We prove Gromov's conjecture on the total mean curvature of fill-ins in various cases. Our methods are based on surgery to reduce the statement to fill-ins of spheres, which can be treated by instances of the positive mass theorem. For spin fill-ins, where we permit the mean curvature to take negative values, we build on a classical surgery result of Lawson-Michelsohn and a recent positive mass theorem with creases by Kazaras-Khuri-Lin. For non-spin fill-ins of spin manifolds, where we assume the mean curvature to be non-negative, we develop a novel quantitative surgery process to reduce the general situation to a result of Shi-Wang-Wei. We also treat the case of fill-ins of non-spin manifolds, provided there is a fixed positive lower bound on the mean curvature.
Hirayama Disease is a spinal muscular atrophy which presents with varying degrees of unilateral or asymmetric bilateral distal muscle weakness of the upper extremity. It is a rare, non-progressive motor neuron disease, mostly affecting young males. Although considered to have a relatively stationary clinical course after a period of initial progression, it can be functionally impairing in some patients. Here, we present a case of a 20-year-old male who complained of weakness of his right upper extremity for 1 year with difficulty performing activities of daily life. This case highlights the role of radiologist in identifying the subtle findings in cervical spine MRI of patients with such presentation. Moreover, it emphasizes the importance of including flexion imaging MRI sequences in a patient with suspicion of Hirayama disease.
Medical physics. Medical radiology. Nuclear medicine
We exhibit a homotopy theoretic proof of the Fundamental Theorem of Poincaré surgery in the simply connected case. We also deduce the Poincaré transversality exact sequence.
We introduce the notion of contact round surgery of index $1$ on Legendrian knots in a general contact 3-manifold. It generalizes the notion of contact round surgery of index 1 on Legendrian knots introduced by Adachi. In $\left(\mathbb{S}^3, ξ_{st}\right)$, we introduce the notion of contact round surgery of index 2 on a Legendrian knot and realize Adachi's contact round 2-surgery on a convex torus as a contact round surgery of index $2$ on a Legendrian knot in $\left(\s^3, ξ_{st}\right)$. We associate surgery diagrams to contact round surgeries of indices 1 and 2 on Legendrian knots in $\left(\mathbb{S}^3, ξ_{st}\right)$. With this set-up, we show that every closed connected contact 3-manifold can be obtained by performing a sequence of contact round surgeries on some Legendrian link in $\left(\mathbb{S}^3, ξ_{st}\right)$, thus obtaining a contact round surgery diagram for each contact 3-manifold. This is analogous to the result of Ding-Geiges for contact Dehn surgeries. We also discuss a bridge between certain pairs of contact round surgery diagrams of indices 1 and 2, and contact $(\pm1)$-surgery diagrams. We use this bridge to establish the result mentioned above. In the end, we derive a corollary that gives sufficient conditions on contact round surgeries to produce symplectically fillable manifolds.
Mahmut Berkman, Ayhan Aritamur, Harzem Ozger
et al.
Abstract
The late results of surgically treated Plateau Tibial Fractures in the years 1975-1985 in Orthopaedics and Traumatology Department of the University of Istanbul Faculty of Medicine have been analyzed and the results in literature have been compared and evaluated. We have given views on thrapy in the light of all this knowledge
ÖzetBu araştırmada İst. Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı’nda 1975-1985 yılları arasında cerrahi tedavi uygulanmış plato-tibial kırıkların geç sonuçları araştırılmış sonuçlar literatür bilgileri ile karşılaştırılarak değerlindirilmiş ve bunların ışığında tedavi konusundaki görüşler bilidirilmiştir.
Introduction:
Metallosis is a pathological condition associated with the release of metal debris from joint implants, particularly metal-on-metal (MoM) articulations in total hip arthroplasty (THA). The metal debris triggers adverse local tissue reactions, including aseptic lymphocyte-vasculitis-associated lesions (ALVALs), pseudotumor formation, and progressive implant loosening.
Case Report:
Case 1 - A 64-year-old male presented with hip pain and limping 15 years after an uncemented MoM THA. Investigations revealed femoral stem loosening. Intraoperatively, dark synovial fluid, necrotic tissue, elevated cobalt, and chromium levels were consistent with metallosis were identified. Revision surgery replaced the components with alternative bearings, and the patient returned to normal activities within a year. Case 2 - A 63-year-old female with bilateral MoM THAs reported similar symptoms 15-year post-surgery. Imaging identified a pseudotumor and femoral loosening. Elevated serum metal ion levels confirmed the diagnosis. Revision surgery revealed ALVAL, and components were replaced with ceramic-on-polyethylene implants, resolving symptoms.
Conclusion:
Metallosis poses a significant risk in MoM THA, caused by wear and corrosion, leading to systemic and local tissue damage. Timely diagnosis through clinical evaluation, imaging, and serum metal ion levels is critical for intervention. Revision surgeries are effective in managing metallosis and restoring function. These cases highlight the importance of long-term monitoring and the consideration of alternative bearing surfaces in hip arthroplasty.
Orthopedic surgery, Diseases of the musculoskeletal system
Advancements in tissue engineering are crucial for successfully healing tendon-bone connections, especially in situations like anterior cruciate ligament (ACL) restoration. This study presents a new and innovative three-dimensional scaffold, reinforced with nanofibers, that is specifically intended for acellular tendon complexes. The scaffold consists of a distinct layered arrangement comprising an acellular tendon core, a middle layer of polyurethane/type I collagen (PU/Col I) yarn, and an outside layer of poly (L-lactic acid)/bioactive glass (PLLA/BG) nanofiber membrane. Every layer is designed to fulfill specific yet harmonious purposes. The acellular tendon core is a solid structural base and a favorable environment for tendon cell functions, resulting in considerable tensile strength. The central PU/Col I yarn layer is vital in promoting the tendinogenic differentiation of stem cells derived from tendons and increasing the expression of critical tendinogenic factors. The external PLLA/BG nanofiber membrane fosters the process of bone marrow mesenchymal stem cells differentiating into bone cells and enhances the expression of markers associated with bone formation. Our scaffold's biocompatibility and multi-functional design were confirmed through extensive in vivo evaluations, such as histological staining and biomechanical analyses. These assessments combined showed notable enhancements in ACL repair and healing. This study emphasizes the promise of multi-layered nanofiber scaffolds in orthopedic tissue engineering and also introduces new possibilities for the creation of improved materials for regenerating the tendon-bone interface.
We show that the good quantum LDPC codes of Panteleev-Kalachev \cite{PK} allow for surgery using any logical qubits, albeit incurring an asymptotic penalty which lowers the rate and distance scaling. We also prove that we can satisfy 3 of the 4 conditions for performing surgery \textit{without} incurring an asymptotic penalty. If the last condition is also satisfied then we can perform code surgery while maintaining $k, d\in Θ(n)$.
Michał Maciejewski, Piotr Janusz, Michalina Dudkiewicz
et al.
Introduction. Radial neck fractures in children are rare and account for 1-3% of all childhood trauma. Severe displacement of the fracture can lead to a higher incidence of complications, such as limited range of motion (ROM), pain, instability, neurovascular trauma, premature physeal closure, cubitus valgus, radial head overgrowth, avascular necrosis and improper ossification. The treatment outcome depends on the injury type, treatment method and presence of complications.Aim. The purpose of the study was to assess the outcome of patients treated with elastic-stable intramedullary nailing (ESIN) regarding different radial head angulations and to search for risk factors of a poor outcome.Materials and methods. Twenty-six consecutive patients treated between October 2020, and March 2022, due to radial neck fracture were included in the study. Closed reduction and ESIN fixation were performed. If failed, A K-wire assisted reduction or open reduction was performed. A radiological evaluation was performed pre- and post surgery and at the last follow-up. At the last follow-up visit, the elbow range of motion (ROM) was measured and the Mayo Elbow Performance Score (MEPS) was established. The follow-up was after 25 months. Results. The angulation before surgery was 42.4 and the next day after surgery was 6.9, p = 0.0001. Further correction was observed and at the last follow-up it was 2.5, p = 0.001. We found no complications besides one skin irritation by an implant and 2 reduced ROM. The MEPS was 97.7. The difference in MEPS between Judet IVB (angulation before surgery> 80) 92.5 and other patients 98.6 was significant, p = 0.04674. There was no significant difference in MEPS, ROM, between patients immobilized in a plater cast versus in a sling, Conclusions. Closed reduction with the use of ESIN can be considered a safe procedure with a low rate of complications. Patients with an angulation >80 revealed worse functional effects. Cast immobilization did not reveal a negative or a positive impact on the treatment result.
Zachary Troiani BA, Michael Harrington MD, Afshin Anoushiravani MD
et al.
Background: The Broström procedure with suture tape augmentation has become commonplace for surgical treatment of chronic lateral ankle instability. However, there is no consensus among surgeons whether internal bracing of the ATFL alone or a combined ATFL and calcaneofibular ligament (CFL) internal brace produces superior clinical outcomes. This retrospective study aims to investigate whether isolated internal bracing of the ATFL has comparable outcomes to combined ATFL and CFL brace. Methods: There were 85 patients from a single tertiary medical center’s electronic medical record identified who underwent an ATFL or ATFL and CFL reconstruction between January 2017 and December 2020. Postoperative outcomes including patient satisfaction, ankle instability, ankle pain, and the need for revision surgery at 1-year follow-up were evaluated. Results: Forty-eight patients underwent isolated ATFL reconstruction, and 37 underwent combined ATFL and CFL reconstruction. The choice was made between the 2 options based on surgeon preference. At 1-year follow-up, postoperative outcomes were statistically indistinguishable between the 2 treatment groups. Conclusion: The modified Broström reconstruction with ATFL and CFL reconstruction with an internal brace did not produce superior functional outcomes measured at 1 year compared to isolated ATFL reconstruction. Further investigation of long-term functional outcomes is needed to evaluate the long-term efficacy of combined or single-ligament reconstruction. Level of Evidence: Level III, retrospective study.
Anna Nordenholm, Eric Hamrin Senorski, Olof Westin
et al.
Abstract Background Chronic Achilles tendon rupture is associated with persistent weakness at push-off with the affected foot and poor balance, resulting in significant alterations to normal gait. Surgical repair is the most common treatment for improving gait in patients with a Chronic Achilles tendon rupture, but, to date, the outcomes have not been quantified in the literature. Methods A total of 23 patients with a Chronic Achilles tendon rupture (mean age 61 ± 15 years) underwent three-dimensional gait analysis according to a standardized protocol using an optical tracking system. Data of spatiotemporal, kinematic and kinetic variables were collected preoperatively and one year postoperatively. In addition, the postoperative gait biomechanics were compared with the gait biomechanics of a control group consisting of 70 healthy individuals (mean age 49 ± 20 years). The prospectively collected data were analyzed by an independent t test. Results Postoperatively, increments were found in gait speed (mean difference − 0.12 m/s), stride length (− 0.12 m), peak ankle moment (− 0.64 Nm/kg), peak ankle power (− 1.38 W/kg), peak knee power (− 0.36 m) and reduced step width (0.01 m), compared with preoperative gait biomechanics (p < 0.014). Compared with the control group, patients with a Chronic Achilles tendon rupture exhibited slower postoperative gait speed (mean difference 0.24 m/s), wider step width (− 0.02 m), shorter stride length (0.16 m), longer relative stance phase (− 2.15%), lower peak knee flexion (17.03 degrees), greater peak knee extension (2.58 degrees), lower peak ankle moment (0.35 Nm/kg), peak ankle power (1.22 W/kg) and peak knee power (1.62 W/kg), (p < 0.010). Conclusion Surgical intervention and postoperative rehabilitation can be an effective treatment for alterations in gait after a Chronic rupture of the Achilles tendon. However, at one year postoperatively, patients still exhibit impairments in spatiotemporal variables and knee and ankle power compared with healthy controls.
Orthopedic surgery, Diseases of the musculoskeletal system
Postoperative delirium is prevalent in older patients and associated with worse outcomes. Recent data in animal studies demonstrate increases in inflammatory markers in plasma and cerebrospinal fluid (CSF) even after aseptic surgery, suggesting that inflammation of the central nervous system may be part of the pathogenesis of postoperative cognitive changes. We investigated the hypothesis that neuroinflammation was an important cause for postoperative delirium and cognitive dysfunction after major non-cardiac surgery. After Institutional Review Board approval and informed consent, we recruited patients undergoing major knee surgery who received spinal anesthesia and femoral nerve block with intravenous sedation. All patients had an indwelling spinal catheter placed at the time of spinal anesthesia that was left in place for up to 24 h. Plasma and CSF samples were collected preoperatively and at 3, 6, and 18 h postoperatively. Cytokine levels were measured using ELISA and Luminex. Postoperative delirium was determined using the confusion assessment method, and cognitive dysfunction was measured using validated cognitive tests (word list, verbal fluency test, digit symbol test). Ten patients with complete datasets were included. One patient developed postoperative delirium, and six patients developed postoperative cognitive dysfunction. Postoperatively, at different time points, statistically significant changes compared to baseline were present in IL-5, IL-6, I-8, IL-10, monocyte chemotactic protein (MCP)-1, macrophage inflammatory protein (MIP)-1α, IL-6/IL-10, and receptor for advanced glycation end products in plasma and in IFN-γ, IL-6, IL-8, IL-10, MCP-1, MIP-1α, MIP-1β, IL-8/IL-10, and TNF-α in CSF. Substantial pro- and anti-inflammatory activity in the central neural system after surgery was found. If confirmed by larger studies, persistent changes in cytokine levels may serve as biomarkers for novel clinical trials.
Yuanqiao Wu, Johnfredy Loaiza, Rohin Banerji
et al.
Abstract Background Although deformation and fracture of the vertebral endplate have been implicated in spinal conditions such as vertebral fracture and disc degeneration, few biomechanical studies of this structure are available. The goal of this study was to quantify the mechanical behavior of the vertebral endplate. Methods Eight‐five rectangular specimens were dissected from the superior and/or inferior central endplates of human lumbar spine segments L1 to L4. Micro‐computed tomography (μCT) imaging, four‐point‐bend testing, and ashing were performed to quantify the apparent elastic modulus and yield stress (modulus and yield stress, respectively, of the porous vertebral endplate), tissue yield stress (yield stress of the tissue of the vertebral endplate, excluding pores), ultimate strain, fracture strain, bone volume fraction (BV/TV), bone mineral density (BMD), and various measures of tissue density and composition (tissue mineral density, ash fraction, and ash density). Regression was used to assess the dependence of mechanical properties on density and composition. Results Wide variations in elastic and failure properties, and in density and tissue composition, were observed. BMD and BV/TV were good predictors of many of the apparent‐level mechanical properties, including modulus, yield stress, and in the case of the inferior vertebral endplate, failure strains. Similar values of the mechanical properties were noted between superior and inferior vertebral endplates. In contrast to the dependence of apparent stiffness and strength on BMD and BV/TV, none of the mechanical properties depended on any of the tissue‐level density measurements. Conclusion The dependence of many of the mechanical properties of the vertebral endplate on BV/TV and BMD suggests possibilities for noninvasive assessment of how this region of the spine behaves during habitual and injurious loading. Further study of the nonmineral components of the endplate tissue is required to understand how the composition of this tissue may influence the overall mechanical behavior of the vertebral endplate.
Mehmet Kocaoglu, Bernd Landsleitner, Jacek Kotas
et al.
Abstract
Avascular necrosis of navicular bone is very rarely seen. This entity which was first described by Preiser, in 1909 begins with pain and tenderness, and limitation of range of motion of the wrist. We present a case at 20 Years of age. The history ofthe patient didn t reveal any wrist trauma. By physical examination the range of motion of the wrist was limited. MRI revealed diminished blood supply to the navicular bone. The case was classified as stage IV avascular necrosis and was treated by denervation ofthe wrist. Because of the presentation of a patient with this very rare disease, the case is introduced along with discussion of the related literature.
Özet
Naviküler kemiğin avasküler nekrozu vakasına literatürde çok nadir olarak rastlanır. İlk defa 1909 yılında patolojisi Preiser in tarif ettiği bu hastalıkta el bileğinde ağrı, hassasiyet ve hareket kısıtlanması söz konusudur. Bu çalışmada Proser hastalığı teşhisi konularak tedaviye alınan 20 yaşındaki nadir bir olgu sunuldu. Hastanın anamnezinde travma yoktu el bileği hareketleri kısıtlanmıştı. Yapılan NMR tetkiklerinde naviküler kemikteki kanlanmanın ileri derecede azaldığı tespit edildi. Evre IV olarak değerlendirilen vakada palyatif bir girişim olarak Wilhelm tekniğine göre el bileği denervasyon uygulandı. Bu nadir olgu dolayısıyla konu ile ilgili literatür gözden geçirildi.
Tolga Akkaya, Salim Ersozlu, Ahmet Fevzi Ozgur
et al.
Abstract
Objectives: We evaluated early results of kyphoplasty for osteoporotic vertebral compression fractures with regard to the level of pain, activity levels of patients, and radiographic restoration of the vertebra bodies.\nMethods: Sixteen patients (4 males, 12 females; mean age 63 years; range 55 to 72 years) with osteoporotic vertebral compression fractures in the lumbar spine were treated with kyphoplasty. The procedure was performed at 21 levels, with a minimum of 3 ml (range 3 to 6 ml) of cement per level. The mean time from the onset of symptoms to the application was six days (range 2 to 16 days). The effectiveness of the procedure was evaluated by a visual analog scale (VAS: 0 no pain; 10 very severe pain) before kyphoplasty, and after the first day and one month of the procedure. In addition, restoration of the vertebra bodies was assessed on pre- and postoperative radiographs by measuring the anterior, middle, and posterior heights. The mean follow-up was 11 months (range 4 to 30 months).\nResults: The mean VAS scores were 8.8 (range 7 to 10), 2.4 (range 1 to 5), and 1.6 (range 0 to 3) before kyphoplasty, and after the first day and one month of the procedure, respectively (p<0.0001). All the patients returned to preinjury levels of activity within the first month. No collapse or refracture occurred in the treated vertebrae. Changes in the anterior, middle, and posterior heights of the vertebra bodies after the procedure were not significant. The only complication was the development of an additional fracture in the nearby segment in two patients, for which kyphoplasty was performed.\nConclusion: With proper patient selection, kyphoplasty is an effective and reliable option for osteoporotic vertebral compression fractures, yielding 80% to 95% success rates.
Özet
Amaç: Osteoporotik vertebra kompresyon kırığı (VKK) nedeniyle erken dönemde yapılan kifoplasti sonrası hastaların ağrı durumu, aktivite düzeyleri ve radyografik olarak vertebra cisminin restorasyonu değerlendirildi. \nÇalışma planı: Çalışmaya lomber bölgede oluşan osteoporotik VKK nedeniyle erken dönemde kifoplasti uygulanan 16 hasta (4 erkek, 12 kadın; ort. yaş 63; dağılım 55-72) alındı. Kifoplasti uygulanan toplam seviye sayısı 21 idi ve seviye başına en az 3 ml (dağılım 3-6 ml) çimento enjekte edildi. Semptomların başlaması ile cerrahi işlem arasındaki süre ortalama altı gündü (dağılım 2-16 gün). İşlemin etkinliğini değerlendirmek için, tanı konduğunda, kifoplasti sonrası birinci günde ve bir ay sonra görsel analog skala (GAS: 0 hiç ağrı yok, 10 çok şiddetli ağrı) kullanıldı. Kifoplasti öncesi ve sonrasında vertebra gövdesinin ön, orta ve arka yükseklikleri direkt grafilerde ölçülerek vertebranın restorasyonu değerlendirildi. Ortalama takip süresi 11 ay (dağılım 4-30 ay) idi.\nSonuçlar: Girişim öncesinde ortalama 8.8 (dağılım 7-10) olan GAS skoru girişim sonrası birinci günde 2.4 (dağılım 1-5), birinci ayda 1.6 (dağılım 0-3) bulundu (p<0.0001). Tüm hastaların ilk bir ay içinde kırık öncesi aktivite düzeylerine geldiği görüldü. Kifoplasti uygulanan vertebralarda çökme veya yeni kırık görülmedi. Kompresyon kırığı olan vertebraların ön, orta ve arka cisim yükseklikleri girişim öncesine göre anlamlı değişim göstermedi. Komplikasyon olarak iki hastada komşu segmentte ek VKK gelişti ve bunlara yönelik yine kifoplasti uygulandı.\nÇıkarımlar: Kifoplasti, osteoporotik VKK’de uygun hasta seçimiyle %80-95 gibi yüksek başarı oranlarına sahip güvenilir ve etkin bir tedavi yöntemi olarak kabul edilebilir.
Abstract
Objective: Timing of surgery in hip fracture patients using antiplatelet agents is a controversial issue. Clopidogrel is an antiplatelet drug widely used in the treatment of many diseases. In this study, we aimed to investigate the outcomes of early surgery in hip fracture patients using clopidogrel.
Methods: Elderly patients with femoral neck fractures who underwent open surgery between 2009 and 2014 were evaluated. Two hundred and eleven patients were included in the study. Patients were separated into 3 groups. Group 1 was constituted of patients using clopidogrel who had been operated on within 48 h after admission (n=74), Group 2 was constituted of patients using clopidogrel who had been operated on after the fifth day of admission (n=55), and Group 3 was constituted of patients not using clopidogrel who had been operated on within 48 h after admission (n=83). Length of hospital stay, amount of blood transfusion, rate of complication, and mortality rate were assessed for comparison of groups.
Results: Age, sex, preoperative hemoglobin values, and ASA scores were not different between the groups. Amount of blood transfusions was higher in Group 1 (p=0.023). Duration of hospital stay was longer in Group 2 (p<0.01), as was complication rate (25.4%) (p<0.01). Mortality within 30 days and within the first 3 months post-surgery was significantly higher in Group 2 (p=0.031, p<0.01; respectively).
Conclusion: Surgery should not be postponed in hip fracture patients using clopidogrel.
Özet
Amaç: Antiplatelet tedavi alırken kalça kırığı gelişen hastaların cerrahi mu¨dahale zamanlaması tartışmalı bir durumdur. Klopidogrel birçok hastalığın tedavisinde yaygın olarak kullanılan antiplatelet bir ilaçtır. Bu çalışmada klopidogrel tedavisi alırken kalça kırığı olan hastaların cerrahi mu¨dahale sonuçlarını karşılaştırmayı amaçladık.
Çalışma planı: 2009 ile 2014 yılları arasında ileri yaş femur boyun kırığı nedeni ile açık cerrahi uygulanan hastalar geriye dönu¨k olarak tarandı. Çalışmaya 211 hasta dahil edildi. Hastalar; klopidogrel kullanan ve ilk 48 saat içinde opere edilenler (grup 1, 74 hasta), klopidogrel kullanan ve beşinci gu¨nden sonra opere edilen (grup 2, 55 hasta) ve herhangi bir antiagregan kullanmayan (grup 3, 82 hasta) olarak u¨ç gruba ayrıldı. Gruplar kan transfu¨zyon miktarı, yatış su¨resi, komplikasyon ve mortalite açısından karşılaştırıldı.
Bulgular: Gruplar arasında yaş cinsiyet operasyon öncesi hemoglobin değerleri ve ASA skorları açısından anlamlı fark tespit edilemedi. Birinci gruptaki hastaların daha fazla kan transfu¨zyonu ihtiyacı oldu (p=0.023). İkinci grupta hastanede kalış su¨resi daha yu¨ksek idi (p<0.01) ve daha yu¨ksek oranda (%25.4) komplikasyon göru¨ldu¨ (p<0.01). İkinci gruptaki hastalarda ilk otuz gu¨n içinde ve ilk u¨ç ay içinde ölu¨m oranı diğer gruplara göre daha yu¨ksek bulundu (sırasıyla, p=0.031, p<0.01).
Çıkarımlar: Kalça kırıklarında cerrahi mu¨dahale klopidogrel kullanan hastalarda ertelenmemelidir.
DOI: 10.3944/AOTT.2015.14.0160
Bu özet, makalenin henüz redaksiyonu tamamlanmamış haline aittir ve bilgi verme amaçlıdır. Yayın aşamasında değişiklik gösterebilir.
Rusheel Nayak BA, Milap Patel DO, Anish R. Kadakia MD
Category: Hindfoot; Ankle; Midfoot/Forefoot Introduction/Purpose: The tibiocalcaneonavicular ligament (TCNL) is formed from the confluence of the superficial deltoid ligament and the superomedial spring ligament. In advanced flexible adult acquired flatfoot deformity (AAFD), progressive strain on the TCNL can lead to spring ligament tears, deltoid insufficiency, and eventual medial peritalar instability. Historically, medial peritalar instability was corrected using calcaneal osteotomy in conjunction with isolated spring or deltoid reconstruction. A recent study (Brodell et al.) demonstrated the efficacy of TCNL reconstruction in patients with medial peritalar instability. The purpose of this study is to add to this literature using patient-reported and radiographic outcomes in patients undergoing TCNL reconstruction. Patient-reported outcomes were collected using Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) surveys. Methods: Sixteen patients (mean age 50.25 years; 11 female, 5 male) who underwent TCNL reconstruction were prospectively identified. TCNL reconstruction was indicated for stage IIB patients (n=13) with large spring ligament tears (>1.5cm on MRI or intraoperatively) or if osseous correction did not provide adequate talonavicular joint correction. TCNL reconstruction was indicated in stage IV patients (n=3) if deltoid reconstruction required additional medial stabilization. No patients underwent lateral column lengthening osteotomies. PROMIS scores were obtained at baseline and at minimum 12-months follow-up (average 16 months). Surgical success was determined using minimum clinically important differences (MCID), defined as improvement greater than one-half the standard deviation of each pre-operative PROMIS domain (PF: +2.9 and PI: -2.5). Pre- and post-operative radiographic parameters were measured: talonavicular uncoverage angle, talonavicular uncoverage percentage, AP talo-first metatarsal angle, Meary’s angle, and medial cuneiform height (MCH). Correlation coefficients determined the relationship between radiographic parameters and PROMIS scores. Results: PROMIS PF scores improved significantly from 38.1+-5.8 to 44.1+-7.1 (p=0.0087). PROMIS PI scores improved significantly from 62.9+-5.1 to 52.3+-8.9 (p=0.0025). Seventy-nine and 77 percent of patients had successful surgeries, as defined by MCIDs in the PROMIS PF and PI domains, respectively. Talonavicular uncoverage percentage and Meary’s angle improved significantly from 34.4+-13.4 to 26.3+-9.9 percent (p=0.0360) and 19.2+-8.8 to 15.3+-6.2 degrees (p=0.0089), respectively. Talonavicular uncoverage angle improved from 29.3+-9.6 to 23.3+-8.0 degrees (p=0.0562), AP talo-first metatarsal angle improved from 15.2+-10.2 to 10.4+-9.0 degrees (p=0.0555), and MCH improved from 13.5+-6.2 to 15.9+-4.8 millimeters (p=0.1374). Post- operative MCH correlated significantly with post-operative PROMIS PF scores (r=0.5941; p=0.0152). Change in AP talo-first metatarsal angle correlated significantly with change in PROMIS PI scores (r=0.5682; p=0.0427). No other correlations were significant. Conclusion: Patients with stage IIB and stage IV AAFD who undergo TCNL reconstructions have excellent patient-reported and radiographic outcomes. Reconstruction of the medial longitudinal arch, as measured by post-operative MCH, is associated with higher post-operative functionality. Surgical correction of midfoot abduction, as measured by change in the AP talo-first metatarsal angle after surgery, is associated with improvements in pain. In patients with medial peritalar instability, TCNL reconstruction can be a valuable technique to correct the sagittal arch, prevent excessive midfoot abduction, and improve pain and functionality.