Patient-reported Outcomes of Calcaneonavicular Coalitions Treated With Surgical Excision and Fat Graft Interposition: A Two-Center Experience
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Published:
Jun 15, 2021
Keywords:
Foot, adolescent, calcaneonavicular, coalition resection
Main Article Content
Abstract
Background: The purpose of the present study was to evaluate clinical/radiographic outcomes, and complications for calcaneonavicular coalition (CNC) excision and fat graft interposition in patients under the age of 18.
Materials and Methods: A retrospective review of all pediatric patients surgically treated with symptomatic CNC at two institutions was performed. Demographic data and postoperative complications were recorded. Functional results were evaluated with AOFAS Ankle-hindfoot Scale and Visual Analog Scale (VAS). Radiographic assessment of coalition recurrence was performed on the most recent oblique radiograph (resected gap remaining <50%).
Results: Between January 2008 and January 2018, 52 patients (65 feet) with CNC were surgically treated. Forty patients (48 feet) met the inclusion criteria and were available for evaluation. The average age at surgery was 11.9 years old (range 9-17 years old). The average follow-up was 43 months. The average AOFAS score improved from 58.9±8 points preoperative to 92.9±7.8 points postoperatively (p<0.001). Preoperative pain scores averaged 6.9 ± 2.5 points. At the last follow-up, the VAS score was 0.49 ±1.1 points (p<0.001). Most patients (87.5%) were painless at the last follow-up and five patients (6 feet) had occasional pain with strenuous activities. Five complications were recorded: wound dehiscence (N=3) and superficial infection (N=2). Two feet (4.2%) had coalition regrowth on the postoperative radiographs without requiring further surgery.
Conclusion: Calcaneonavicular coalition excision with fat graft interposition can improve function and relieve pain with a low rate of complications in the pediatric-adolescent population.
Materials and Methods: A retrospective review of all pediatric patients surgically treated with symptomatic CNC at two institutions was performed. Demographic data and postoperative complications were recorded. Functional results were evaluated with AOFAS Ankle-hindfoot Scale and Visual Analog Scale (VAS). Radiographic assessment of coalition recurrence was performed on the most recent oblique radiograph (resected gap remaining <50%).
Results: Between January 2008 and January 2018, 52 patients (65 feet) with CNC were surgically treated. Forty patients (48 feet) met the inclusion criteria and were available for evaluation. The average age at surgery was 11.9 years old (range 9-17 years old). The average follow-up was 43 months. The average AOFAS score improved from 58.9±8 points preoperative to 92.9±7.8 points postoperatively (p<0.001). Preoperative pain scores averaged 6.9 ± 2.5 points. At the last follow-up, the VAS score was 0.49 ±1.1 points (p<0.001). Most patients (87.5%) were painless at the last follow-up and five patients (6 feet) had occasional pain with strenuous activities. Five complications were recorded: wound dehiscence (N=3) and superficial infection (N=2). Two feet (4.2%) had coalition regrowth on the postoperative radiographs without requiring further surgery.
Conclusion: Calcaneonavicular coalition excision with fat graft interposition can improve function and relieve pain with a low rate of complications in the pediatric-adolescent population.
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Masquijo, J. J., Allende, V., Porta Alesandria, J., López Villagra, M. B., & Paz, M. J. M. (2021). Patient-reported Outcomes of Calcaneonavicular Coalitions Treated With Surgical Excision and Fat Graft Interposition: A Two-Center Experience. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(3), 342-348. https://doi.org/10.15417/issn.1852-7434.2021.86.3.1201
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Clinical Research
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References
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8. Masquijo J, Allende V, Torres-Gomez A, Dobbs MB. Fat graft and bone wax interposition provides better functional outcomes and lower reossification rates than extensor digitorum brevis after calcaneonavicular coalition resection. J Pediatr Orthop 2017;37(7):e427-e431. https://doi.org/10.1097/BPO.0000000000001061
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11. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the anklehindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15(7):349-53. https://doi.org/10.1177/107110079401500701
12. Richter M. A new foot and ankle outcome score: Questionnaire based, subjective, Visual-Analogue-Scale, validated and computerized. J Foot Ankle Surg 2006;12(4):191-9. https://doi.org/10.1016/j.fas.2006.04.001
13. McCormack HM, Horne DJ, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol
Med 1988;18(4):1007-19. https://doi.org/10.1017/s0033291700009934
14. Khoshbin A, Law PW, Caspi L, Wright JG. Long-term functional outcomes of resected tarsal coalitions. Foot Ankle Int 2013;34(10):1370-5. https://doi.org/10.1177/1071100713489122
15. Mosier KM, Asher M. Tarsal coalitions and peroneal spastic flat foot. A review. J Bone Joint Surg Am 1984;66(7):976-84. PMID: 6480656
16. Gonzalez P, Kumar SJ. Calcaneonavicular coalition treated by resection and interposition of the extensor digitorum brevis muscle. J Bone Joint Surg Am 1990;72(1):71-7. PMID: 2104855
17. Fuson S, Barrett M. Resectional arthroplasty: treatment for calcaneonavicular coalition. J Foot Ankle Surg
1998;37(1):11-5. https://doi.org/10.1016/s1067-2516(98)80005-7
18. Alter SA, McCarthy BE, Mendicino S, DiStazio J. Calcaneonavicular bar resection: a retrospective study. J Foot
Surg 1991;30(4):383-9. PMID: 1940041
19. Moyes ST, Crawfurd EJ, Aichroth PM. The interposition of extensor digitorum brevis in the resection of
calcaneonavicular bars. J Pediatr Orthop 1994;14(3):387-8. https://doi.org/10.1097/01241398-199405000-00024
20. Levy MM, Joyner CJ, Virdi AS, Reed A, Triffitt JT, Simpson AH, et al. Osteoprogenitor cells of mature human
skeletal muscle tissue: an in vitro study. Bone 2001;29(4):317-22. https://doi.org/10.1016/s8756-3282(01)00585-3
21. Williamson RV, Staheli LT. Partial physeal growth arrest: treatment by bridge resection and fat interposition. J
Pediatr Orthop 1990;10(6):769-76. PMID: 2250063
22. Jupiter JB, Ring D. Operative treatment of post-traumatic proximal radioulnar synostosis. J Bone Joint Surg Am
1998;80(2):248-57. https://doi.org/10.2106/00004623-199802000-00012
23. Masquijo JJ, Vazquez I, Allende V, Lanfranchi L, Torres-Gomez A, Dobbs MB. Surgical reconstruction for
talocalcaneal coalitions with severe hindfoot valgus deformity. J Pediatr Orthop 2017;37(4):293-7.
https://doi.org/10.1097/BPO.0000000000000642
24. Tachdjian MO. The child’s foot. Philadelphia: WB Saunders; 1985:261-94.
25. Lavigne M, Boddu Siva Rama KR, Doyon J, Vendittoli PA. Bone-wax granuloma after femoral neck osteoplasty.
Can J Surg 2008;51(3):E58-60. PMID: 18682762
2. Harris RI. Peroneal spastic flat foot (rigid valgus foot). J Bone Joint Surg Am 1965;47(8):1657-67. PMID: 5841035
3. Stormont DM, Peterson HA. The relative incidence of tarsal coalition. Clin Orthop Relat Res 1983;(181):28-36.
PMID: 6641062
4. Masquijo JJ, Jarvis J. Associated talocalcaneal and calcaneonavicular coalitions in the same foot. J Pediatr Orthop B 2010;19(6):507-10. https://doi.org/10.1097/BPB.0b013e32833ce484
5. Kothari A, Masquijo J. Surgical treatment of tarsal coalitions in children and adolescents. EFORT Open Rev
2020;5(2):80-89. https://doi.org/10.1302/2058-5241.5.180106
6. Jayakumar S, Cowell HR. Rigid flatfoot. Clin Orthop Relat Res 1977;(122):77-84. PMID: 837623
7. Mubarak SJ, Patel PN, Upasani VV, Moor MA, Wenger DR. Calcaneonavicular coalition: treatment by excision and fat graft. J Pediatr Orthop 2009;29(5):418-26. https://doi.org/10.1097/BPO.0b013e3181aa24c0
8. Masquijo J, Allende V, Torres-Gomez A, Dobbs MB. Fat graft and bone wax interposition provides better functional outcomes and lower reossification rates than extensor digitorum brevis after calcaneonavicular coalition resection. J Pediatr Orthop 2017;37(7):e427-e431. https://doi.org/10.1097/BPO.0000000000001061
9. Weatherall JM, Price AE. Fibrin glue as interposition graft for tarsal coalition. Am J Orthop (Belle Mead NJ)
2013;42(1):26-9. PMID: 23431536
10. Upasani VV, Chambers RC, Mubarak SJ. Analysis of calcaneonavicular coalitions using multi-planar threedimensional computed tomography. J Child Orthop 2008;2(4):301-7. https://doi.org/10.1007/s11832-008-0111-3
11. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the anklehindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15(7):349-53. https://doi.org/10.1177/107110079401500701
12. Richter M. A new foot and ankle outcome score: Questionnaire based, subjective, Visual-Analogue-Scale, validated and computerized. J Foot Ankle Surg 2006;12(4):191-9. https://doi.org/10.1016/j.fas.2006.04.001
13. McCormack HM, Horne DJ, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol
Med 1988;18(4):1007-19. https://doi.org/10.1017/s0033291700009934
14. Khoshbin A, Law PW, Caspi L, Wright JG. Long-term functional outcomes of resected tarsal coalitions. Foot Ankle Int 2013;34(10):1370-5. https://doi.org/10.1177/1071100713489122
15. Mosier KM, Asher M. Tarsal coalitions and peroneal spastic flat foot. A review. J Bone Joint Surg Am 1984;66(7):976-84. PMID: 6480656
16. Gonzalez P, Kumar SJ. Calcaneonavicular coalition treated by resection and interposition of the extensor digitorum brevis muscle. J Bone Joint Surg Am 1990;72(1):71-7. PMID: 2104855
17. Fuson S, Barrett M. Resectional arthroplasty: treatment for calcaneonavicular coalition. J Foot Ankle Surg
1998;37(1):11-5. https://doi.org/10.1016/s1067-2516(98)80005-7
18. Alter SA, McCarthy BE, Mendicino S, DiStazio J. Calcaneonavicular bar resection: a retrospective study. J Foot
Surg 1991;30(4):383-9. PMID: 1940041
19. Moyes ST, Crawfurd EJ, Aichroth PM. The interposition of extensor digitorum brevis in the resection of
calcaneonavicular bars. J Pediatr Orthop 1994;14(3):387-8. https://doi.org/10.1097/01241398-199405000-00024
20. Levy MM, Joyner CJ, Virdi AS, Reed A, Triffitt JT, Simpson AH, et al. Osteoprogenitor cells of mature human
skeletal muscle tissue: an in vitro study. Bone 2001;29(4):317-22. https://doi.org/10.1016/s8756-3282(01)00585-3
21. Williamson RV, Staheli LT. Partial physeal growth arrest: treatment by bridge resection and fat interposition. J
Pediatr Orthop 1990;10(6):769-76. PMID: 2250063
22. Jupiter JB, Ring D. Operative treatment of post-traumatic proximal radioulnar synostosis. J Bone Joint Surg Am
1998;80(2):248-57. https://doi.org/10.2106/00004623-199802000-00012
23. Masquijo JJ, Vazquez I, Allende V, Lanfranchi L, Torres-Gomez A, Dobbs MB. Surgical reconstruction for
talocalcaneal coalitions with severe hindfoot valgus deformity. J Pediatr Orthop 2017;37(4):293-7.
https://doi.org/10.1097/BPO.0000000000000642
24. Tachdjian MO. The child’s foot. Philadelphia: WB Saunders; 1985:261-94.
25. Lavigne M, Boddu Siva Rama KR, Doyon J, Vendittoli PA. Bone-wax granuloma after femoral neck osteoplasty.
Can J Surg 2008;51(3):E58-60. PMID: 18682762