bluuebunny/crossref_metadata_2025 huggingface dataset:
Describing Teachers’ Well-Being Prior to and 18 Months After COVID-19 School Closures, with a Focus on Early-Career Teachers and Teachers of Color
Authors: McLean Leigh , Bryce Crystal , Johnson Brooke
Published: December 2023

The COVID-19 pandemic has introduced several unprecedented challenges to the U.S. public education system that have negatively impacted the nation’s teaching workforce. This study describes fourth grade teachers’ depressive and anxious symptoms and burnout prior to and 18 months after prolonged COVID-19 school closures in the 2020/2021 academic year. Within this, we provide further insight into the well-being of early-career teachers and teachers of color in order to highlight groups of teachers that may have been differentially impacted by pandemic-related stressors. Independent samples t-tests and analysis of variance (ANOVA) indicated that teachers who reported on their well-being after schools resumed markedly higher depressive symptoms, anxious symptoms, and burnout than teachers who reported prior to school closures, and that symptoms were highest among early-career teachers and teachers of color in the latter group, with teachers of color in the latter group reporting the highest symptomatology levels across all outcomes. Results can inform efforts to support teachers as we continue to navigate the long-term effects of the pandemic on teachers and students, and provide evidence that early-career teachers and teachers of color should be especially prioritized for targeted support.
The School-ties Between Top Management Executive and Audit Partner: Exploring From Earnings Management in Indonesia
Authors: Soeprajitno Raden Roro Widya Ningtyas , Ningsih Sri , Harymawan Iman , Dhar Bablu Kumar , Cahyono Suham
Published: December 2023

The objective of this study is to investigate the impact of school ties between top management executives, such as the Chief Executive Officer and Chief Financial Officer, and external parties, including auditors, on a company’s earnings management practices. This study uses fixed effect regression method to test the hypotheses, whether school ties between top management executives and audit partner will affect on the practical earnings management. The authors obtained sample from Indonesia Stock Exchange Commission during 2010 to 2022 and includes several causality tests to robust the empirical result from current study. Our findings suggest a noteworthy positive association between school-ties linking the Chief Executive Officer (CEO) and the Auditor with Earnings Management. However, our analysis reveals that other combinations of school ties exhibit an opposite effect. The findings of this study suggest that ties between internal and external parties within a company may be a factor that investors should carefully consider when evaluating the accuracy and reliability of financial reports. As such, it may be prudent to avoid investing in such companies. Despite prior research extensively examining the measurement of accrual-based earnings management, the literature lacks discussion regarding its association with the potential influence of ties. Thus, this study aims to fill this gap by investigating the relationship between top management school ties and earnings management.
Impacts of Blockchain on Accounting in the Business
Authors: Giang Nguyen Phu , Tam Hoang Thi
Published: December 2023

There have been many studies on the blockchain, however blockchain research in the accounting field is scarce. The article outlines the characteristics and steps to apply blockchain in accounting. The article also identifies and measures the factors affecting the application of blockchain in accounting in enterprises, proving that the application of blockchain impacts the quality of the accounting information system of enterprises. The article shows that incorporating blockchain in accounting will help the accounting at businesses optimize the security, safety, and transparency of accounting information. We collected data on 195 manufacturing firms in six sectors. This study’s primary data analysis method is the SEM structural equation modeling method. The article used AMOS software to evaluate and measure the influence of each factor on the application of blockchain and the effect of blockchain on the accounting information system in enterprises. The article analyzed four aspects: the level of information technology of the accountant (IT), Information Security Infrastructure (SI), Training (TR), and Legality and Regulation (LR), affecting the application of blockchain in the business. The independent variables TR (training) and IT (information technology) have an impact on BL (Blockchain). We also find that the independent variable IT (information technology) has the most substantial impact on Blockchain adoption, followed by the independent variable TR (training), which has the second most influential impact on Blockchain adoption. For the accounting information system, the results show that applying blockchain will substantially impact accounting information, along with the safety factor of information infrastructure SI also has an evident influence. The results show that applying blockchain in accounting, information technology, and professional training are core issues with significant influence. The issue of guaranteed infrastructure also determines the effectiveness and efficiency of blockchain applications for accounting information systems. I declare that this is my scientific work; it is my original work. I commit that all data sources and ideas are my research and have never been published anywhere.
Exploring Effectiveness of Relationship Marketing on Artificial Intelligence Adopting Intention
Authors: Cheng Cheng-Feng , Huang Chien-Che , Lin Ming-Chang , Chen Ta-Cheng
Published: December 2023

The major contribution of present study is to revisit how consumer obtain high adoption intention of artificial intelligence (AI)’s production/service based on symmetric and asymmetric thinking in data analysis. In recent years, technology involving AI has become key technology for success worldwide and has received prominence among academics and practitioners. Accordingly, it is necessary to identify the relationships among relationship marketing, AI perceived usefulness, perceived ease of use, perceived risk, and adoption intention. The main contribution of the symmetric approach (i.e., SEM, structure equation modeling) is to test the research hypothesis to determine the net effect between the variables, and asymmetric approach (i.e., fsQCA, fuzzy set qualitative comparative analysis) contributes to the identification of sufficient conditions leading to high level adoption intention in the concept of fuzzy sets. With symmetric approach, results of path analysis of SEM indicate that impacts of trust are greater than that of commitment. Similarly, perceived usefulness of AI has a greater impact on the adoption intention. Furthermore, AI perceived risk is negative associate with adoption intention. With asymmetric approach, intermediate solutions from fsQCA show that there are three sufficient conditions for high adoption intention of AI. For instance, one of configurations or sufficient conditions is trust, commitment, and AI perceived usefulness present but perceived ease of use absent.
Visual Mapping of Social Commerce Articles on WoS Database Between 1995 and 2023
Authors: Kavacik Mustafa , Çinar Kevser , Zafer Kavacik Saadet
Published: December 2023

The goal of this research is to evaluate the social commerce. With this goal, this research aims to determine: (1) the longitudinal distribution of the articles and citations in social commerce (2) the most productive countries, journals, and affiliations in social commerce articles; (3) the most cited articles in social commerce research; and (4) the most recurrent keywords and Web of Science (WoS) categories are involved in the social commerce studies. The research conducted social commerce research papers published between 1995 and 2023 in the WoS database. We used the following search query: “social commerce*,” “social electronic commerce*,” “social e-commerce*,” “s-commerce*,” “Facebook commerce*,” “Instagram commerce*,” and “social media commerce*” The study examines 965 articles, were recorded on September 21, 2023. The data obtained were figured with the visual mapping technique. Various techniques, such as bibliographic coupling of countries, journals, and institutions of authors, co-authorship of countries, co-citation of journals, and co-occurrence of author keywords, were used in bibliometric analysis. Most of the research was in 2022, and the greatest number of citations were in 2022. The most efficient country was China. Swansea University was the most productive affiliation, with publications, citations and total links. It is found that the articles were primarily written in the field of Business, with 363 papers. There has been a substantial surge in the volume of studies on social commerce since 2013, indicating a significant growth in research interest in this field. Finally, researchers working on social commerce can understand the literature based on this current study.
Advanced HIV Disease at Antiretroviral Therapy Initiation and Treatment Outcomes Among Children and Adolescents Compared to Adults Living With HIV in Kinshasa, Democratic Republic of the Congo
Authors: Chabikuli Otto Nzapfurundi , Ditekemena John D. , Sigwadhi Lovemore Nyasha , Mulenga Astrid , Mboyo Aimé , Bidashimwa Dieudonne , Nachega Jean B.
Published: December 2023

Background: Little is known about advanced HIV disease (AHD) at antiretroviral therapy (ART) initiation among children and adolescents living with HIV (CALHIV) and related age disparities in the Democratic Republic of the Congo (DRC). Methods: We conducted a retrospective cohort analysis of routine program data collected among adults, adolescents, and children living with HIV in 6 health zones in Kinshasa, DRC from 2005 to 2020. Results: Thirty-two percent of those who initiated ART had AHD. Compared to adults, adolescents had a 15% higher risk of AHD (RR: 1.15; 95% CI: 1.08-1.21; P < .001). Despite their higher risk of AHD, adolescents had a lower risk of mortality (aSHR: 0.72; 95% CI: 0.52-0.99; P = .047) and lower cumulative death events versus adults (aSHR: 0.44; 95% CI: 0.34-0.59; P < .001). Conclusions: ADH at ART initiation is highly prevalent in Kinshasa, DRC, and adolescents are disproportionally impacted. There is a need to scale up high-impact HIV interventions targeting CALHIV.
Breastfeeding a Premature Baby During the Covid-19 Pandemic in Perinatology: An Exploration of Mothers’ Experiences
Authors: Hanum Syafrida , Rustina Yeni , Waluyanti Fajar Tri
Published: December 2023

This study was conducted to explore the meaning of mothers’ experiences of breastfeeding premature babies while being treated in the perinatology room during the COVID-19 pandemic. A descriptive phenomenological design was used in this study to describe the meaning of mothers’ experiences. In-depth interviews were conducted with 11 mothers. The analysis of transcribed data resulted in three themes: (1) The pandemic has made it difficult for me to meet my baby, (2) Breastfeeding is not easy, and (3) I am a breast milk pumper. The breastfeeding experience of having a premature baby and being cared for by perinatology during a pandemic is full of challenges and limited support. The results of this study suggest that a review of the current regulations be carried out, and the staff be given continuing lactation education to strengthen breastfeeding support to mothers with premature babies.
Interprofessional Active Learning for Chronic Pain: Transforming Student Learning From Recall to Application
Authors: Helms Jeb , Frankart Laura , Bradner Melissa , Ebersole Jonathan , Regan Beck , Crouch Taylor
Published: December 2023

Chronic pain (CP) affects over 50 million Americans daily and represents a unique challenge for healthcare professionals due to its complexity. Across all health professions, only a small percentage of the curriculum is devoted to treating patients with CP. Unfortunately, much of the content is delivered passively via lecture without giving students an opportunity to practice the communication skills to effectively treat patients in the clinic. An interprofessional team of health educators identified 5 essential messages that students frequently struggle to convey to patients with CP. Those messages were based on interprofessional and profession-specific competencies to treat patients with CP from the International Association for the Study of Pain. The 5 messages highlighted the importance of (1) therapeutic alliance, (2) consistent interdisciplinary language, (3) patient prognosis, (4) evidence for pain medicine, surgery, and imaging, and (5) early referral to the interprofessional team. For each message, the team summarized relevant research supporting the importance of each individual message that could serve as a foundation for didactic content. The team then developed active learning educational activities that educators could use to have students practice the skills tied to each message. Each learning activity was designed to be delivered in an interprofessional manner.
Fusion Rates in Tibiotalocalcaneal Arthrodesis with Tantalum Coated Metal Cup Augmentation
Authors: Romiyo Vineeth , Mahjoub Adel , Gentile Pietro , Freeland Erik
Published: December 2023

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Tantalum coated metal spacers (TCMS) have recently been utilized to fill and provide structure to large bony defects in the hindfoot. TCMS have a porous structure and elastic modulus similar to cancellous bone, increasing resistance to collapse, as well as osteoconductive properties that allow for bony ingrowth. At this time, there is still a paucity of literature assessing the use and outcomes of TCMS in foot and ankle surgery, more specifically as bridging structures for large bony defects when performing tibiotalocalcaneal (TTC) arthrodesis. This study serves to assess clinical outcomes and fusion rates of patients who underwent TTC arthrodesis utilizing intramedullary nailing with tantalum coated metal cup augmentation for large bony defects.

Methods:

We retrospectively reviewed the charts of 20 patients who underwent TTC fusion with TCMS augmentation at our local tertiary care center between 2015-2021. The CT scans at the six-month post-operative window were reviewed by one orthopaedic surgeon to determine the presence of bony fusion, which was defined as having at least 50% fusion mass. From the initial cohort, we collected the following modified foot function index scores for 13 patients: PROMIS Physical Health (0-20), PROMIS Mental health (0-20), Foot Function Index (0-170), Activity Limitation Scale (0-30), Pain Scale (0-50) and Disability Scale (0-90).

Results:

The mean age of our cohort was 53.9 (± 12.9) with a mean CCI of 1.54 (± 1.127) and mean follow up of 451.5 days (± 353.3). Mean modified foot function index scores included: PROMIS Physical Health 12.15 (± 3.34), PROMIS Mental health 12.23 (± 4.82), Foot Function Index 91.08 (± 47.59), Activity Limitation Scale 15.00 (± 10.42), Pain Scale 25.00 (± 14.77) and Disability Scale 51.00 (± 25.06). The post-operative complication rate was 30.8% in which 3 patients required a revision surgery via nail dynamization and one patient required a below knee amputation due to an infected nonunion of the TTC arthrodesis. The overall fusion rate at the 6-month postoperative visit was 69.2%.

Conclusion:

Unlike prior studies, we were able to obtain 6-month post-operative CT scans to delineate successful fusions with a larger number of patients (n=13). Given the paucity of literature looking at TCMS augmented fusions in foot and ankle surgery, our data will contribute to our understanding and efficaciousness of this relatively new use of TCMS in foot and ankle surgery. Further studies are needed to evaluate the efficacy of TCMS augmented fusions as a viable surgical approach as well an alternative to standard nail dynamizations with structural grafts.
Incidence of Postoperative Rerupture of Achilles Tendon and Associated Risk Factors in South Korea: A National Population-Based Study
Authors: Choi Yoon Hyo , Choi Ji Hye , Lee Dong Yeon , Kyung Min Gyu , Lee Kyoung Min , Lee Kyoung Min
Published: December 2023

Category:

Sports; Ankle

Introduction/Purpose:

Achilles tendon rerupture (ATRR) is a frequently occurring complication following the treatment of an Achilles tendon rupture (ATR) that can lead to disability; however, comprehensive risk factors for the development of postoperative ATRR remain unclear. We aimed to determine the incidence rate of postoperative ATRR and its associated risk factors, including comorbidities and medication, among the South Korean population.

Methods:

This study was performed based on Health Insurance Review and Assessment claims data, which covers 98% of the overall Korean population. Patients with ATR were identified according to the disease code S86.0 (Achilles tendon injury) of the Korean classification of disease between 2007 and 2020, and a washout period of 1 year was set. Instances of reoperation on the Achilles tendon between 42 and 365 days after the initial surgery, in the absence of infection or skin necrosis, were classified as cases of Achilles tendon rerupture (ATRR). Data on age, sex, comorbidities, and medications were collected and statistically analyzed.

Results:

Between 2009 and 2018, the incidence of surgical treatment for primary ATR was 9.91 per 100,000 person-years, showing a significant annual increase. The postoperative rerupture rate was 2.14% and did not show a significant increase. Male sex, young age, preexisting Achilles tendinopathy, osteoarthritis, and preoperative exposure to non-steroidal anti-inflammatory drugs and opioids were risk factors for postoperative ATRR.

Conclusion:

This information needs to be considered when determining the surgical treatment for patients with Achilles tendon rupture. The study results provoke further biological and clinical research on the risk factors for postoperative ATRR.
Intellectual Property and Royalty Payments Among Foot and Ankle Surgery Fellowship Faculty
Authors: Dominick Casciato , Page Trevor , Perkins Jacob , Vacketta Vincent G. , Hyer Christopher
Published: December 2023

Category:

Other

Introduction/ Purpose:

Faculty of the American College of Foot and Ankle Surgeons and American Orthopedic Foot and Ankle Society fellowship programs are uniquely positioned to provide advanced clinical and surgical training to fellows. One aspect of this training may include product design and mentorship through the associated intellectual property (IP) and patent timeline. This study describes the payments received and IP held among foot and ankle surgery fellowship faculty.

Methods:

A review of foot and ankle surgeons with royalties or license payments disclosed on the CMS Open Payments Database from 2014-2020 was conducted. Members with payments were then cross-referenced with the US Patent Full-Text Database to identify patents held. Fellowship affiliation, practice location, patent office, number of patents, citations, patent h-index, type of patent, and yearly payment values were recorded.

Results:

Among the 2,801 surgeons, 53 fellowship affiliates and 46 non-affiliates maintained at least one patent and royalty/license payment. A total of 576 patents and 19191 citations were assessed. The median number of patents and citations held by fellowship faculty was 3 and 60, respectively, while the median total payment value reached $165197.09. Fixation devices comprised most of the patents and citations. Payment value positively correlated with number of patents held (p=0.01), citations (p=0.007), and patent h-index (p=0.01) among fellowship-affiliated surgeons.

Conclusion:

Foot and ankle surgery fellowship faculty payments for IP is associated with the number and citability of patents held. While a small proportion of faculty were paid for intellectual property, the number of patents held and citations was comparable to other specialties.
Is there a Correlation Between the Distance to Healthcare Facilities and Postoperative Complications after Achilles Tendon Rupture? A Geospatial Study
Authors: Mirochnik Karina , Nassour Nour , Hendriks Joris R.H , Ranganathan Noopur , Lucaciu Andreea R. , Ashkani-Esfahani Soheil , Guss Daniel , Waryasz Gregory
Published: December 2023

Category:

Ankle; Other

Introduction/Purpose:

Geospatial access to healthcare is defined as the ability of patients to obtain healthcare services based on their locations. Therefore, we aimed to investigate patients’ proximity to healthcare and its correlation with the complications of surgically treated Achilles tendon rupture (ATR), including venous thromboembolism (VTE), re-rupture, and wound dehiscence. The outcome of this study can help providers and policy makers to determine the equity of healthcare for these patients in the area under their coverage.

Methods:

We included 426 patients who lived in the United States (US) tri-state area who received surgical treatment for ATR. We used patient and hospital addresses and zip codes to calculate the distances to healthcare centers. A geographic information system (GIS) platform analysis in the tri-state was completed using Maptive, powered by Google Maps, to create heat maps displaying the geographical distribution of patients treated for ATR with and without complications (Figure 1). The Shapiro–Wilk test was used to determine normal distribution. Mann–Whitney U test was used to compare the groups with and without complication. The point biserial correlation test was used to determine any correlations between driving distance and the incidence of complications (p < 0.05 was considered significant).

Results:

The average driving distance to the patient’s specific healthcare center was 62.16 ± 76.54 km. There was no significant difference between the distances for patients with and without overall complications (p = 0.65), with and without VTE (p = 0.70), with and without re-rupture (p = 0.84), and with and without wound problems (p = 0.36). No correlation between complications and the distance to healthcare centers was found (p = 0.65; Table 1).

Conclusion:

Geospatial information is important within the context of healthcare accessibility and can provide crucial guidance to healthcare planning for patients and healthcare policymakers. Although this study showed that distance to healthcare facilities did not lead to significantly higher complication rates amongst ATR patients, it does not resolve the need for further studies looking at a larger population and broader geographical segments. These studies can be used to assess the equity of healthcare in specific areas and make modifications if needed.
Lessons Learned – the Learning Curve of Percutaneous Hallux Valgus Correction Using 3rd Generation MICA in 106 Consecutive Cases
Authors: Toepfer Andreas Kurt
Published: December 2023

Category:

Bunion; Other

Introduction/Purpose:

Minimally-invasive Chevron and Akin osteotomy (MICA) represents the third-generation percutaneous hallux valgus surgery which is characterized by an extra-articular osteotomy, stable internal fixation and a high potential for correction. Compared to other percutaneous techniques of the foot, MICA is generally regarded as an advanced and demanding surgical procedure with a prolonged learning curve. The aim of this study is to analyze a single-surgeons learning curve with his first 106 consecutive MICA procedures.

Methods:

Between May 2018 and November 2022, 106 consecutive MICA procedures performed by the author were prospectively analyzed focusing on surgery duration, number of fluoroscopies, radiological correction results and surgery- associated complications using a modified Clavien-Dindo classification. There were 95 female and 11 male patients with a mean age of 53y (range 16-78y). The mean preoperative intermetatarsal angle I/II (IMA) was 15,7°, the mean hallux valgus angle (HVA) 28,7°.

Results:

The average amount of radiological correction was 12,6° for IMA and 16,8° for HVA. Overall, the mean surgery duration was 41,6min. (range 27-90min.), the number of fluoroscopies (fs) was 110,8 (range 64-186 fs). Comparing the first 10 MICAS vs. the last 10 procedures, both surgery duration and the amount of fluoro shots decreased significantly (58,8min vs. 32,4min and 165,9 fs vs. 83,1fs). According to the modified Clavien-Dindo classification, there were three grade 1 complications (superficial cellulitis requiring oral antibiotics), four grade 2 complications (1 intraoperative conversion to open surgery, 1 delayed union, 2 symptomatic recurrences) and one grade 3 complication (delayed wound-healing requiring superifical wound revision). Overall screw removal rate was 18 /106 cases, all due to prominent hardware with square headless designed screws (non-beveled).

Conclusion:

This study represents the largest case series on the learning curve of MICA. Although the learning curve is prolonged requiring specific training and intensive practice, the rate of severe complications is not increased compared to open hallux valgus surgery. The use of bevel-headed screws is strongly advised to reduce the rate of secondary hardware removal. The learning curve manifests itself predominantly in a decreasing operation time and lower number of fluoroscopies. Adherence to the principles of MICA with stable fixation and meticulous intraoperative control of each surgical step helps to reduce complications and allows for adequate correction from the beginning.
Natural Course of Talar Avascular Necrosis During Short-Term Follow-Up and Factors Associated with Disease Progression
Authors: Choi Yoon Hyo , Lee Dong Yeon , Kyung Min Gyu , Lee Kyoung Min , Lee Kyoung Min
Published: December 2023

Category:

Ankle; Hindfoot

Introduction/Purpose:

This retrospective cohort study aimed to investigate the natural history of talar avascular necrosis (AVN) during short-term outpatient follow-up and to identify the risk factors for progression to collapse and arthritic changes.

Methods:

Thirty-four cases of talar AVN from 34 patients (15 males, 19 females) were included. The mean age of the patients was 48.9 years (SD 16.0 years) and the mean follow-up period was 39.5 months (SD 42.0 months). The patients were divided into two groups i.e., progression and non-progression groups. The progression group consisted of those who showed aggravation of the Ficat stage during the follow-up period or advanced arthritis of the ankle joint (Ficat stage 4) at presentation. Demographic data and information regarding medical comorbidities, trauma history, bilaterality, and location of the lesion (shoulder vs. non-shoulder lesions) were collected. Following the univariate analysis, a binary logistic regression analysis was performed.

Results:

The location of the talar AVN was the only significant factor (p=0.047) associated with disease progression. A total of 14.3% (2 of 14) of the central (non-shoulder) talar AVN lesions showed progression, while 50% (10 of 20) of shoulder lesions aggravated during follow-up. Age, sex, bilaterality, medical comorbidities, and trauma history were not associated with progressive talar collapse or subsequent arthritic changes in talar AVN.

Conclusion:

Conservative treatment should be considered for a central lesion of the talar AVN because it tends to remain stable without progression. A more comprehensive study with a larger study population is required to establish the surgical indications for talar AVN.
Objective Analysis of Regional Tibiotalar Joint Changes in Ankle Osteoarthritis Assessed by Semi- Automated 3D Distance Mapping
Authors: Behrens Andrew , Dibbern Kevin , Anderson Donald D. , Talaski Grayson M. , Carvalho Kepler A.M. , Mansur Nacime Salomao Barbachan , de Cesar Netto Cesar
Published: December 2023

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Ankle osteoarthritis is a degenerative joint disease characterized by the narrowing of the tibiotalar joint space and in late stages, eventual tibiotalar contact and subchondral bone loss. Traditional methods of assessing changes in the joint space (such as assessment on 2D radiographs) are subjective and do not fully consider the three-dimensional nature of articular surfaces. Weight-bearing CT (WBCT) provides a unique perspective by placing the joints of the lower extremity in a loaded, functional position, and may help to better quantify changes in joint space. Determining the presence and progression of ankle arthritis is difficult. It is our hope that novel 3D distance mapping technologies using images acquired from WBCT may assist with the detection and characterization of progression of ankle osteoarthritis.

Methods:

In this IRB-approved, retrospective case-control study, we analyzed WBCT data of 9 ankle osteoarthritis patients and 20 healthy controls. Patients included in this study had no identifiable talar tilt. Segmentations were created using an automated segmentation software package (DISIOR Bonelogic 2.0) Principal component analysis was used to divide the talar dome into nine subregions. The articular facet of the medial malleolus was also analyzed. We used 3D distance mapping to objectively measure joint space width across the tibiotalar joint and assessed changes in distance in each of the nine subregions of the talar dome articular surface. Overall mean distances for each subregion analyzed were calculated. Comparisons between the control and ankle arthritis cases were performed with independent t-tests, assuming unequal variances. P-values < 0.05 were considered significant.

Results:

Changes in the mean distances are reported in the attached figure. The medial side of the talar experienced significant decreases in mean joint space width. The middle medial subregion experienced the largest decrease in mean joint space width with a reduction of 35% when compared to controls (p = 0.017). Increases in joint space width were observed on the lateral aspect of the talar dome, However, these increases were not found to be significant.

Conclusion:

The purpose of this study is twofold: to quantify changes in joint space using 3D distance mapping technique and to evaluate the utility of a commercial automated segmentation software package. In this cohort, there was a significant decrease on the medial side of the talar dome – this change can be attributed to cartilage degeneration. To our knowledge, this is the first study to analyze changes in ankle osteoarthritis using a fully automated segmentation method. Automated segmentation and 3D distance mapping provide a useful tool for the quantification of osteoarthritis-associated joint space changes.
One Year Outcomes of the H-AMIC Procedure for Osteochondral Lesions of the Talus
Authors: Haldar Anil , Ardakani Amir Hossain Gahanbani , Patel Shelain , Welck Matthew J. , Malhotra Karan , Cullen Nicholas
Published: December 2023

Category:

Ankle; Basic Sciences/Biologics

Introduction/Purpose:

Osteochondral lesions of the talus (OLTs) present a challenging clinical problem. Hyaluronic acid assisted autologous membrane-induced chondrogenesis (H-AMIC) is a technique where a polyglycolic acid and hyaluronin membrane scaffold (Chondrotissue®) is affixed over an area of talar bone marrow stimulation. Our study aims to assess the efficacy of this technique.

Methods:

We undertook a prospective study on consecutive adult patients at our unit who had H-AMIC procedures between January 2020 and November 2021 to treat single, symptomatic OLTs, >1.5cm2, refractory to previous management. Data was collected on patient reported outcomes (MOxFQ, EQ5D, satisfaction), ankle range of movement, and complications at 1-year post-surgery. Fifteen patients were included in this study with a mean age of 33.8±20.9 years. Mean duration of symptoms was 7.9±5.2 years, with a mean of 1.5 previous procedures (range 0 to 3). All patients had osteotomies to gain access to the OLT (13 medial malleolar, 2 fibular).

Results:

Mean improvements greater than the minimum clinically important difference (MCID) were seen in MOxFQ-Pain (61.7±26.1 to 48.3±21.8, p=0.112), MOxFQ-Walking (64.6±21.8 to 46.6±23.9, p=0.067), MOxFQ-Social (63.67±22.5 to 41.8±29.2, p=0.055), although none reached statistical significance. No difference was seen in EQ5D. Overall improvements were seen in MOxFQ-Pain in 58.3%, MOxFQ-Walking in 75%, and MOxFQ-Social in 83.3% of patients. Overall, 11 patients (73.3%) were satisfied with the procedure. Patients displayed improvement in plantarflexion from 33.1±5.5 to 42.0±7.9 degrees (p=0.002) and no change to dorsiflexion. There were no complications.

Conclusion:

The H-AMIC procedure is a promising and safe option for larger osteochondral lesions of the talus. Early results suggest improved range of motion despite osteotomy and clinically (but not statistically) significant improvement in function in a group of patients with longstanding symptoms and previous failed surgery. Larger, adequately powered cohorts may establish statistical efficacy of this technique compared with alternative techniques.
Outcomes following Peroneal Tendoscopy for Peroneal Tendon Disorders: A Systematic Review
Authors: Butler James J. , Nair Akshay A. , Campbell Hilary T. , Azam Mohammad T. , Kennedy John G.
Published: December 2023

Category:

Other; Ankle

Introduction/Purpose:

The purpose of this systematic review was to evaluate the clinical and radiological outcomes at short-term follow-up following peroneal tendoscopy for the treatment of peroneal tendon disorders.

Methods:

During October 2022, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following peroneal tendoscopy for the treatment of peroneal tendon disorders. Data regarding patient demographics, pathological characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed.

Results:

Nine studies were included. In total, 264 patients (269 tendons) underwent peroneal tendoscopy for the treatment of peroneal tendon disorders at a weighted mean follow-up of 30.5±11.4 months. The peroneal tendon disorders included: peroneal tendon tear (89 patients), peroneal tenosynovitis (85 patients), low lying muscle belly (54 patients) and peroneal tendon subluxation (17 patients). The weighted mean AOFAS score improved from a pre-operative score of 76.0 to a weighted mean post-operative score of 96.0. The complication rate was 3.8%, the most common of which was persistent lateral ankle pain (1.1%). Two failures (0.007%) were reported, both of which underwent repeat peroneal tendoscopy, tenosynovectomy and low lying muscle belly resection.

Conclusion:

This systematic review demonstrated improvement in subjective clinical outcomes together with a low complication rate and low failure rate at short-term follow-up following peroneal tendoscopy for the treatment of peroneal tendon disorders. However, the level of evidence was low and the quality of evidence was poor. In addition, there was significant heterogeneity between the included studies. Further higher quality studies are warranted to determine the optimal role of peroneal tendoscopy for the management of peroneal tendon disorders.
Predictors of Intraoperative and Early Complications in Total Ankle Replacement
Authors: Cornelius Canon C. , Greaser Michael , Gauvain Taggart , Beaver Richard , Duncan Leslie A. , McGarvey William
Published: December 2023

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Predictors of intra operative and early complications following total ankle replacement (TAR) become more important as the incidence and indications for TAR continue to expand. Talar bone loss whether from avascular necrosis, osteoarthritis, or post traumatic arthritis can be a challenging problem to deal with in TAR. The aim of this study is to report predictors of complications in TAR with talar bone loss.

Methods:

A retrospective review using CPT codes for four surgeons over a three-year period at an academic institution was performed. A single surgeon reviewed the immediate preoperative plain radiographs for 200 consecutive patients for talar bone loss. The mortise and lateral views were used to calculate talar bone loss and then averaged (Fig 1). 37 patients were identified as having talar bone defects of greater than 20 percent when the two measurements were averaged. Our preoperative variables we looked at were size of talar defect, location, and cause of talar defect and postoperatively, the implant choice. Our primary outcomes were intraoperative fracture, reoperation, subsidence, and revision surgery.

Results:

The average follow up was 23 months. The average defect size was 54 percent with a range of 20 to 100 percent. Mann U Whitney tests were performed that showed a relationship between the lateral and overall percentage of talar bone loss being predictive of subsidence of the talar component. A Fischer exact test showed a that a chamfered talus cut was protective against subsidence. The mean of the talar bone loss for the chamfered components were 40% versus 58% in flat cut. There were no other significant differences when comparing complications, fracture, reoperation, or wound complications.

Conclusion:

While TAR for patients with talar bone loss can be a good option for the patient and surgeon it does have a higher complication rate than standard TARs. Careful attention should be given to the percentage of talar bone loss. Flat cut and revision style components were more likely to be used in worse situations, so it is not the authors belief that they are more prone to subsidence. All patients over 20% bone loss need extensive discussion regarding potential complications and additional procedures. Talar bone loss is a difficult problem to deal with but TAR is a viable option.
Retrograde Drilling for Hepple-V Subchondral Lesion of Talus using 3D Image-based Navigation Assisted Endoscopic Technique
Authors: Shijun Wei
Published: December 2023

Category:

Ankle; Arthroscopy

Introduction/Purpose:

Retrograde drilling remains technically challenging, due to the difficulty of identifying the accurate location of cysts on fluoroscopic images or matching the tip of the drill guide under arthroscopic visualization. This studies aim was to evaluate the 3-dimentional(3D) image-based surgical navigation system assisted endoscopic retrograde drilling technique for subchondral lesions of the talus.

Methods:

From Mar 2018 to Jun 2020, 21 cases with Hepple-V type subchondral lesions of the talus were treated with 3D image- based surgical navigation system assisted endoscopic retrograde drilling technique. Arthroscopic views were categorized per Pritsch’s classifications. The American Orthopaedic Foot and Ankle Society (AOFAS) scores and Visual Analog Scale (VAS) scores were evaluated at the preoperative and final follow-up appointments. All complications were also recorded.

Results:

The average follow-up time was 29.2 ± 9.4 months (range, 24 – 48). Only 9 cases (42.9%) showed intact and normal cartilage surfaces (grade 0, group A), 12 cases (57.1%) had intact, soft cartilage surfaces (grade I, group B). At the final follow-up, the average of the AOFAS scores and VAS scores were 89.0 ± 2.1 vs 88.3 ± 2.0 and 0.8 ± 0.2 vs 0.8 ± 0.3, respectively. There were no significant differences between both groups. In group B, however, two patients were documented with signs of recurrence after 2 years postoperative. Also, an additional overlying cartilage lesion was noticed in another patient. Finally, two patients were given revised surgery.

Conclusion:

The 3D image-based surgical navigation system assisted endoscopic retrograde drilling technique is accurate, effective and safe for the subchondral lesions of the talus. The ideal indication is subchondral cysts with intact and normal cartilage surfaces. However, these patients are uncommon.
Revision Total Ankle Arthroplasty Outcomes in a Large Single-Center Series: Evaluation of Coronal Plane Deformity Correction and Patient Reported Measures
Authors: Kim Billy I. , Anastasio Albert T. , Valan Bruno N. , Krez Alexandra , DeOrio James K. , Nunley James A. , Easley Mark , Adams Samuel
Published: December 2023

Category:

Ankle Arthritis

Introduction/Purpose:

As total ankle arthroplasty (TAA) rises in popularity nationwide, the incidence of major complications and need for revision TAA will continue to increase. A better understanding of the ability to durably correct deformity and improve patient reported outcomes (PROs) in the TAA revision setting is paramount for surgeons facing the impending wave of failed TAA. Thus, the purpose of this study was to present the largest single-center case series of revision TAA to date and to evaluate improvement in PROs and maintenance of correction of coronal plane deformity in patients undergoing this procedure.

Methods:

This was a single-center, retrospective review of 87 revision TAAs performed between 2007 and 2022. Reoperations for cyst formations only or without metallic component exchange were excluded. The two most common implants used for revision TAA were Inbone II (n=65) and Inbone I (n=14). Mean follow-up was 2.8 ± 2.9 years. Data on patient preoperative characteristics, concurrent procedures, and postoperative complications were collected. The primary outcome measures were time to major complication, reoperation, and infection. Secondary outcomes included PROs and correction of coronal plane deformity measured from both the tibial plafond and talar articulating surface from pre- to post-operatively. Cox regression analyses were performed to compute survivorship.

Results:

The most common concurrent procedures performed concomitantly with revision TAA were gastrocnemius recession (n=31, 35.6%), subtalar arthrodesis (n=18, 20.7%), and talonavicular arthrodesis (n=5, 5.7%). Mean preoperative coronal plane deformity measured off both the tibial plafond and talar articular surface improved after revision TAA. 1- and 5-year survivorship from major complication, reoperation, and infection is shown in Table 2. Fourteen patients underwent subsequent revision, including TAA (n= 6, 6.9%), arthrodesis (n= 4, 4.6%), below-the-knee amputation (n= 2, 2.3%), or implantation of an antibiotic spacer (n= 2, 2.3%). At one-year postoperatively, mean VAS pain score, SF36, and AOFAS Hindfoot score was 18.2 ± 16.0, 73.0 ± 13.3, and 68.8 ±:9.3, respectively, representing an improvement in PROs after revision TAA.

Conclusion:

In the largest single-center series of patients undergoing single or double component exchange revision TAA, we demonstrate durable improvements in coronal plane deformity measured off both the tibial plafond and talar articular surface. We also noted 63.0% survivorship with regards to reoperation and improvements in average PROs across the cohort. Overall, revision TAA is a successful procedure, but is associated with higher failure rates at 5 years than primary TAA.
Safe Zones Analysis for Lateral Column Lengthening Using Weightbearing CT and Distance Mapping
Authors: Barbero Agustin , Efrima Ben , Indino Cristian , Ramalingam Kuharajan , Maccario Camilla , Usuelli Federico Giuseppe
Published: December 2023

Category:

Hindfoot; Midfoot/Forefoot

Introduction/Purpose:

Lateral column lengthening (LCL) is the cornerstone for flexible, progressive collapsing foot correction. Evans LCL (ELCL) and Hinterman LCL (HLCL) are the most used surgical techniques. ELCL is performed between the anterior and medial facets and endangers specific os-calcis subtypes (OSCT). HLCL passes in a safe zone between the posterior and medial facets and should be suitable for all OSCTs. However, both osteotomies are associated with increased subtalar osteoarthritis, indicating iatrogenic damage. Distance mapping (DM) enables visualization of the relative distance between two articular surfaces using color patterns. This study aims to measure the safe zones for LCL using DM.

Methods:

Using the Bruckner et al. classification, two raters categorized 134 patients and 200 feet into the four OSCTs. Four angles were measured. The proximal posterior safe zone (PSZ) and distal PSZ angles defined the safe zone for HLCLO; it was measured for all OSCTs. The proximal anterior safe zone (ASF) angle and the distal ASF defined the safe zone for ELCLO. They were measured only in cases where a discontinuity between the two facets exists or in the absence of anterior facet. A statistical comparison between the groups was made

Results:

The mean proximal PSZ angle was 68+/-7 degrees, the distal PSZ angle was 75+/-5, the Proximal ASZ angle was 89+/-6 degrees, and the distal ASZ angle was 95+/- 5 degrees. There were no statistically significant differences between the OSCTs. In five patients, the PSZ morphology did not allow planning for HLCLO.in 13 cases; the ASZ left insufficient bone stock between the ELCLO and the calcaneal cuboid joint.

Conclusion:

In this study, we used DM to determine the safe zone for LCL. The high OSCT and morphology variability call for patient-specific LCL preoperative planning. DM could be reliably used to tailor the optimal surgical solution.
Supramalleolar Osteotomy Combined with Medial Malleolar Osteotomy for Varus Ankle Osteoarthritis with Varus Medial Malleolar Deformity
Authors: Hio Naohiro , Taki Masanori
Published: December 2023

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

In some cases of varus ankle osteoarthritis (VAO), the varus medial malleolar deformity causes widening of the mortise and reduced conformity. In such cases, the angles of the medial distal tibial platform and the angle of the talar medial shoulder are different, so it is necessary to match the angles of both to improve the compatibility of the mortise. We performed lateral closing wedge supramalleolar osteotomy (LCWSMO) with opening wedge medial malleolar osteotomy (OWMMO) to achieve lateral shift of the load-bearing axis and mortise-plasty at the same time. The purpose of this study was to evaluate the therapeutic outcomes of this technique for VAO with the varus medial malleolar deformity.

Methods:

The subjects were 12 joints in 12 cases, two males and ten females, the mean age at the surgery was 58.2 years (36-76 years), and the mean follow-up period was 9 years and 1 month (1-20 years and 4 months). After LCWSMO was performed, OWMMO was made to fit the mortise, and autogenous bone grafting was performed in the gap. Additional surgery included two lateral ligament reconstructions, one osteochondral graft, and one high tibial osteotomy. Clinical evaluation was performed using the score of Takakura et al. For arthroscopic evaluation, we used our five grades classification, which is based on the percentage of eburnation areas on the articular surface. The radiographic assessments were the Takakura-Tanaka staging system, the tibial articular surface angle, the tibial lateral surface angle, the talar tilting angle, and the ratio of the medial distal tibial platform angle to the medial talar shoulder angle.

Results:

The clinical score improved from a preoperative average of 65.0±9.3 points to 82.8±9.8 points at the final follow-up. All arthroscopic grade improved at one year after surgery except one each of grade 2 and grade 3 joints which remained unchanged. According to the postoperative radiographic staging, 6 joints had improved, 3 had not changed, and 3 had progressed. The tibial articular surface angle increased from an average of 84.4 ± 2.1° preoperatively to 97.4 ± 3.6° at the last observation, the tibial lateral surface angle from 80.5 ± 2.5° to 83.7 ± 5.9°, the talar tilting angle increased 11.3 ± 4.7° to 7.9 ± 4.3°, and the ratio of the medial distal tibial platform angle to the medial talar shoulder angle from 112.3±4.9% to 103.6±5.8%.

Conclusion:

For VAO with varus medial malleolar deformity and large mortise opening, good results can be obtained by lateral shift the load-bearing axis with LCWSMO and improving the fit of the mortise with OWMMO.