Orthogate Subspecialty Journal Scan: Foot and Ankle
Curated critical appraisals of recent high-impact trials and practice-changing studies across foot and ankle, structured using the SBAR framework for immediate surgical and clinical application.
- 1. Accuracy and Precision of Computer-assisted Navigation Compared With Patient-Specific Instrumentation and Conventional Methods in Total Ankle Arthroplasty. - The Journal of the American Academy of Orthopaedic Surgeons Level II
- 2. Deltoid Ligament Repair Does Not Improve Radiographic or Clinical Outcomes in Weber Type C Pronation-External Rotation Ankle Fractures - Journal of orthopaedic trauma Level I
- 3. Guided Growth for Pediatric Ankle Valgus - Journal of pediatric orthopedics Level III
1. Accuracy and Precision of Computer-assisted Navigation Compared With Patient-Specific Instrumentation and Conventional Methods in Total Ankle Arthroplasty.
Authors: Herbel C, Lopez R, Rueff M, Tupper Z, Hamad C et al. | Journal: The Journal of the American Academy of Orthopaedic Surgeons (Sep 2026) | View Source / DOI
Situation
Achieving precise implant alignment in total ankle arthroplasty (TAA) is critical for long-term survivorship, prompting interest in advanced surgical technologies. This study compares the intraoperative accuracy of computer-assisted navigation (CAN), patient-specific instrumentation (PSI), and standard referencing guides (SRG) in TAA.
Background
Total ankle arthroplasty (TAA) has become a viable alternative to ankle arthrodesis (AA) in recent years. However, implant longevity is a concern because malalignment of either the tibial or talar implants has been shown to predispose to premature wear and necessary revision surgery. Thus, customized surgical tools such as computer navigation and patient-specific instrumentation have been used to theoretically improve intraoperative alignment of implants.
Assessment & Findings
- Study Design & Methodology: TAA was done on 36 artificial ankle joint specimens by a single surgeon: 12 using CAN, 12 with PSI, and 12 with SRG instrumentation. All specimens were scanned both preoperatively and postoperatively using a high-precision 3D scanning tool. Resections and implant placements were then analyzed in 3D processing software and compared between surgical modalities. Statistical analysis included one-way ANOVA with associated Tukey tests to assess for differences between groups.
- Primary & Secondary Findings: We found that tibial resections were overall most accurate using CAN, with tibial slope measurements demonstrating significant improvements over PSI (P < 0.001) and conventional instrumentation (P < 0.001). PSI was more accurate than SRG when considering the axial cut height of the tibial resection (P < 0.001). In the talar resections, CAN was statistically superior to SRG methods in two of three measured categories (slope: P < 0.001, axial cut height: P < 0.001).
Recommendation & Practice Takeaway
Clinical Pearl: In this laboratory-based TAA study, we found that both CAN and PSI demonstrated advantages over SRG instrumentation regarding implant placement accuracy. Tibial resections were found to be overall most accurate under CAN guidance, and talar resections were found to be overall most accurate under PSI guidance. In addition, the observed reduction in implant placement variability has potential positive implications for surgeons.
2. Deltoid Ligament Repair Does Not Improve Radiographic or Clinical Outcomes in Weber Type C Pronation-External Rotation Ankle Fractures: A Randomized Controlled Trial.
Authors: Choi J, Yu O, Jung Y, Suh J | Journal: Journal of orthopaedic trauma (Aug 2026) | View Source / DOI
Situation
The management of Weber type C pronation-external rotation ankle fractures involves stabilizing the lateral malleolus and syndesmosis, but the role of direct medial soft tissue repair is debated. This trial evaluates the clinical utility of concurrent deltoid ligament (DL) repair.
Background
While acute deltoid repair theoretically restores medial column stability and prevents talar shift, it adds surgical time and potential morbidity. It remains unclear if this translates to meaningful radiographic or clinical outcome differences over standard fixation alone.
Assessment & Findings
- Study Design & Methodology: Randomized controlled trial.
- Primary & Secondary Findings: Seventy-one patients (no repair: n = 36; DL repair: n = 35) completed the 12-month follow-up. Demographics and preoperative parameters were comparable between the repair and no-repair groups (all P > 0.05), including mean age (33.0 vs. 33.4 years), female distribution (27.8% vs. 28.6%), preoperative MCS on gravity stress view (8.6 vs. 9.7 mm), and preoperative TT on gravity stress view (3.8 degrees vs. 4.1 degree).
Recommendation & Practice Takeaway
Clinical Pearl: Routine repair of the deltoid ligament in Weber C fractures is unnecessary for long-term stability if the fibula and syndesmosis are anatomically reduced and stabilized. Accept the transient early valgus laxity in the non-repaired group, as it predictably resolves without compromising functional recovery at one year.
3. Guided Growth for Pediatric Ankle Valgus: A Systematic Review of Distal Medial Tibial Hemiepiphysiodesis (DMTH) Outcomes.
Authors: Ashkanani M, Ashkanani A, Husain M, Addar A, Hamdy R et al. | Journal: Journal of pediatric orthopedics (Aug 2026) | View Source / DOI
Situation
Pediatric ankle valgus can alter tibiotalar joint mechanics, necessitating intervention to prevent early degeneration. Distal medial tibial hemiepiphysiodesis (DMTH) is commonly used to harness remaining growth for gradual correction.
Background
Despite its widespread use, the magnitude of radiographic correction, incidence of rebound deformity after hardware removal, and overall complication rates of DMTH are derived from heterogeneous, low-level studies.
Assessment & Findings
- Study Design & Methodology: PubMed, Ovid MEDLINE, and Embase were searched, and 17 retrospective studies (549 patients and 800 ankles) met the inclusion criteria. Pooled outcome measures included the lateral distal tibial angle (LDTA), tibiotalar angle (TTA), tibiotalar tilt (TT), correction rate, complication rate, and rebound.
- Primary & Secondary Findings: Preoperative pooled means were TT 13.8, LDTA 78.4, and TTA 76.2 degrees. The pooled radiographic outcomes demonstrated substantial correction, with TT, LDTA, and TTA improving to 0.6, 87.6, and 86.4 degrees, respectively, and the alignment remained largely preserved after implant removal, with corresponding values of TT 3.3, LDTA 85.5, and TTA 85.4 degrees. The overall correction occurred at an average rate of 0.6 degrees per month over a mean duration of 18.6 months before implant removal.
Recommendation & Practice Takeaway
Clinical Pearl: DMTH is a reliable, low-morbidity technique for correcting pediatric ankle valgus, yielding an average correction of 0.6 degrees per month. Counsel families that a slight rebound effect is anticipated after hardware removal, so slight overcorrection prior to implant extraction may be a prudent surgical strategy.
