Dan Moriwaki

Background: Although arthroscopic lateral ankle ligament repair for chronic lateral ankle instability (CLAI) is widely performed, the association between patient age and postoperative outcomes remains unclear. This study aimed to investigate the clinical outcomes of arthroscopic lateral ankle ligament repair across a broad age spectrum. Methods: We retrospectively reviewed 934 patients who underwent arthroscopic lateral ankle ligament repair for CLAI with a modified lasso-loop stitch using a suture anchor; all procedures were performed by a single surgeon. Patients were classified into 5 age groups: skeletally immature (SI; P < .001). Time to free gait ( P = .004), jogging ( P < .001), and return to full sports activities ( P < .001) differed significantly among groups; older patients tended to require longer recovery times. SI, AD, and YA groups demonstrated higher postoperative SAFE-Q scores than the EP group in several subscales, particularly in physical and social functioning. In contrast, no age-related differences were observed in the sports activity subscale. Conclusion: The association between age and postoperative outcomes after arthroscopic lateral ankle ligament repair varied across outcome domains. Younger patients demonstrated better outcomes in several functional subscales and achieved faster recovery milestones; however, advanced age alone should not be considered a contraindication to arthroscopic lateral ankle ligament repair. Level of Evidence: Level III, retrospective cohort study.

Background: Nitinol staples (NSs) are increasingly used in foot and ankle surgery; nonetheless, staple breakage incidence and determinants remain incompletely defined. This study examined NS breakage in a large consecutive series, focusing on anatomical site, implant geometry, and fixation strategy. Methods: We retrospectively reviewed 333 patients (379 feet) who underwent foot and ankle surgery with 2-legged NS between 2021 and 2025. Overall, 702 staples were analyzed. Staple breakage was assessed on plain radiographs at a minimum follow-up of 6 months to evaluate implant integrity during the critical phase of bone union. Anatomical location, implant geometry (symmetric vs asymmetric), and fixation type (isolated vs combined) were analyzed. Multivariable logistic regression was performed to explore factors associated with breakage in the hindfoot. Results: The overall breakage rate was 4.0% (28/702). Breakage rates varied by anatomical site, with higher rates in the calcaneocuboid (22.2%), talonavicular (12.5%), tibiotalar (8.9%), and other joints than in the first ray (0.37%). In the calcaneocuboid joint, isolated staple fixation showed a higher breakage rate (33.3%) than staple fixation with an adjunct screw (6.7%). In second metatarsal shortening osteotomies, asymmetric staples demonstrated a higher breakage rate (35.7%) than symmetric staples (1.0%). Although most breakages were asymptomatic, 2 patients required revision surgery for symptomatic nonunion. In the hindfoot cohort, procedure category (Chopart arthrodesis) showed an association with breakage; however, with the numbers available, no significant association could be detected for body mass index or sex. Conclusion: The overall breakage rate for 2-legged NS was 4.0%. Breakage was more frequent in several high-demand hindfoot joints, and in second metatarsal osteotomies using asymmetric staples. Hybrid fixation showed a lower breakage rate in the first ray and calcaneocuboid joint. These exploratory findings suggest that anatomical site, staple geometry, and fixation strategy may contribute to the risk of radiographic staple breakage.

Background: Modified Lapidus procedure is well established for severe hallux valgus (HV). Nonetheless, postoperative recurrence remains a clinical concern. Peroneus longus (PL) functions as a dynamic stabilizer of the first ray, and its insertion at the base of the first metatarsal may be partially resected during osteotomy. Notably, PL dysfunction may contribute to recurrence by contributing to postoperative first ray instability. Nevertheless, extent of PL insertion resection during modified Lapidus procedure has not been quantified. This study aimed to evaluate the extent of resected PL insertion during modified Lapidus procedure. Methods: We retrospectively reviewed 80 feet from 74 patients with severe HV. We simulated 2 osteotomy methods: lateral wedge osteotomy at the base of the first metatarsal (M-method) and lateral wedge osteotomy at the distal medial cuneiform (C-method). On radiographs, resected lateral edge length of the first metatarsal (rM1-length) to correct intermetatarsal angle (IMA) to 0° was measured. Based on the rM1-length, 3-dimensional computed tomography models were used to measure whole PL insertion length, resected PL insertion length (rPL-length), and percentage of resected PL insertion (%-rPL). These parameters between the M-method and the C-method were compared. Cutoff value of the IMA for diagnosing feet with %-rPL greater than 50% using the M-method was evaluated. Results: rM1-length, rPL-length, and %-rPL were significantly greater with the M-method than with the C-method (all P < .001). Notably, the mean %-rPL with the M-method exceeded 50%. The IMA cutoff value was 21.4°; however, with the numbers available, no statistically significant difference was detected in the rPL-length and %-rPL with the C-method above and below this cutoff. Conclusion: Lateral wedge osteotomy at the first metatarsal may result in substantial PL insertion resection during the modified Lapidus procedure. Lateral wedge osteotomy of the medial cuneiform bone may better preserve PL insertion and potentially have implications for first ray stability.