal-arch height, anteroposterior talocalcaneal (AP-TC), lateral angle talocalcaneal-talocalcaneal (LAT-TC), anteroposterior-talonavicular coverage (AP-TNC), talonavicular coverage (TNC), and the American Orthopedic Foot and Ankle Society (AOFAS) indicated triple arthrodesis (TAO) as the best treatment. Moreover, double arthrodesis (DAO) provided the best treatment effect on the function score. Furthermore, according to traditional meta-analysis, the summary of standardized mean differences (SMD) indicated that the surgical interventions are associated with significant improvements in LAT-CP (SMD − 1.78), LAT-arch height (SMD − 4.95), AOFAS (SMD − 5.24), AP-TMT1 (SMD 2.45), LAT-TMT1 (SMD 1.97), AP-TC (SMD 3.05), LAT-TC (SMD 2.20), AP-TNC (SMD 2.07), TNC (SMD 1.70), and function score (SMD 0.95). Our findings indicated that MDCO, LCL, TAO, or DAO might be the best surgical approaches for AAFD treatment. Furthermore, patients who received surgical interventions had significant improvements in symptoms and function.

Background: Midfoot osteotomy has been previously confirmed to be a good method to correct pes cavus. How to fix the osteotomy and which point to choose for the procedure has been a focus for most surgeons. The aim of this study was to analyse the outcomes of a series of patients who had been treated for pes cavus deformity using midfoot osteotomy combined with adjacent joint sparing internal fixation. Materials and methods: Between 2008 and 2012, 17 patients with a mean age of 16.8 years (12–36 years) were tracked after treatment by midfoot osteotomy combined with adjacent joint sparing internal fixation with three cannulated screws between the Lisfranc line and Cyma line. Clinical outcomes were assessed by measuring improvements of appearance and function, American Orthopedic Foot and Ankle Society (AOFAS) scores, and radiographic changes. Results: The mean follow-up time was 25.3 months (range, 10–50). The mean healing time from the osteotomy was 7.8 weeks (range, 6–12). The appearance and weight-bearing function were significantly improved in all patients. At a final follow-up, the mean AOFAS score was 75.8/100 points (range, 63–90). The mean Meary's angle, calcaneal pitch angle, tibiotalar angle, and Hibb's angle values improved from 26.3 to 5.5, 44.5 to 28.3, 133.1 to 100.8 and 66.9 to 41.1, respectively. Adjacent joints presented no obviously arthritic degeneration at the follow-up. Subjectively, 94.1% of patients were very satisfied or satisfied with minor reservations. Objective outcomes were excellent or good in 88.2% of feet. Conclusion: For the treatment of rigid pes cavus deformity, extra-articular midfoot osteotomy combined with adjacent joint sparing internal fixation is effective and safe. This surgical technique is especially effective with low rates of arthritic degeneration and joint stiffness in the adjacent joints and little reduction of ankle and foot flexibility.

Background: Reconstructing bone structures and stabilizing adjacent joints are clinical challenges in treating talar necrosis and collapse (TNC). 3D printing technology has been demonstrated to improve the accuracy of talar replacement. This study aimed to evaluate anatomical talar replacement and the clinical results. Methods: Nine patients with TNC were enrolled between 2016 and 2020. The prosthetic shape and size were designed by CT post-processing and mirror symmetry technology. The clinical outcomes included radiographic parameters of the forefoot, hindfoot, and ankle alignment, ankle activity, recurrent pain, and peri-operative complications. Results: After a mean follow-up of 23.17 ± 6.65 months, degenerative arthritis and prosthetic dislocation and other complications were not observed on plain radiographs. Each 3D-printed talar prosthesis was placed in the original anatomical position. The parameters which have significant changes pre-operative and post-operative are as follows: talar height, 27.59 ± 5.99 mm and 34.56 ± 3.54 mm (95% CI − 13.05 to − 0.87, t = 2.94, P = 0.032) and Meary’s angle, 11.73 ± 4.79° and 4.45 ± 1.82° (95% CI 1.29~22.44, t = 2.89, P = 0.034). The AOFAS hindfoot score improved from 26.33 ± 6.62 to 79.67 ± 3.14 at the final follow-up (95% CI 43.36~63.30, t = 13.75, P = 0.000). The VAS score decreased from 6.33 ± 1.03 to 0.83 ± 0.75 (95% CI 4.40~6.60, t = 12.84, P = 0.000). The post-operative satisfaction scores regarding pain relief, activities of daily living, and return to recreational activities were good to excellent, and the change of activity range was statistically significant. Conclusions: The 3D printing patient-specific total talar prostheses allowed anatomical reconstruction in TNC. This novel treatment with 3D-printed prostheses could serve as a reliable patient-specific alternative in TNC.

Tibiotalocalcaneal arthrodesis with headless compression screws has not been previously reported. We hypothesized that these screws could be suitable for tibiotalocalcaneal arthrodesis because of their special design. This study aimed to evaluate the clinical outcomes of patients undergoing tibiotalocalcaneal arthrodesis with headless compression screws for the treatment of severe arthropathy of the ankle and subtalar joint. From 2010 to 2015, 23 patients with severe ankle and subtalar arthropathy underwent tibiotalocalcaneal arthrodesis. All surgeries were completed by a senior surgeon in the same hospital. These patients were 18~76 years (mean 54.6 years) old; the duration of their disease was 9~38 months (mean 13.2 months). The study population included 12 males and 11 females; 12 patients underwent surgery on the left and 11 on the right. Indications for surgery included avascular necrosis of the talus (n = 14), severe posttraumatic arthritis (n = 4), osteoarthritis (n = 2), terminal tuberculous arthritis (n = 1), rheumatoid arthritis (n = 1) and Charcot neuroarthropathy (n = 1). A lateral oblique incision was performed to expose the subtalar joint, and an anteromedial longitudinal incision was used to expose the ankle joint. After the articular surfaces were removed, the tibia, talus and calcaneus were carefully aligned and fixed with two headless compression screws. Patients were followed up at 6 weeks and 3, 6 and 9 months after surgery; they were evaluated by Roles and Maudsley patient satisfaction scores, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score, visual analogue scale (VAS) score and radiographic evaluation. Seventeen patients were studied, with a mean follow-up time of 6.5 months (range 5–24). The mean Roles and Maudsley patient satisfaction score was 1.41 at the last follow-up; most of the patients were satisfied with the surgery results. The mean preoperative AOFAS Ankle-Hindfoot Score was 29.6 (range 18–37), while the mean last follow-up AOFAS Ankle-Hindfoot Score was 68.5 (range 61–80). The VAS score for preoperative functional pain was 6.95 (range 3–10) compared to 1.56 (range 0–3) postoperatively (P < 0.001). The mean surgical duration was 57 (range 42–125) min. The mean time to union was 3.8 months (range 3–12 months); fusion of the ankle and subtalar joint was successful in all patients. One patient experienced delayed wound healing. Tibiotalocalcaneal arthrodesis with headless compression screws for the treatment of severe arthropathy of the ankle and subtalar joint is an effective treatment that is minimally invasive and is associated with a short operation time, high fusion rate, low incidence of complications and good postoperative recovery.

The articles that have reported on the size at which a segmental defect of clavicular non-union requires bone grafting are scarce. This study evaluated the functional and radiologic results of fixation by locking compression plate (LCP) without bone graft when the defect size is less than 2 cm following bone sclerosis removal for the treatment of clavicular non-union. The study included 17 patients with mid-shaft clavicular non-union. All patients underwent bone sclerosis resection and fixation using LCP without bone graft. The patients were evaluated preoperatively, and after a minimum of 24 months (mean, 44.47 months; range, 24 to 60 months) postoperatively in terms of the disabilities of the arm, shoulder and hand (DASH) score, the Constant-Murley score, and radiography. In this study, no patients were lost to follow-up. The mean DASH score improved from 38.76 ± 7.76 (31.00–46.52) points preoperatively to 19.88 ± 7.18 (12.70–27.06) points 2 years postoperatively (P < 0.01). The mean Constant-Murley score improved from 41.59 ± 8.81 (32.78–50.40) points preoperatively to 75.47 ± 13.50 (61.97–88.97) points 2 years postoperatively (P < 0.01). Radiographs revealed fracture union in all patients. No correlations between the defect size and the postoperative Constant-Murley score or between the defect size and the postoperative DASH score were found based on Pearson tests. No complications, particularly acromioclavicular joint complications and sternoclavicular joint complications, were observed. In conclusion, we can suggest, from the findings of our study, that bone sclerosis resection and fixation using LCP without bone graft is effective for the treatment of clavicular non-union involving a gap of less than 2 cm and has a low rate of complications.

Background: Fibrosis is a significant pathological feature of chronic skeletal muscle injury, profoundly affecting muscle regeneration. Fibro-adipogenic progenitors (FAPs) have the ability to differentiate into myofibroblasts, acting as a primary source of extracellular matrix (ECM). the process by which FAPs differentiate into myofibroblasts during chronic skeletal muscle injury remains inadequately explored. Method: mouse model with sciatic nerve denervated was constructed and miRNA expression profiles between the mouse model and uninjured mouse were analyzed. qRT/PCR and immunofluorescence elucidated the effect of miR-27b-3p on fibrosis in vivo and in vitro. Dual-luciferase reporter identified the target gene of miR-27b-3p, and finally knocked down or overexpressed the target gene and phosphorylation inhibition of Smad verified the influence of downstream molecules on the abundance of miR-27b-3p and fibrogenic differentiation of FAPs. Result: FAPs derived from a mouse model with sciatic nerves denervated exhibited a progressively worsening fibrotic phenotype over time. Introducing agomiR-27b-3p effectively suppressed fibrosis both in vitro and in vivo. MiR-27b-3p targeted Transforming Growth Factor Beta Receptor 1 (TGF-βR1) and the abundance of miR-27b-3p was negatively regulated by TGF-βR1/Smad. Conclusion: miR-27b-3p targeting the TGF-βR1/Smad pathway is a novel mechanism for regulating fibrogenic differentiation of FAPs. Increasing abundance of miR-27b-3p, suppressing expression of TGF-βR1 and inhibiting phosphorylation of smad3 presented potential strategies for treating fibrosis in chronic skeletal muscle injury.