Accessory Anterolateral Talar Facet Resection Reduces Pain and Improves Functional Outcomes

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: The accessory anterolateral talar facet (AALTF) is a recognized anatomical variant of the talocalcaneal articulation that has gained increasing clinical attention due to its association with talocalcaneal impingement and sinus tarsi syndrome. The AALTF presents varying prevalence across studies, ranging from 3.6% in general MRI populations to over 30% in symptomatic patients. Its clinical significance lies in its potential role in mechanical stress, causing foot pain and restricted subtalar joint motion, particularly when associated with tarsal coalition. Comprehensive studies involving larger cohorts with detailed clinical and radiological assessments remain limited. This study aims to evaluate a large cohort of patients with AALTF and concurrent pathologies and assessing clinical outcomes. Methods: This retrospective study evaluated patients diagnosed with AALTF who underwent surgical resection between 2016 and 2023. Data were collected from preoperative and postoperative assessments, including Patient Reported Outcomes Measurement Information System (PROMIS), Visual Analog Scale (VAS) scores, Foot Function Index (FFI), American Orthopaedic Foot & Ankle Society (AOFAS) scores, and Oxford Ankle Scores. Patients were evaluated preoperatively, at 6 months, 12 months, and the latest follow-up. Preoperative imaging included assessments of the angle of Gissane and sinus tarsi fat obliteration, with concurrent tarsal coalition assessed as confounding factor. Statistical analysis was performed using Wilcoxon signed-rank tests to compare preoperative and postoperative outcomes. Results: Seventeen feet from 13 patients (mean age: 15.6 years, range: 12–23) underwent AALTF resection with a mean follow-up of 16.9 months (range: 12–24). The AOFAS score improved from 53.8 ± 15.7 preoperatively to 78.6 ± 9.4 at 6 months (p =0.001) and 82.3 ± 12.6 at the latest follow-up. The Oxford score decreased from 39.1 ± 21.2 preoperatively to 15.1 ± 10.4 at 6 months (p =0.001) and 10.8 ± 10.3 at the latest follow-up. FFI decreased from 22.6 ± 16.0 to 10.3 ± 11.5 (p < 0.001). PROMIS scores increased from 63.4 ± 9.0 to 86.2 ± 11.8. VAS improved from 6.1 ± 1.3 to 3.1 ± 1.1 at 6 months (p =0.001). The angle of Gissane decreased from 131.4° to 125.7° (p =0.004). Conclusion: Surgical resection of AALTF leads to significant improvements in pain relief and foot function. PROMIS, VAS, and AOFAS scores demonstrated substantial postoperative benefits, and radiological correlations supported the clinical findings. The results confirm that addressing AALTF, particularly in cases with concurrent tarsal coalitions, is effective in improving patient outcomes. Further prospective studies are recommended to validate these findings and improve surgical strategies.