bluuebunny/crossref_metadata_2025 huggingface dataset:
Metformin and retinal diseases in preclinical and clinical studies: Insights and review of literature
Authors: Amin Shivam V , Khanna Saira , Parvar Seyedeh P , Shaw Lincoln T , Dao David , Hariprasad Seenu M , Skondra Dimitra
Published: January 2022

Metformin is one of the most prescribed drugs in the world giving potential health benefits beyond that of type 2 diabetes (T2DM). Emerging evidence suggests that it may have protective effects for retinal/posterior segment diseases including diabetic retinopathy (DR), age-related macular degeneration (AMD), inherited retinal degeneration such as retinitis pigmentosa (RP), primary open angle glaucoma (POAG), retinal vein occlusion (RVO), and uveitis. Metformin exerts potent anti-inflammatory, antiangiogenic, and antioxidative effects on the retina in response to pathologic stressors. In this review, we highlight the broad mechanism of action of metformin through key preclinical studies on animal models and cell lines used to simulate human retinal disease. We then explore the sparse but promising retrospective clinical data on metformin’s potential protective role in DR, AMD, POAG, and uveitis. Prospective clinical data is needed to clarify metformin’s role in management of posterior segment disorders. However, given metformin’s proven broad biochemical effects, favorable safety profile, relatively low cost, and promising data to date, it may represent a new therapeutic preventive and strategy for retinal diseases.
In vitro contractile studies within isolated tissue baths: Translational research from Visible Heart® Laboratories
Authors: Upchurch Weston J , Iaizzo Paul A
Published: January 2022

The isolated tissue bath research methodology was first developed in 1904. Since then, it has been recognized as an important tool in pharmacology and physiology research, including investigations into neuromuscular disorders. The tissue bath is still used routinely as the instrument for performing the “gold standard” test for clinical diagnosis of malignant hyperthermia susceptibility – the caffeine-halothane contracture test. Our research group has utilized this tool for several decades for a range of research studies, and we are currently one of four North American diagnostic centers for determining susceptibility for malignant hyperthermia. This review provides a brief summary of some of the historical uses of the tissue bath. Important experimental considerations for the operation of the tissue bath are further described. Finally, we discuss the different studies our group has performed using isolated tissue baths to highlight the broad potential applications.
Allele-specific silencing by RNAi of R92Q and R173W mutations in cardiac troponin T
Authors: Migliore Loredana , Galvagni Federico , Pierantozzi Enrico , Sorrentino Vincenzo , Rossi Daniela
Published: January 2022

Autosomal dominant mutations in sarcomere proteins such as the cardiac troponin T ( TNNT2) are the main genetic causes of human hypertrophic cardiomyopathy and dilated cardiomyopathy. Allele-specific silencing by RNA interference (ASP-RNAi) holds promise as a therapeutic strategy for downregulating a single mutant allele with minimal suppression of the corresponding wild-type allele. Here, we propose ASP-RNAi as a possible strategy to specifically knockdown mutant alleles coding for R92Q and R173W mutant TNNT2 proteins, identified in hypertrophic and dilated cardiomyopathy, respectively. Different siRNAs were designed and validated by luciferase reporter assay and following analysis in HEK293T cells expressing either the wild-type or mutant TNNT2 alleles. This study is the first exploration of ASP-RNAi on TNNT2-R173W and TNNT2-R92Q mutations in vitro and gives a base for further application of allele silencing as a therapeutic treatment for TNNT2-mutation-associated cardiomyopathies.
Transient fetal intrathoracic cyst first detected during the 11- to 13-week scan: A resolving pericardial cyst?
Authors: Sepulveda Waldo , Stuardo Patricio
Published: January 2022

Introduction:

The prenatal detection of an intrathoracic cyst during the first trimester of pregnancy is an exceedingly rare condition. In this report, we describe a case of first-trimester intrathoracic cyst causing cardiac dextroposition, which resolved by 24 weeks’ gestation.

Case report:

A 5-mm intrathoracic cyst causing cardiac dextroposition was detected during the routine sonographic scan performed at 12 weeks + 2 days. The cyst remained stable in size until 20 weeks and was no longer identified during focused fetal echocardiography at 24 weeks.

Discussion:

Our case demonstrates that a first-trimester intrathoracic cyst can have a benign course, either by remaining stable in size or even undergoing complete resolution during the second trimester. A focused sonographic examination should therefore be undertaken as follow-up to determine the final prognosis of these lesions.

Conclusion:

The etiology of intrathoracic cysts detected in the first trimester is unclear and could represent a resolving pericardial cyst.
Benefits and Risks of Mammography Screening in Women Ages 40 to 49 Years
Authors: Grimm Lars J. , Avery Carolyn S. , Hendrick Edward , Baker Jay A.
Published: January 2022

Breast cancer screening in the United States is complicated by conflicting recommendations from professional and governmental organizations. The benefits and risks of breast cancer screening differ though by age which should influence shared decision-making discussions. Compared to older women, women ages 40 to 49 years have a lower risk of breast cancer, but the types of breast cancer that develop are often more aggressive with a poorer prognosis. Furthermore, younger women have a longer life expectancy and fewer comorbidities. The primary benefits of screening for women in their 40s are a reduction in breast cancer mortality, years of life lost to breast cancer, and morbidity of breast cancer treatment by detecting cancers at an earlier stage. Compared to older women, the risks of breast cancer screening in women ages 40 to 49 years includes more false positive recalls and biopsies as well as transient anxiety. Concerns regarding radiation induced malignancy and overdiagnosis are minimal in this age group. The shorter lead time of breast cancer in women ages 40 to 49 years also favors shorter screening intervals. This information should help inform providers in their shared decision-making discussions with patients.
Visualizing the Knowledge Domain of Language Experience: A Bibliometric Analysis
Authors: Jiang Jiaxing , Fan Lin
Published: January 2022

Research on language experience (LE) has covered numerous topics in psychology, linguistics, and other relative disciplines. Such research is based on people’s experiences of the world, and substantial attention has been paid to this subject. In order to investigate the foundation and influential works of LE studies, we adopt CiteSpace software to analyze 30,045 published articles/reviews from the Web of Science by focusing on the co-citation analysis in terms of discipline, articles, and journals. The results present that (1) language systems in LE research interact mutually rather than separate from each other and (2) bilingualism is always a hot topic in the past few decades and will be popular in the next decades. These findings further indicate some issues to be resolved. One is about the relations between language systems and the other is the psychological interpretation in language experiences conflicts in practical language use.
Does Medicaid Expansion Improve Access to Care for Ankle Sprains?
Authors: Hoch Caroline P. , Scott Daniel J. , Scott Daniel J. , Gross Christopher E.
Published: January 2022

Category:

Ankle; Sports; Other

Introduction/Purpose:

Prior research has found Medicaid patients face greater difficulty scheduling appointments with orthopaedic surgeons compared to those with other insurance. Recently, a number of states have expanded Medicaid coverage as part of the affordable care act, although it is unclear how this expansion impacts the ability of these patients to obtain access to orthopaedic surgeons. We questioned whether Medicaid patients face additional barriers to care for treatment of ankle sprains, an extremely common athletic injury. Our goal was to determine whether individual state Medicaid expansion status, as well as type of insurance accepted, affected access to care for ankle sprains.

Methods:

Four pairs of Medicaid expanded (Kentucky, Louisiana, Iowa, Arizona) and unexpanded (North Carolina, Alabama, Wisconsin, Texas) states in similar geographic locations were chosen. Twelve foot and ankle practices from each state (N=96) were randomly selected from the American Orthopaedic Foot & Ankle Society directory. Each clinic was called twice to request an appointment for a fictitious 16-year-old with a first-time ankle sprain with either in-state Medicaid insurance or Blue Cross Blue Shield (BCBS) private insurance.

Results:

An appointment was obtained at 63 (65.6%) clinics when calling with BCBS and 44 (45.8%) clinics with Medicaid (P=.006). There was a significant difference in appointment scheduling based on insurance status in Medicaid unexpanded states (Medicaid=21, 43.8% vs. BCBS=34, 70.8%; P=.007). However, this difference was not significant in Medicaid expanded states (Medicaid=23, 47.9% vs. BCBS=29, 60.4%; P=.219). In addition, in all states except Iowa, a Medicaid expanded state, more appointments were scheduled using BCBS than Medicaid. The three most common reasons for appointment denial were inability to provide an insurance identification number (47.1%), insurance status (23.5%), and lack of referral (17.6%). The waiting period for an appointment was not significantly different depending on insurance status or Medicaid expansion status (Medicaid=3.30 days, BCBS=3.43 days, P=.152).

Conclusion:

For patients with first-time ankle sprains, access to care is more difficult using Medicaid insurance rather than private insurance, especially in Medicaid unexpanded states. However, when granted an appointment, Medicaid patients waited a comparable amount of time to the appointment as those using private insurance.
Does the Radiographic Lateral View of the Lesser Toe Matter in A Trauma? A Retrospective Analyses of 378 Radiographs
Authors: Mansur Nacime S. , Kitagaki Danilo P. , Gonçalves João P. , Foni Noel O. , Araujo Caio Augustus F. , Sanchez Gustavo T.
Published: January 2022

Category:

Lesser Toes; Trauma

Introduction/Purpose:

To evaluate the importance of a radiographic lateral view in diagnosing lesser toes traumatic conditions.

Methods:

Between January 2018 and March 2018, 378 radiographs of 126 patients evaluated in an emergency care hospital for trauma in the lesser toe were retrospectively evaluated for presence of lesser toes traumatic conditions. Patients were selected if a complete series of radiographs were performed, anteroposterior (AP), lateral (LA) and Oblique (OB). Radiographs of the same patient were duplicated and divided in two groups: standard group (AP and OB) and complete group (AP + LA + OB). Images were examined by four independent examiners with different degrees of experience. Each examiner randomly evaluated the same patient twice (one for each group). Kappa index was used to evaluate intra and inter-examiner concordance, and the two- proportion equality test was used to calculate statistical significance.

Results:

Mean age of patients was 37.2 years (4-85yr), 144 injuries were diagnosed in standard group (28.6%) and 266 injuries (52.8%) in complete group (p<0.001). Individually, each examiner had an improvement in the number of lesions diagnosed when comparing group assessment (p<0.001). Kappa index was superior to 0.60 for all examiners in standard group.

Conclusion:

In conclusion, the addition of true lateral view was able to detect misdiagnosed injuries in lesser toes trauma and improved the number of diagnosed lesions in 84.6%.
Medial Approaches to the Posterior Malleolus: A Comparative Cadaveric Study
Authors: Palma Joaquin , Urrutia Tomas , Morales Sergio
Published: January 2022

Category:

Ankle; Trauma

Introduction/Purpose:

Ankle fractures are the most common fractures of the lower extremity. In spite of that, there is still no consensus regarding the best way to approach posterior malleolus (PM) fractures. The aim of this study is to compare the degree of PM exposure, tension of the flap containing the medial neurovascular bundle (NVB) and distance between the surgical incision and the NVB using three different posteromedial ankle approaches.

Methods:

Three different posteromedial approaches were compared: direct medial (DM) modified posteromedial (MPM) and posterior paramedian (PPM). Each approach was performed four times using a standardized technique. With a digital tensiometer, the minimal tension of the flap containing the NVB that allowed proper exposure of the PM was measured. In a second stage, an axial cut 1cm proximal to the tibiotalar joint was performed in nine frozen pieces and PM exposure degree and distance between the incision and the NVB was measured.

Results:

The median minimal tension was DM: 14,78 N, MPM: 8N and PPM: 5,75N. The median distance between the incision and the NVB was DM: 17mm, MPM: 6mm and PPM: 28mm. The median degree of exposure was DM: 51%, MPM: 58% and PPM: 72%.

Conclusion:

The PPM approach achieved the highest degree of PM exposure, with the lowest tension applied to the NVB and allowing the greatest distance between the incision and the NBV. Thus, we believe it should be considered the approach of choice for large fractures compromising the posteromedial and posterolateral aspect of the PM.
Are Outcomes Following Crossed Lag-Screw Modified Lapidus Technique for Hallux Abductovalgus Comparable to Plate-Screw Fixation Technique? A Study of Costs, Radiographic and Patient Reported Outcomes
Authors: Paranjape Chinmay S. , Lalli Trapper , Tennant Joshua N.
Published: January 2022

Category:

Bunion; Diabetes

Introduction/Purpose:

The modified Lapidus (ML) for tri-planar HAV correction is a powerful procedure for correcting hallux valgus (HV) and metatarsal rotation. We assessed implant costs, radiographs, and pre and postoperative patient reported outcome measures of Patient Reported Outcome Information System Physical Function (PROMIS-PF) Computerized Adaptive Test scores (CAT) at an average of 20.2 months followup.

Methods:

We examined patients retrospectively from January 2014 to December 2019. Pre and postoperative PROMIS-PF, radiographic parameters (intermetatarsal angle, IMA and HV angle, HVA), complications, and total surgical time were reviewed from the medical chart. Estimated surgical implants costs were obtained from manufacturers.

Results:

83 patients underwent lag screw lapidus. All had radiographs, 71 had complete PROMIS-PF. Patients were a median age 55.80 (45.55, 53.85), 6.7% male, and 20% diabetic (median A1c 6.4%). Complications included 6.7% delayed wound healing, 13.3% painful hardware, 13.3% superficial infections. Others (7/83 or 8.4%) included complex regional pain syndrome in one, overcorrection in two, paresthesia in one and symptomatic nonunion in three. Preoperative angles were hallux valgus angle 33 (30, 40), IMA 15 (12, 16) which improved at final postoperative follow up to HVA 9 (5, 15) and IMA 7 (6, 9). PROMIS-PF was 43 (37,52) preoperatively, 37 (31, 39) at six weeks, 46 (42, 51) at three months, and 49 (41, 53) at > 360 days. The drop in PROMIS- PF between preop and 6 weeks and the rise from 6 weeks to 3 months were significant. There was no difference between pre and postoperative PROMIS-PF. Implants averaged $140 USD.

Conclusion:

Patients achieved good radiographic correction of HV following ML by our technique. While physical function, measured by the PROMIS-PF, decreased in the acute postoperative period, it increased to near final levels by three months postoperatively. Low complication rate, low cost, and high patient postoperative functional expectations with excellent radiographic correction were demonstrated.
The Course of Tarsal Tunnel Syndrome after Ultrasound-Guided Injections
Authors: Park Joseph S. , Atesok Kivanc , Pierce Jennifer , Small Benjamin , Perumal Venkat , Cooper M. Truitt
Published: January 2022

Category:

Other; Ankle; Hindfoot; Midfoot/Forefoot; Sports

Introduction/Purpose:

Local ultrasound (US)-guided injections of anesthetics with corticosteroids are commonly performed for the conservative treatment of tarsal tunnel syndrome (TTS). This retrospective study aimed to investigate the course of TTS after US-guided injections.

Methods:

The study included patients who were diagnosed with TTS and received US-guided injections as their initial conservative treatment. The patients' pain levels were noted on a scale between zero and ten before and after each injection. The patients were divided into two groups: nonsurgical and surgical groups. The nonsurgical group included patients who had received US-guided injections and were not treated surgically, and the surgical group included those who received US-guided injections and ultimately underwent surgical tarsal tunnel release (TTR). The two groups were compared in terms of age, gender, post-injection follow-up time, and the amount of pain reduction immediately after injection (ΔPN). In the surgical group, the presence or absence of additional foot and ankle pathologies requiring operative treatment during TTR, and outcomes of surgical treatment were also assessed.

Results:

218 patients were diagnosed with TTS and received US-guided injections as their initial treatment. After the injections, 169 patients (77.5%) required no TTR (nonsurgical group) and 49 patients (22.5%) underwent TTR (surgical group). The average ages for the nonsurgical and surgical groups were 53.8 and 48.9 years (P = 0.03). The average time between the injection and final follow-up for the nonsurgical group was 339 days. The average time between the injection and TTR for the surgical group was 145 days. There were no differences in pain relief after the injections between the nonsurgical and surgical groups (mean ΔPN: 3.6 and 3.8, respectively). In the surgical group, 16 patients (32%) presented with additional foot and ankle pathologies that were surgically treated during TTR. The average post-surgical follow up time was 117 days. At final follow up, 41 patients (84%) in the surgical group had no pain or functional impairment.

Conclusion:

US-guided injection can be an effective conservative treatment option for patients with TTS. Surgical release of tarsal tunnel may improve and resolve the overall symtoms of TTS in majority of the patients who do not respond to nonsurgical treatment. Younger age and additional foot and ankle pathologies appear to be associated with greater likelihood of undergoing TTR.
“In-Situ” Joint Preparation Technique for First Metatarsophalangeal Joint Arthrodesis: A Retrospective Comparative Study with “Flat-Cuts” Technique
Authors: Prat Dan , Pridgen Eric , Lee Wonyong , Wapner Keith L. , Chao Wen , O'Connor Kathryn , Farber Daniel C.
Published: January 2022

Category:

Midfoot/Forefoot; Bunion

Introduction/Purpose:

The most common joint preparation techniques mentioned in literature for 1st metatarsophalangeal (MTP) joint arthrodesis are 'cup and cone' and 'flat-cuts'. A third option of an 'in-situ' technique, has rarely been studied. This study compares the clinical, radiographic, and patients-reported outcomes of 'in-situ' joint preparation with a traditional 1st MTP joint preparation technique.

Methods:

The 'in-situ' technique utilizes the same dorsal surgical incision as traditional techniques. Cartilage and osteophyte removal are carried out using standard techniques without the use of specific reamers or a sagittal saw. The arthrodesis is performed in-situ with the similar freedom of joint positioning as the cup and cone technique, and traditional fixation constructs are applied. In this study, A retrospective chart review was performed for patients who underwent 1st MTP joint arthrodesis between January 2015 and December 2019. The complication, revision and non-union rates were examined in a multivariable logistic regression model. Patient reported outcome were analyzed in a repeated measures general linear model. Analysis of variance and Receiver Operating Characteristic were used to assess radiographic measurements.

Results:

Total of 388 1st MTP joint arthrodesis cases were included. Overall, 262 'Flat-Cuts' and 126 'In-Situ' cases were analyzed. Mean follow-up time was 292 days (median 174, SD 305). Joint-preparation technique did not have statistically significant impact on union rates (p=0.311) or revision rates (p=0.898). Diabetes-Mellitus was the most powerful predictor of non-union (p<0.001, OR 6.558, 95% CI: 2.534-16.969) and revision (p=0.02, OR 3.662, 95% CI: 1.230-10.905). The rate of transfer- metatarsalgia was significantly higher in 'flat-cuts' (p=0.015, OR 6.808, 95% CI: 1.460-31.744). Visual-Analogue-Scale and PROMIS- CAT-Physical significantly improved at 6-weeks, 3-months, and at last follow-up in both techniques (p<0.001, p=0.001), and the improvement was comparable between the techniques (p=0.078, p=0.100).'In-situ' technique resulted in significantly less mean 1st- ray shortening (3.05mm vs 7.64mm, p<0.001). In a Receiver-Operating-Characteristic analysis of transfer metatarsalgia and 1st ray shortening, the optimal diagnostic cut-off was 6.87 mm (LR 1.67, AUC 0.652, p=0.005, 95% CI: 0.56-0.74).

Conclusion:

'In-situ' joint preparation technique is a simple, safe, and cost-effective technique for 1st MTP joint arthrodesis. In our series, 'in-situ' technique had a similar or better complication profile than the 'flat-cuts', while providing similar patient- reported outcomes. 'In-situ' technique resulted in significantly less 1st ray shortening, which was a predictor of transfer metatarsalgia.
A New Approach for Stage 2 Adult Acquired Flatfoot Deformity
Authors: Raduan Fernando C. , Coetzee J. Chris , Den Hartog Bryan D. , Seybold Jeffrey D. , Cammack Paul M. , Stone Rebecca M. , Fritz Jacquelyn E. , Seiffert Kayla
Published: January 2022

Category:

Hindfoot

Introduction/Purpose:

Adult Acquired Flatfoot Deformity (AAFD) is a common progressive pathology that mainly affects patients after their 50s. Even though it is not clear yet what causes AAFD, the great majority of patients have their talonavicular (TN) joint sub dislocated in one or more planes. According to the severity of the deformity and its flexibility, different surgical procedures can be performed to realign the foot. The deformities usually happen around the TN joint, making it the center of rotation and angulation (CORA). Corrections on the CORA realign deformities in different planes and his concept can be applied to mostly any deformity. The objective of this study is to evaluate clinically and radiographically patients with stage 2 AAFD submitted to isolated TN fusion.

Methods:

Fifty-four patients (59 feet) from July 2013 to December 2019 with stage 2 AAFD were submitted to isolated TN fusion. All patients had clinical deformity and arch foot collapse associated with pain along the medial hindfoot. Weight-bearing x- rays were performed pre-operatively, the Meary's and calcaneal pitch angles were measured on lateral view and the Talar coverage and Simmon's angle were measured on antero-posterior view. Angles were measured by a fully trained foot and ankle surgeon. Post-operative measurements were done with the same set of images by the same surgeon, one month after the initial measurements. FAAM and VR12 were used to compare patient's clinical status. Patients with previous surgeries on the foot or ankle and patients submitted to other fusions or hindfoot osteotomies were excluded from the study. Gastrocnemius lengthening and toes corrections were not an exclusion criterion.

Results:

Thirty-seven females and seventeen males were evaluated with a mean age 61 years at the time of surgery. Only the FAAM score significantly improved from pre-operative (FAAM = 48.48, VR-12 Mental = 55.73, VR-12 Physical = 37.25) to most recent mean follow-up of 16.2 months (FAAM = 58.45 (p<.001), VR-12 Mental = 57.19 (p=.179), VR-12 Physical = 37.53 (p=.832). The lateral view X-Rays showed Meary's and calcaneal pitch angles mean improving from 27 and 15 degrees pre-operatively to 9 and 18 degrees post operatively (p<.001), whereas Front view foot X-Rays showed Talo-Naviciular coverage angle and Simmon's angle going from 35 and 20 degrees to 5 and 6 degrees respectively (p<.001)

Conclusion:

Isolated talonavicular fusion can correct the deformity on its multiple planes providing not only significant improvement on radiographic alignment but also the FAAM clinical outcome score. Comparative studies should be performed to determine which is the best technique for patients with stage 2 AAFD.
Arthroscopic Bone Marrow Stimulation or Non-Operative Treatment for Osteochondral Lesions of the Tibial Plafond
Authors: Rikken Quinten , Dahmen Jari , Stufkens Sjoerd A. , Kerkhoffs Gino
Published: January 2022

Category:

Ankle; Arthroscopy

Introduction/Purpose:

A paucity of clinical results from osteochondral lesion of the tibial plafond (OLTP) treatment exists in the literature. The primary purpose of this study was therefore to compare the patient reported outcomes of OLTPs treated with arthroscopic bone marrow stimulation (BMS) and non-operative treatment. The secondary purpose was to compare the reintervention- and complication rates.

Methods:

Patients treated either with BMS (BMS group) or any form of non-operative treatment (non-operative group) at a minimum follow-up of 12 months were selected from a retrospective database query of patients treated between 1990 and 2020. Eligible patients were contacted by phone and cross-sectionally included. The primary outcome was the Numeric Rating Scale (NRS) during weightbearing. Secondary outcomes included; the NRS in rest, the Foot and Ankle Outcome Score (FAOS), and the Short Form Health Survey (SF-36) general health questionnaire. Additionally, the reintervention- and complication rates were collected.

Results:

A total of 55 patients were included, which consisted of 15 patients for the non-operative group and 40 patients for the BMS group were analyzed at a mean 73.2 +- 62.9 and 100.5 +- 72.1 months respectively (Table 1). The median NRS during weightbearing was 2 (IQR: 1-5) for the non-operative group and 1.5 (IQR: 0-4) for the BMS group (P= 0.43). The NRS in rest was, similarly, not significantly different between groups. None of the FAOS subscales were found to be significantly different between treatment groups. No reoperations or major complications after follow-up treatment were recorded.

Conclusion:

Clinical outcomes following arthroscopic BMS and non-operative treatment yield moderate to good clinical results in this cross-sectional cohort OLTP patients. Although this study was the first to report outcomes of non-operative treatment of OLTPs and to compare these to BMS, prospective studies are highly needed for these understudied lesions.
Long-Term Clinical Results of Arthroscopic Lift-Drill-Fill and Fixation (LDFF) Treatment for Osteochondral Lesions of the Talus
Authors: Rikken Quinten , Dahmen Jari , Stufkens Sjoerd A. , Kerkhoffs Gino
Published: January 2022

Category:

Ankle; Arthroscopy

Introduction/Purpose:

The purpose of this study was to describe the long-term (> 5 years) clinical results of a novel arthroscopic fixation technique for osteochondral lesions of the talus (OLT), named the Lift, Drill, Fill and Fix (LDFF) technique.

Methods:

18 ankles (17 patients) underwent an arthroscopic LDFF procedure for a primary OLT. The mean follow-up was 6.8 years (range: 68 - 96 months). Pre- and postoperative clinical assessment was prospectively performed by measuring the Numeric Rating Scale (NRS) of pain at rest, during walking, and when running. Additionally, the Foot and Ankle Outcome Score (FAOS) including its subscores of pain, symptoms, activities of daily living, sports, and quality. Additionally, the Short Form-36 (SF-36) was assessed.

Results:

The mean NRS during running significantly improved from 7.8 pre-operatively to 3.7 post-operatively (p = 0.006), the NRS during walking from 5.7 to 1.5 (p < 0.001), and the NRS in rest from 2.3 to 1.0 (p = 0.015). The median FAOS at final follow- up was 80 for pain, 57 for other symptoms, 90 for activities of daily living, 70 for sport, and 55 for quality of life. A pre- and post- operative score comparison was available for fifteen patients, and improved significantly in most subscores. The SF-36 physical component scale significantly improved from 42.9 pre-operatively to 50.1 post-operatively.

Conclusion:

Arthroscopic LDFF of fixable primary OLTs results in excellent pain reduction and improvement of functional outcomes, with sustained results at long-term follow-up. These results indicate surgeons should consider fixation for a fixable OLT.
Total Ankle Arthroplasty with Anatomic Lateral Ankle Stabilization (ATLAS) using Synthetic Graft for Instability in Moderate and Severe Pre-Operative Varus Alignment
Authors: Rushing Calvin J. , Malloy McCoy Antonio M. , McKenna Bryon J. , Berlet Gregory C.
Published: January 2022

Category:

Ankle; Other

Introduction/Purpose:

More than 50% of patients undergoing Total Ankle Arthroplasty (TAA) have some degree of coronal deformity, which is the most common reason for additional procedures. The purpose of the present study was to assess the early clinical and radiographic outcomes for patients who underwent TAA and Anatomic Lateral Ankle Stabilization (ATLAS) using synthetic graft for instability in moderate and severe preoperative varus alignment.

Methods:

Seven ankles with moderate or severe varus alignment underwent TAA with a 3rd generation prosthesis (INBONE-2) and ATLAS using synthetic graft between September 2018 and February 2019 at a single institution, and were at least 1 year postoperative (mean 13.3 months, range 12-15). Medical records and charts were reviewed for any revisions, reoperations, or complications. Weight bearing radiographs were assessed using coronal and sagittal alignment parameters preoperatively, and during the latest follow-up.

Results:

Survivorship for INBONE-2 with ATLAS was 100%; recurrent instability was not observed. Symptomatic talonavicular joint arthritis was recorded for a single patient 12 months postoperatively; there were no revisions, or reoperations. Tibiotalar coronal alignment improved significantly from 17.7 +- 9.3 (range, 10.1-33.6) to 2.3 +- 1.2 (range, 0.9-4.4) degrees (p<0.006), and all ankles achieved neutral alignment in single stage. Regarding sagittal tibiotalar alignment, preoperatively 2 ankles (28.5%) were translated anteriorly and the rest were neutral (71.5%). Significant posterior translation was observed and during the latest follow- up, 4 ankles were neutral (57.1%) and 3 posterior (42.9%) (p<0.009).

Conclusion:

Satisfactory outcomes were observed at a minimum of 1-year follow-up for patients with moderate or severe varus alignment who underwent TAA with INBONE-2 and ATLAS. ATLAS using synthetic graft may afford advantages over previously described repair techniques. Comparative studies between the Brostrum-Gould and ATLAS are warranted in the TAA population.
Predisposing Factors for 30-Day Complications Following Leg Amputation
Authors: Safavi Kiya Shazadeh , Villarreal Joseph , Hussien Doha , Panchbhavi Vinod K. , Jupiter Daniel
Published: January 2022

Category:

Trauma; Ankle; Diabetes; Other

Introduction/Purpose:

While amputation rates and amputation-related morbidity and mortality have been established for select populations, the impact of general demographic factors on postoperative surgical complications remains little studied. This study aims to analyze the influence of numerous demographic variables on specific surgical complications.

Methods:

We extracted data from the American College of Surgeons' National Surgical Quality Improvement Program database from 2012 to 2017 and searched for leg amputations using CPT codes 27881, 27882, 27884, and 27886, identifying 4,162 patients. The association of 29 demographic variables with 4 complications (surgical infection, additional service, deep vein thrombosis [DVT], and sepsis) was analyzed using t tests or chi-squared tests. A logistic regression allowed determination of independent risk factors for each outcome, based on results from the bivariate analyses. Variables found to have P < 0.2 on bivariate analysis were subsequently included in the multivariate analysis of the corresponding surgical complication.

Results:

Preoperative open, 'contaminated,' or 'dirty/infected' wounds, longer intraoperative times, development of sepsis prior to surgery, and admission of patients directly from home or from another hospital's emergency room were found to influence postoperative surgical infection rates. An individual's height, weight, total length of hospital stay, ethnicity, the presence of preoperative open or infected wounds, and wounds classified as 'dirty/infected' preoperatively affected postoperative additional service incidence. Preoperative congestive heart failure and large decreases in body weight, as well as a patient's total length of hospital stay, influenced postoperative DVT rates. A patient's preoperative functional heath status, total length of hospital stay, amputations conducted as emergency cases, as well as preoperative acute renal failure, open or infected wounds, sepsis, 'contaminated' or 'dirty/infected' wounds, impacted postoperative sepsis rates.

Conclusion:

Understanding these risk factors may allow providers to anticipate and address higher rates of complications in certain patient populations.
Comparing Bilateral Feet Computed Tomography Scans Can Improve Surgical Decision Making for Subtle Lisfranc Injury
Authors: Shim Dong Woo
Published: January 2022

Category:

Trauma; Midfoot/Forefoot; Sports

Introduction/Purpose:

Subtle Lisfranc injuries (SLIs) are challenging to diagnose. Although weightbearing (WB) radiographs have been suggested to identify SLIs, approximately 20% are missed on initial radiographic assessment. Computed tomography (CT) has been suggested as an alternative, but has not provided any diagnostic guideline. Therefore we compared measurement techniques on radiographs and bilateral foot CT scans for the efficiency of diagnosis and making surgical decisions for SLI.

Methods:

We retrospectively investigated patients diagnosed with SLIs between January 2014 and January 2020. Distances between both medial cuneiform and second metatarsal base (C1M2), and the first and second metatarsal bases (M1M2), were measured on bilateral WB radiographs. Bilateral foot CT scans were taken, and the distances between C1M2 were checked on the axial and three points of the coronal plane (top, middle, and base) (Figure 1). The surgical indication was > 1 mm of diastasis on CT scan. Clinical outcomes were evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) score at final follow-up. Intraobserver and interobserver agreements were assessed.

Results:

Thirty patients with SLIs were reviewed. Twenty-four patients underwent surgical fixation (Group A) and six patients were treated conservatively (Group B). The side-to-side difference (STSD) of C1M2 and M1M2 distances greater than 1 mm showed 91.7% and 54.2% sensitivity, and 66.7% and 16.7% specificity, respectively. Investigating STSDs of all points on CT scans were informative to discriminate both groups (P <= 0.038). Clinical outcomes showed no significant difference between the groups (P = 0.631). Intraclass and interclass correlation coefficient values showed good to very good reliability, except for STSD of WB M1M2 distance and the coronal top plane.

Conclusion:

Investigating bilateral foot CT scans was significantly efficient and reliable for the diagnosis and treatment plan for SLI. On radiographs, STSD of WB C1M2 distance was more sensitive than STSD of WB M1M2 distance.
Can Bedside Needle Arthroscopy of the Ankle be an Accurate Option in the Office Setting for Intra- Articular Delivery of Injectable Agents?
Authors: Stornebrink Tobias , Stufkens Sjoerd A. , Mercer Nathaniel P. , Kennedy John G. , Kerkhoffs Gino
Published: January 2022

Category:

Ankle; Arthroscopy

Introduction/Purpose:

To evaluate accuracy and patient experience of inspection-injections of the ankle with in-office needle arthroscopy in a relevant clinical setting - including patients with end-stage ankle pathology and/or a history of prior surgery.

Methods:

This was a prospective study that included adult patients who were scheduled for an injection with hyaluronic acid to the tibiotalar joint. In our center, these injections are used as a last resort prior to extensive surgery. The primary outcome was injection accuracy, which was defined as injecting through the arthroscopic cannula with intra-articular positioning confirmed by a clear needle arthroscopic view of the joint space. Secondary outcome measures included a patient reported numeric rating scale (NRS, 0-10) of pain during the procedure and willingness of patients to return for the same procedure. NRS of ankle pain at rest and during walking was collected during the intervention and at two-week follow-up. Complications were monitored from inclusion up to a two-week control visit.

Results:

We performed 24 inspection-injections (11 (46%) males, mean age 47.8 +- 14.5 years). The indication was end-stage osteoarthritis in 21 (88%) cases - eight (33%) Kellgren-Lawrence grade IV, 10 (42%) Kellgren-Lawrence grade III - and an osteochondral defect in three (13%) cases. Fourteen (58%) patients had had prior ankle surgery - 11 (46%) patients had had multiple prior surgeries. Accuracy was confirmed in 22 (88%) cases. The three unsuccessful injections all occurred in patients with Kellgren-Lawrence grade IV osteoarthritis. Median NRS of pain during the procedure was 1 (IQR 0 - 2). Willingness to return was 100%. Median NRS of pain in rest decreased from 4 (IQR 2 - 5) at intervention to 3 (IQR 1 - 5) at follow-up (p < 0.01). The median NRS of pain during walking decreased from 8 (IQR 6 - 8) to 7 (IQR 4 - 8) (p < 0.01). There were no complications.

Conclusion:

In-office needle arthroscopy of the ankle under local anesthesia is a procedure that is well tolerated by patients. It is able to provide intra-articular delivery of injectable agents with high accuracy. Accuracy can be expected to approach 100% if patients with total ventral joint obliteration and a history of extensive prior ankle surgery are excluded.
Surgical Takedown Approaches to Insertional Achilles Tendinopathy: A Systematic Review
Authors: Thompson John M. , McCoy Antonio M. Malloy , Nguyen Kevin N. , Casciato Dominick , So Eric , Prissel Mark A. , Ahluwalia Jaime A. , Tewilliager Tyler
Published: January 2022

Category:

Hindfoot

Introduction/Purpose:

Various techniques of surgical detachment for treatment of insertional Achilles tendinopathy have been described, including lateral release, medial release, central tendon splitting (CTS), and complete detachment.

Methods:

A systematic review of electronic databases was performed, encompassing 17 studies involving 703 patients and 746 feet, to compare outcomes associated with surgical takedown techniques.

Results:

Observed results include wound complication rates (CTS 2.8%; Lateral 0%; Medial 0.4%; Complete 1.3%), post-operative rupture rates (CTS 0.7%; Lateral 0.8%; Medial 0.7%; Complete 2.6%), rate of revision (CTS 0.4%; Lateral 0.9%; Medial 4.2%; Complete 2.6%), rate of infection (CTS 1.1%; Lateral 1.7%; Medial 3.7%; Complete 6.5%). Lateral takedown group was found to have a statistically significant lower rate of complications compared to the complete takedown group (p=0.0029).

Conclusion:

In light of these results, it is recommended that patient characteristics such as case specific tendon pathology and calcaneal morphology take precedent in determining the surgical approach to Achilles takedown.
An Oblique Trans-Syndesmotic Screw to Augment Fixation of Distal Fibula Fractures: A Technique Guide
Authors: Villarreal Eric D. , Strickland Carson D. , Richardson David R.
Published: January 2022

Category:

Trauma; Ankle

Introduction/Purpose:

A subset of patients with low, transverse fractures of the lateral malleolus are at increased risk of malreduction and late loss of reduction. In patients with poor bone quality and transverse or short oblique fractures at or distal to the tibiotalar joint, distal fixation is often inadequate with a single interfragmentary lag screw. Furthermore, these fractures are susceptible to malreduction by pre-contoured locking plates. To address this, a technique was developed to augment fixation of the distal fragment and decrease the likelihood of loss of reduction. The senior author's technique for this procedure, as well as indications for the technique and a few representative cases, are provided.

Methods:

This technique involves placement of an oblique tricortical or quadricortical screw from the distal fibula into the tibia in an distal-lateral to proximal-medial direction. The screw is placed either outside of or through the distal-most hole of a one-third tubular plate placed in a neutralization position. The screw trajectory is similar to that of a typical syndesmosis screw in the sagittal plane but is aimed proximally rather than parallel to the tibial plafond. The screw enters the tibia at Chaput's tubercle, just lateral to the joint. The indications for this technique are transverse and short oblique Danis-Weber B distal fibular fractures in which there is inadequate purchase between the plate and the distal fragment. While the purpose of this screw is not to stabilize the syndesmosis, it can be used with other augmentation techniques, such as trans-syndesmotic screws, in high-risk patients with osteoporosis and/or neuropathy.

Results:

This technique has been used for many years by the senior author. There have been no implant failures (e.g. broken screws) or major complications associated with this technique. Three representative cases demonstrate appropriate indications and outcomes for this technique. These include patients with significant neuropathy or osteoporosis who present with a particularly troublesome fracture pattern (transverse fibular fracture at or below the level of the tibiotalar joint). This screw, along with any other syndesmotic screws, is removed at 3-4 months according to the senior author's protocol.

Conclusion:

A distal oblique trans-syndesmotic screw can be used to supplement current fibular fracture fixation constructs. It is easy to place under fluoroscopic guidance and generally is removed after fracture union, similar to standard syndesmosis screws. The use of this screw helps prevent the malreduction that can potentially occur when treating transverse or short-oblique Weber B distal fibular fractures with a locking plate. In our series of patients at a large urban tertiary referral center, this technique has produced good outcomes with no reportable complications.
Defining an Anatomic and Radiographic Safe Zone for Posterior Malleolar Ankle Hardware Fixation
Authors: Williams Caroline , Momenzadeh Kaveh , Michalski Max , Kwon John Y. , Miller Christopher P.
Published: January 2022

Category:

Ankle; Trauma

Introduction/Purpose:

There is a lack of consensus regarding optimal management of Posterior Malleolar Fractures (PMFs). Indirect reduction and fixation with posterior-anterior (PA) screw shows promise of avoiding the risks associated with direct reduction or indirect anterior to posterior (AP) approaches. Some authors have raised concerns about potential risk to nearby structures with PA technique, including hardware prominence into the syndesmosis. This study highlights the use of a posteromedial vertical syndesmotic line as a fluoroscopic landmark, helping surgeons avoid intra-syndesmotic placement.

Methods:

Indirect PA screw placement was completed on ten cadaveric specimens, followed by fluoroscopy in mortise and lateral views. Dissection was performed to assess screw placement relative to the posteromedial border of the syndesmosis. The posterior border of the syndesmosis was marked with a radiopaque wire. Repeat imaging was completed to validate the fluoroscopic posteromedial vertical syndesmotic line is representative of the posteromedial border of the tibial incisura.

Results:

On dissection, 9 of 10 cadavers had accurate screw placement with no penetration into the syndesmosis (Figure 1, bottom left & bottom right). Corresponding imaging showed the screw head to be medial to the marker on mortise view. For the specimen with penetration into the syndesmosis, imaging confirmed that the screw head was lateral to the marker on mortise views (Figure 1, top center & top right). The radiopaque marker correlated with the posteromedial vertical syndesmotic line for all specimens when comparing anatomic to radiographic findings. A radiographic safe zone is defined for the PA screw 12 mm medial to the vertical syndesmotic line to ensure no iatrogenic injury to the FHL tendon.

Conclusion:

This study demonstrated that the posterior incisura tibialis fluoroscopic landmark is unambiguous in localizing the posterior syndesmotic border (Figure 1, top left) and that screws medial to this line are safely out of the syndesmosis, while screws placed lateral are either in or at risk of intra-syndesmotic placement. A safe zone is defined for screw placement.
Prediction of cellulose nanofibril (CNF) amount of CNF/polypropylene composite using near infrared spectroscopy
Authors: Murayama Kazushige , Kobori Hikaru , Kojima Yoichi , Aoki Kenji , Suzuki Shigehiko
Published: January 2022

The final goal of this study is to establish a classification method of cellulose nanofibril (CNF)/plastic composites such as their CNF amount, CNF types, and resin types, which are expected to progress the commercialization in the future, using near infrared (NIR) spectroscopy. To achieve this goal, NIR spectra of injection and film samples with different types and addition ratios of CNFs in CNF/polypropylene (PP) composites were measured and analyzed in the range of 1000–2200 nm. The results of the principal component analysis using all samples suggest that CNF addition ratio and sample shape could be expressed by principal component (PC) 1 and PC2 scores, which relate to the chemical components of PP and CNF complexly. Furthermore, the partial least-squares (PLS) regression model was able to predict the CNF addition ratio with about 2.0% accuracy, regardless of CNF type and sample shape. To develop an easier model compared to the PLS model, it was calculated to the simple linear regression model, which used the absorbance quotient of optimum wavelengths combination (OWC). Although this model did not have the accuracy to use the quality control, it is able to discriminate CNF addition ratio of CNF/PP composites with almost the same accuracy as the PLS model. However, if it is possible to separate the sample shapes before the analysis, it is suggested that the OWC regression model is able to predict CNF addition ratio of CNF/PP composites with less than 1% accuracy.