Ankle osteoarthritis (OA) is a degenerative condition that impacts quality of life. Total ankle replacement (TAR) represents a significant advancement in orthopedic surgery. Objectives: The purpose was to provide an overview of the indications, outcomes, and complications of anterior and lateral surgical approaches in TAR, as well as return to sport following surgery. Methods: The PubMed, MEDLINE, Scopus, and Cochrane Central databases were searched. The keywords used were “total ankle arthroplasty”, “total ankle replacement”, “ankle anterior approach”, “ankle lateral approach”, “outcomes”, “return to sport”, and “complications”, and the search included articles published from 2014 to 2024. Results: Successful functional outcomes, return to athletic activity, and return to the previous level of sports performance after surgery have been reported at rates of over 60%. The anterior approach restores the normal tibial slope but presents a high risk of wound-healing complications and medial malleolar fractures. The lateral approach allows an anatomic placement of the implant, but it is associated with fibular complications and a high risk of revision surgery. Return to sport is feasible in low-impact sports such as cycling, swimming, and dancing. Conclusions: The anterior and lateral approaches for TAR yielded satisfactory functional outcomes and rates of return to athletic activity. Different intra- and post-operative complications and revision surgery should be managed properly to optimize outcomes.

Background and Objectives: Achilles tendon ruptures in middle-aged individuals with systemic comorbidities represent a growing clinical challenge. Revision surgery, indicated in cases of tendon re-rupture, remains technically demanding and lacks standardized treatment protocols. This comprehensive review aimed to summarize current evidence regarding indications, outcomes, and complications associated with the most commonly employed revision techniques and explores the potential of artificial intelligence (AI) in improving management and outcomes. Materials and Methods: A literature review was performed in accordance with PRISMA guidelines. The PubMed, MEDLINE, and Cochrane Central databases were used to search keywords. We included articles (1) reporting indications, outcomes, and/or complications of revision surgery for Achilles tendon rupture; (2) reporting a minimum mean follow-up of >12 months; and (3) written in English. Six studies met the inclusion criteria, with a total of 3250 patients analyzed. A methodological quality assessment using the Modified Newcastle–Ottawa Quality Assessment Scale was performed, and all articles were found to be of high quality. Results: Surgical strategies were stratified based on defect size: 5 cm: fascial turndown flaps, autografts (e.g., semitendinosus), or allografts. Tendon transfers showed satisfactory functional outcomes but varied in complication rates. Allografts offered reduced donor site morbidity. The use of AI and wearable sensors has demonstrated potential in preoperative planning, complication prediction, and real-time rehabilitation monitoring. Conclusions: Achilles tendon revision surgery requires a patient-specific, defect-oriented approach. Combined surgical techniques are often necessary for large or non-viable lesions. The integration of AI represents a promising advancement in enhancing surgical decision-making, optimizing rehabilitation, and improving long-term clinical outcomes.

Article: Surgical interventions for ankle osteoarthritis in the athletic population - Minerva Orthopedics 2021 December;72(6):604-9 - Minerva Medica - Journals