Foot and ankle surgery: new frontiers for translational advancements
Foot and ankle surgery represents one of the fastest growing and most actively developing fields within orthopaedics. Rapidly expanding indications for intervention in areas such as multidirectional instability, posttraumatic ankle osteoarthritis, and progressive collapsing foot deformity have revolutionized the traditional thinking regarding the management of these conditions. At the junction between basic science and clinical research, translational research within foot and ankle exemplifies the tremendous advancements across our field over the past several decades.
Improved cadaveric modeling techniques have allowed researchers to more appropriately investigate ligamentous and bony repair techniques prior to widespread adoption in live patients (1). Richter et al. have utilized industrial robotic technology guided via computational navigation systems capable of detecting load bearing motion to the foot and ankle to compare total ankle arthroplasty (TAA) systems (2). These authors found no differences with respect to shifting or dislocation of the tibial or talar components or forces, torques, or motions between the two tested TAA prosthesis designs. In the present special series of Annals of Translational Medicine, Wixted et al. present a systematic review and metanalysis comparing cadaveric studies which evaluate differing suture endo-button configurations to assess their relative effect on the stability of the syndesmotic reduction and functional movement of the ankle (3). Despite substantial emphasis throughout the literature on use of two suture endo-button constructs and divergent endo-button configurations, these authors find no significant differences in biomechanical parameters when comparing single and double suture endo-button constructs.
As the use of TAA worldwide continues to grow yearly (4), continued investigation into improved designs to reduce aseptic loosening and improve survivorship rates of the procedure is of paramount importance. In a narrative review outlining modern advancements in TAA, Shaffrey et al. summarize the history of the evolution of TAA, and discuss outcomes and innovations related to TAA (5). These authors highlight emerging areas of particular interest, including the advent of patient specific instrumentation (PSI) for TAA, and the use of additive manufacturing to produce anatomically-specific implants such as total talus replacements, which can be used in conjunction with TAA in the setting of talar collapse and concomitant end-stage ankle arthritis. This same research team has published extensively in TAA, particularly with regards to cadaveric modeling of gait simulation both before and after TAA. Recently, Henry et al. demonstrated altered kinematics of the ankle and talonavicular joint in TAA performed either with or without concomitant subtalar arthrodesis (6). These important findings may portend implant failure due to aberrant contact mechanics at the bone-implant interface when TAA is performed with subtalar arthrodesis, and may help elucidate rates of progression of adjacent joint degenerative change.
In the realm of foot and ankle trauma, a rising percentage of geriatric patients necessitates a change in our understanding of optimal management strategies, including a more tailored approach for specific patient scenarios. Mair et al. outline the current strategies for complex ankle fracture, asserting that while open reduction and internal fixation remains the treatment of choice for the majority of complex ankle fractures, tibiotalocalcaneal nailing or conservative options can also be used in the select patient (7).
This series of Annals of Translational Medicine presents a collection of reviews and original articles on the current state-of-the-art in foot and ankle surgery, with a particular focus on translational advancements. We are grateful to the authors who have already contributed to the series, and look forward to ongoing submissions. As the past several decades have shown and the coming years are sure to continue to prove, we are living in an exciting time for foot and ankle surgeons. We hope this special series will continue to illuminate advancements within the field, and will provide further didactically strong and motivational articles.
Acknowledgments
Funding: None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Translational Medicine for the series “Foot and Ankle Surgery”. The article did not undergo external peer review.
Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-2023-28/coif). The series “Foot and Ankle Surgery” was commissioned by the editorial office without any funding or sponsorship. A.T.A. served as the unpaid Guest Editor of the series, and reports consulting fees received from QPIX Solutions. The author has no other conflicts of interest to declare.
Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
- Khambete P, Harlow E, Ina J, et al. Biomechanics of the Distal Tibiofibular Syndesmosis: A Systematic Review of Cadaveric Studies. Foot Ankle Orthop 2021;6:24730114211012701. [Crossref] [PubMed]
- Richter M, Zech S, Westphal R, et al. Robotic cadaver testing of a new total ankle prosthesis model (German Ankle System). Foot Ankle Int 2007;28:1276-86. [Crossref] [PubMed]
- Wixted CM, Luo EJ, Stauffer TP, et al. Biomechanical profile of varying suture button constructs in cadaveric specimens: a systematic review and meta-analysis. Ann Transl Med 2023;11:344. [Crossref] [PubMed]
- Law TY, Sabeh KG, Rosas S, et al. Trends in total ankle arthroplasty and revisions in the Medicare database. Ann Transl Med 2018;6:112. [Crossref] [PubMed]
- Shaffrey I, Henry J, Demetracopoulos C. An evaluation of the total ankle replacement in the modern era: a narrative review. Ann Transl Med 2023; [Epub ahead of print]. [Crossref]
- Henry JK, Sturnick D, Rosenbaum A, et al. Cadaveric Gait Simulation of the Effect of Subtalar Arthrodesis on Total Ankle Replacement Kinematics. Foot Ankle Int 2022;43:1110-7. [Crossref] [PubMed]
- Mair O, Pflüger P, Hanschen M, et al. Treatment strategies for complex ankle fractures-current developments summarized in a narrative review. Ann Transl Med 2023;11:387. [Crossref] [PubMed]
