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Article: Midfoot Fusion Using Superconstructs for the Charcot Foot: Current Techniques and Complications.

Sammarco, Vincent James / Sammarco, Josika A / Baratz, Mark E / Sammarco, G James

2023 Volume 73, Page(s) 231–245

Abstract: Neuroarthropathy of the foot and ankle presents a series of challenges. The treating physician faces a perfect storm of pathomechanics, deformity, and medical comorbidities. Successful treatment requires a systematic approach in diagnosis, nonsurgical ... ...

Abstract	Neuroarthropathy of the foot and ankle presents a series of challenges. The treating physician faces a perfect storm of pathomechanics, deformity, and medical comorbidities. Successful treatment requires a systematic approach in diagnosis, nonsurgical management, surgical management, and long-term maintenance of the affected extremity. Nonsurgical care of the Charcot foot remains the mainstay of treatment and is successful in most cases. Surgery has become more accepted for patients with severe deformity. The concept of a superconstruct has been introduced to describe modern surgical techniques and implants that have been developed since the early 2000s where stability and durability are maximized. A superconstruct is defined by four factors: (1) fusion is extended beyond the zone of injury to bridge the area of bony dissolution; (2) aggressive bone resection is performed to allow for adequate reduction of deformity without undue tension on the soft- tissue envelope; (3) stronger implants are used than for nonneuropathic fusion procedures, including some specifically developed for fixation of the Charcot foot; and (4) the devices are applied in a position that maximizes mechanical stability to allow the implants to become load sharing. It is important to review the current techniques and implants used in fusion of the neuropathic midfoot and discuss the expected outcomes and complications based on the authors' experience.
MeSH term(s)	Humans ; Arthrodesis/methods ; Arthropathy, Neurogenic/surgery ; Arthropathy, Neurogenic/complications ; Diabetic Foot/surgery ; Diabetic Foot/complications ; Plastic Surgery Procedures
Language	English
Publishing date	2023-11-03
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	802490-x
ISSN	0065-6895
ISSN	0065-6895
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Article: Lashing technique to correct metatarsus primus varus is not new.

Sammarco, G James

Foot & ankle international

2008 Volume 29, Issue 1, Page(s) 119; author reply 120

MeSH term(s)	Hallux Valgus/surgery ; Humans ; Metatarsal Bones/surgery ; Suture Techniques
Language	English
Publishing date	2008-01
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	1183283-6
ISSN	1944-7876 ; 1071-1007
ISSN (online)	1944-7876
ISSN	1071-1007
DOI	10.3113/FAI.2008.0001
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Article: Re: syndesmosis procedure: a non-osteotomy approach to metatarsus primus varus correction.

Sammarco, G James

Foot & ankle international

2008 Volume 29, Issue 5, Page(s) 551; author reply 551

MeSH term(s)	Hallux Valgus/surgery ; Humans ; Metatarsal Bones/surgery ; Suture Techniques
Language	English
Publishing date	2008-05-13
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	1183283-6
ISSN	1944-7876 ; 1071-1007
ISSN (online)	1944-7876
ISSN	1071-1007
DOI	10.3113/FAI.2008.0551
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Article: Peroneus tertius muscle as a cause of snapping and ankle pain: a case report.

Sammarco, G James / Henning, Carlo

The American journal of sports medicine

2007 Volume 35, Issue 8, Page(s) 1377–1379

MeSH term(s)	Adult ; Ankle Joint/physiopathology ; Arthroscopy ; Humans ; Male ; Muscle, Skeletal/physiology ; Ohio ; Pain/etiology
Language	English
Publishing date	2007-08
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	197482-8
ISSN	1552-3365 ; 0363-5465
ISSN (online)	1552-3365
ISSN	0363-5465
DOI	10.1177/0363546506298107
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Article ; Online: Lasso stitch with peroneal retinaculoplasty for repair of fractured os peroneum: a report of two cases.

Sammarco, Vincent James / Cuttica, Daniel J / Sammarco, G James

Clinical orthopaedics and related research

2009 Volume 468, Issue 4, Page(s) 1012–1017

Abstract: Unlabelled: Fracture of the os peroneus with retraction of the peroneus longus tendon can lead to weakness, instability, and progressive foot deformity. Treatment recommendations vary and include simple immobilization, repair of the fractured ossicle, ... ...

Abstract	Unlabelled: Fracture of the os peroneus with retraction of the peroneus longus tendon can lead to weakness, instability, and progressive foot deformity. Treatment recommendations vary and include simple immobilization, repair of the fractured ossicle, excision of part or all of the fractured ossicle with repair of the tendon and tenodesis with the peroneus brevis tendon. We present two patients treated with excision of the proximal fragment and repair of the tendon to the distal fragment with relief of pain and restoration of function. The distal fragment was captured with a looped suture which allowed avoidance of a plantar exposure while still achieving an adequate repair. We also describe a technique for retinaculoplasty of the inferior peroneal retinaculum which we believe important to prevent postoperative adhesions to the tendon. Level of evidence: Level V, expert opinion. See Guidelines for Authors for a complete description of levels of evidence.
MeSH term(s)	Adult ; Female ; Foot ; Fractures, Bone/complications ; Fractures, Bone/physiopathology ; Fractures, Bone/surgery ; Humans ; Male ; Orthopedic Procedures/methods ; Reconstructive Surgical Procedures ; Recovery of Function ; Rupture ; Sesamoid Bones/injuries ; Sesamoid Bones/physiopathology ; Sesamoid Bones/surgery ; Suture Techniques ; Tendon Injuries/complications ; Tendon Injuries/physiopathology ; Tendon Injuries/surgery ; Tendons/physiopathology ; Tendons/surgery ; Treatment Outcome
Language	English
Publishing date	2009-03-31
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	80301-7
ISSN	1528-1132 ; 0009-921X
ISSN (online)	1528-1132
ISSN	0009-921X
DOI	10.1007/s11999-009-0822-x
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Article: Pantalar arthrodesis for post-traumatic arthritis and diabetic neuroarthropathy of the ankle and hindfoot.

Herscovici, Dolfi / Sammarco, G James / Sammarco, V James / Scaduto, Julia M

Foot & ankle international

2011 Volume 32, Issue 6, Page(s) 581–588

Abstract: Background: Pantalar arthrodesis is an important salvage option for stabilizing the hindfoot and salvaging the limb following trauma or collapse. This report evaluates the healing rates and complications which occur in diabetics and post-traumatic ... ...

Abstract	Background: Pantalar arthrodesis is an important salvage option for stabilizing the hindfoot and salvaging the limb following trauma or collapse. This report evaluates the healing rates and complications which occur in diabetics and post-traumatic patients. Materials and methods: Twenty patients presenting with post-traumatic arthritis of the ankle-hindfoot (twelve) or with Type II or Type IIIA Charcot arthropathy (eight) were managed with a pantalar fusion. Followup averaged 46 months. Patients were evaluated using the Short Form-36 (SF-36), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, the Short Musculoskeletal Function Assessment (SMFA) and the Visual Analog Pain Scale (VAS). Results: There were no amputations in either group. Casting averaged 14.9 weeks, full weightbearing was achieved at 25.1 weeks and time to union averaged 44.1 weeks. Average age was 56.3 yrs. and BMI averaged 34.2. Fourteen patients (70%) had their surgery performed in multiple stages. Acceptable outcomes were noted for all patients for the SF-36, AOFAS and SMFA scores. VAS scores averaged 2.2. There were ten complications (50%); four patients (two in each group) required additional surgery. Conclusions: Pantalar arthrodesis is a reasonable salvage option for patients with severe post traumatic arthropathy and neuropathic arthropathy. Patients should be informed of the increased risks as well as the long periods of postoperative immobilization and nonweightbearing. We believe a pantalar arthrodesis can produce acceptable outcomes regardless of the cause of disability, with a staged or single approach, and whether the surgery is performed with plates and screws or an intramedullary device.
MeSH term(s)	Adult ; Aged ; Ankle Injuries/complications ; Ankle Joint/surgery ; Arthritis/etiology ; Arthritis/surgery ; Arthrodesis/methods ; Arthropathy, Neurogenic/surgery ; Body Mass Index ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Retrospective Studies ; Salvage Therapy ; Talus/surgery ; Weight-Bearing
Language	English
Publishing date	2011-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	1183283-6
ISSN	1944-7876 ; 1071-1007
ISSN (online)	1944-7876
ISSN	1071-1007
DOI	10.3113/FAI.2011.0581
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Book: Rehabilitation of the foot and ankle

Sammarco, G. James

1995

Author's details	[edited by] G. James Sammarco
MeSH term(s)	Ankle ; Foot ; Athletic Injuries/rehabilitation ; Foot Deformities/rehabilitation ; Foot Diseases/rehabilitation ; Fractures, Bone/rehabilitation ; Sports ; Sprains and Strains/rehabilitation
Language	English
Size	xiv, 402 p. :, ill.
Publisher	Mosby
Publishing place	St. Louis
Document type	Book
ISBN	9780801677717 ; 0801677718
Database	Catalogue of the US National Library of Medicine (NLM)

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Article: Outcome of surgical treatment of tarsal tunnel syndrome.

Sammarco, G James / Chang, Laurette

Foot & ankle international

2003 Volume 24, Issue 2, Page(s) 125–131

Abstract: One hundred and eight ankles in 72 patients were evaluated from July 1986 to July 1997 with clinical findings and positive electrodiagnostic studies of tarsal tunnel syndrome. Clinical data included physical findings, subjective complaints, duration of ... ...

Abstract	One hundred and eight ankles in 72 patients were evaluated from July 1986 to July 1997 with clinical findings and positive electrodiagnostic studies of tarsal tunnel syndrome. Clinical data included physical findings, subjective complaints, duration of symptoms, trauma history, steroid injections, nonsteroidal use and workman's compensation involvement. Associated medical conditions included diabetes, back pain and arthritis. Sixty-two patients underwent tarsal tunnel release, with 13 of them bilateral. There were 44 females and 18 males, 35 right feet and 40 left feet. The average age was 49 years. Preoperative symptom duration was 31 months. Average length of follow-up was 58 months. Average time for return to usual activity was nine months. All patients had at least a 12-month follow-up, and compared with both (Maryland Foot Score) MFS and AOFAS postoperative scores. Preoperative MFS scores obtained prior to 1994, were 61/100 (average), and postoperative MFS scores were 80/100 (average). Postoperative AOFAS scores were 80/100 (average). Patients with symptoms less than one year had postoperative MFS/AOFAS scores significantly higher than those with symptoms greater than one year. The most common surgical findings included arterial vascular leashes indenting the nerve and scarring about the nerve. Varicosities and space occupying lesions were present also. The outcome of surgery was not affected by the presence or absence of trauma. Patients with tarsal tunnel syndrome warrant surgery when significant symptoms do not respond to conservative management. Meticulous surgical technique must be followed. Improvement in foot scores is predictable even when a discrete space-occupying lesion is not present and when symptoms have been present for periods of greater than one year.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Electrodiagnosis ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Tarsal Tunnel Syndrome/complications ; Tarsal Tunnel Syndrome/diagnosis ; Tarsal Tunnel Syndrome/surgery ; Treatment Outcome
Language	English
Publishing date	2003-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	1183283-6
ISSN	1944-7876 ; 1071-1007
ISSN (online)	1944-7876
ISSN	1071-1007
DOI	10.1177/107110070302400205
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Article: Treatment of talar osteochondral lesions using local osteochondral graft.

Sammarco, G James / Makwana, Nilesh K

Foot & ankle international

2002 Volume 23, Issue 8, Page(s) 693–698

Abstract: Twelve patients with an osteochondral lesion of the talus were treated with excision of the lesions and local osteochondral autogenous grafting. The lesion was accessed through a replaceable bone block removed from the anterior tibial plafond. The graft ... ...

Abstract	Twelve patients with an osteochondral lesion of the talus were treated with excision of the lesions and local osteochondral autogenous grafting. The lesion was accessed through a replaceable bone block removed from the anterior tibial plafond. The graft was harvested from the medial or lateral talar articular facet on the same side of the lesion. The average age of the patients was 41 years and duration of symptoms was 90 months (ave.). There were six males and six females with the right talus involved in eight and the left in four patients. Graft sizes ranged from four to eight millimeters in diameter. There was a significant improvement in the AOFAS score from 64.4 (ave.) pre-operatively to 90.8 (ave.) postoperatively (p<0.0001), at a follow-up of 25.3 months (ave.). The AOFAS score was slightly higher in patients under 40 years of age and in those without pre-existing joint arthritis. All patients were very satisfied with the procedure. Arthroscopy performed in two patients at six and 12 months following surgery showed good graft incorporation. No complications occurred at the donor site or the site of bone block removal on the distal tibia. The results show that stage III and IV talar osteochondral lesions can be accessed successfully excising a tibial bone block and using local autogenous osteochondral graft harvested from the ipsilateral talar articular facet.
MeSH term(s)	Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Orthopedic Procedures/methods ; Osteochondritis Dissecans/diagnostic imaging ; Osteochondritis Dissecans/surgery ; Osteotomy/methods ; Radiography ; Talus/diagnostic imaging ; Talus/transplantation ; Transplantation, Autologous
Language	English
Publishing date	2002-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	1183283-6
ISSN	1944-7876 ; 1071-1007
ISSN (online)	1944-7876
ISSN	1071-1007
DOI	10.1177/107110070202300803
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Article ; Online: Midtarsal arthrodesis in the treatment of Charcot midfoot arthropathy. Surgical technique.

Sammarco, V James / Sammarco, G James / Walker, Earl W / Guiao, Ronald P

The Journal of bone and joint surgery. American volume

2010 Volume 92 Suppl 1 Pt 1, Page(s) 1–19

Abstract: Background: Fracture-dislocation of the midfoot with collapse of the longitudinal arch is common in patients with neuropathic arthropathy of the foot. In this study, we describe a technique of midfoot arthrodesis with use of intramedullary axial screw ... ...

Abstract	Background: Fracture-dislocation of the midfoot with collapse of the longitudinal arch is common in patients with neuropathic arthropathy of the foot. In this study, we describe a technique of midfoot arthrodesis with use of intramedullary axial screw fixation and review the results and complications following use of this technique. Methods: A retrospective study of twenty-two patients who had undergone surgical reconstruction and arthrodesis to treat Charcot midfoot deformity was performed. Bone resection and/or osteotomy were required to reduce deformity. Axially placed intramedullary screws, inserted either antegrade or retrograde across the arthrodesis sites, were used to restore the longitudinal arch. Radiographic measurements were recorded preoperatively, immediately postoperatively, and at the time of the last follow-up and were analyzed in order to assess the amount and maintenance of correction. Results: Patients were evaluated clinically and radiographically at an average of fifty-two months. Complete osseous union was achieved in sixteen of the twenty-two patients, at an average of 5.8 months. There were five partial unions in which a single joint did not unite in an otherwise stable foot. There was one nonunion, with recurrence of deformity. All patients returned to an independent functional ambulatory status within 9.5 months. Weight-bearing radiographs showed the talar-first metatarsal angle, the talar declination angle, and the calcaneal-fifth metatarsal angle to have improved significantly and to have been corrected to nearly normal values by the surgery. All measurements remained significantly improved, as compared with the preoperative values, at the time of final follow-up. There were no recurrent dislocations. Three patients had a recurrent plantar ulcer at the metatarsophalangeal joint that required additional surgery. There were eight cases of hardware failure. Conclusions: Open reduction and arthrodesis with use of multiple axially placed intramedullary screws for the surgical correction of neuropathic midfoot collapse provides a reliable stable construct to achieve and maintain correction of the deformity.
MeSH term(s)	Arthrodesis/methods ; Arthropathy, Neurogenic/surgery ; Bone Screws ; Contracture/surgery ; Contraindications ; Fluoroscopy ; Foot Diseases/surgery ; Humans ; Joint Dislocations/surgery ; Retrospective Studies
Language	English
Publishing date	2010-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	220625-0
ISSN	1535-1386 ; 0021-9355
ISSN (online)	1535-1386
ISSN	0021-9355
DOI	10.2106/JBJS.I.01289
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