Since the first total ankle arthroplasty (TAA) was performed in 1970, the number of TAA procedures for end-stage ankle osteoarthritis has gradually increased as an alternative to arthrodesis. There are two types of TAAs: mobile-bearing and fixed-bearing. Each has its own advantages and disadvantages, but both have evolved over time from the first generation to the fourth generation, with improvements addressing earlier limitations. Although fourth-generation TAAs were introduced to the market in the early 2010s and long-term outcomes remain uncertain, early reports have shown favorable survival rates of 92%-98% and significant improvements in functional and pain scores two years after surgery. The design of TAA devices has advanced through improvements in mechanisms, anatomical shapes, materials, and surgical approaches. These advancements have improved, and will continue to improve clinical outcomes and survival rates with each new generation.

This article provides an overview of the classification of progressive collapsing foot deformity (PCFD), along with a mnemonic aid for memorization. It also outlines the classification of spring ligament insufficiency, the surgical procedure selection process for stage 1 PCFD, and a detailed summary of surgical techniques, including key tips and potential pitfalls.

The surgical overview covers the following: patient positioning, evaluation of spring ligament insufficiency and procedure selection using tendoscopy, assessment and management timing of gastrocnemius–Achilles tendon contracture, preparation of the calcaneocuboid joint, and medial exposure for flexor digitorum longus tendon (FDLT) transfer. Two novel techniques developed by the author are introduced: corrective repair of the spring ligament (CORRS), a repair method addressing forefoot varus associated with spring ligament damage; and spring ligament reconstruction by remnant posterior tibial tendon (PTT) preservation (SREPP), a reconstruction technique that uses remnant PTT tissue to treat extensive spring ligament ruptures and concurrently correct forefoot varus. The article also offers surgical tips for FDLT transfer, bone grafting, and lateral column lengthening (LCL) via calcaneocuboid distraction arthrodesis (CCDA), with special attention to avoid residual forefoot varus.

Correction of midfoot and forefoot varus is emphasized as a crucial element in performing LCL for stage 1 PCFD. CORRS and SREPP are presented as effective adjunctive techniques that enhance the outcomes of CCDA by preventing over-lengthening and residual forefoot varus.

Arthroscopic techniques were first established in the early 20^th century to provide alternative surgical treatment options for orthopedic pathologies. The discoveries and innovations of orthopedic pioneers provided the foundation for what is known today as the modern in-office needle arthroscope. The latest innovative optics in second-generation needle arthroscopes allow enhanced visualization of most joints and tendons and provide a visual platform that can facilitate a variety of surgical techniques. As a result, patients experience excellent clinical outcomes, along with increased satisfaction and greater cost-effectiveness when undergoing such procedures. The purpose of this review is to discuss the history, modern advancements, techniques, clinical outcomes, and cost-benefit analysis of in-office needle arthroscopy.

Introduction: Few reports described the effects and clinical outcomes of peroneal tendon pathologies in patients undergoing arthroscopic repair for lateral ankle instability.

Methods: Patients were stratified into those who underwent arthroscopic ankle lateral ligament repair alone (Group N) and those who underwent arthroscopic ankle lateral ligament repair in combination with surgery for peroneal tendon pathologies (Group P). Group P was further divided into patients without peroneal tendon dislocation (Group PT) and those with peroneal tendon dislocation (Group PD). Arthroscopic ankle lateral ligament repair was performed first, followed by additional surgery for peroneal tendon pathology in Group P. Subjective clinical outcome scores were assessed preoperatively and at 2 years postoperatively using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q).

Results: A total of 311 patients who met the inclusion and exclusion criteria were included in this study. There were 248 patients in Group N and 63 patients in Group P. Of the 63 patients in Group P, 46 were classified into Group PT and 17 into Group PD. In all groups, SAFE-Q scores significantly improved in all categories 2 years after surgery compared with preoperatively. At 2 years postoperatively, SAFE-Q scores showed statistically significant differences in all categories between Group P and Group N, Group PT and Group N, and Group PD and Group N (p < 0.0001), with Group N having higher scores.

Conclusions: Although surgical treatment for lateral ankle instability associated with peroneal tendon pathologies was effective, the presence of peroneal tendon pathologies had a negative effect on the postoperative clinical outcomes of arthroscopic repair for lateral ankle instability.