bluuebunny/crossref_metadata_2025 huggingface dataset:
State-Level Implementation of Health and Safety Policies to Prevent Sudden Death and Catastrophic Injuries Within Secondary School Athletics
Authors: Adams William M. , Scarneo Samantha E. , Casa Douglas J.
Published: September 2017

Background:

Sudden death and catastrophic injuries during sport can be attenuated with the implementation of evidence-based health and safety policies. However, the extent of the implementation of these policies within secondary school athletics is unknown.

Purpose:

To provide an assessment of the implementation of health and safety policies pertaining to the leading causes of sudden death and catastrophic injuries in sport within secondary school athletics in the United States.

Study Design:

Descriptive epidemiology study.

Methods:

A rubric for evidence-based practices for preventing the leading causes of death and catastrophic injuries in sport was created. The rubric comprised 5 equally weighted sections for sudden cardiac arrest, head injuries, exertional heat stroke, appropriate medical coverage, and emergency preparedness. State high school athletic association (SHSAA) policies, enacted legislation, and Department of Education policies were extensively reviewed for all 50 states and the District of Columbia. States meeting the specific criteria in the rubric, which required policies to be mandated for all SHSAA member schools, were awarded credit; the weighted scores were tabulated to calculate an aggregate score. States were then ranked from 1 (best) to 51 (worst) based on the aggregate score achieved.

Results:

The median score on the rubric was 47.1% (range, 23.00%-78.75%). States ranked 1 through 10 (from 78.75% to 56.98%) were North Carolina, Kentucky, Massachusetts, New Jersey, South Dakota, Missouri, Washington, Hawaii, Wisconsin, and Georgia, respectively. States ranked 11 through 20 (from 56.03% to 50.55%) were Arkansas, New York, Mississippi, West Virginia, Oregon, Illinois, Tennessee, Arizona, Texas, and District of Columbia, respectively. States ranked 21 through 30 (from 49.40% to 44.00%) were Virginia, Pennsylvania, Florida, New Mexico, Alabama, Maine, Rhode Island, Indiana, Nevada, and Utah, respectively. States ranked 31 through 40 (from 43.93% to 39.80%) were Ohio, Delaware, Alaska, Vermont, Louisiana, Maryland, Oklahoma, Connecticut, Idaho, and South Carolina, respectively. States ranked 41 through 51 (from 38.73% to 23.00%) were Michigan, North Dakota, Nebraska, New Hampshire, Kansas, Wyoming, Minnesota, Montana, Iowa, California, and Colorado, respectively.

Conclusion:

State scores ranged from 23.00% to 78.75% for the implementation of evidence-based best practices for preventing the leading causes of sudden death and catastrophic injuries (sudden cardiac arrest, traumatic head injuries, exertional heat stroke, and exertional sickling) in sport. Continued advocacy for the development and implementation of policies at the secondary school level surrounding sudden death and catastrophic injuries is warranted to optimize the health and safety of these student athletes.
Comparison of Clinical Failure Rates After 2 Techniques of Subpectoral Mini-Open Biceps Tenodesis: Sequence and Suture Passage Technique Matter
Authors: Schrock John B. , Kraeutler Matthew J. , Bravman Jonathan T.
Published: September 2017

Background:

A number of techniques are available for performing biceps tenodesis, the majority of which result in good or excellent outcomes. However, failure may result in pain and/or dissatisfying biceps deformity.

Purpose:

To compare the clinical failure rates of 2 methods of suture passage in subpectoral biceps tenodesis with suture anchors performed by the senior author.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A retrospective chart review was conducted of patients who underwent biceps tenodesis under the care of the senior author. Operative notes were used to determine whether the procedure was performed with a BirdBeak (BB) suture passer or a free needle (FN). Each subsequent clinical follow-up note was used to determine participation in physical therapy and duration, follow-up duration, and whether clinical tenodesis failure had occurred. Biceps tenodesis failure was defined as either cosmetic deformity (“Popeye” sign), pain at the tenodesis site, or need for revision.

Results:

Overall, 163 patients met the inclusion criteria (BB, n = 112; FN, n = 51). Mean follow-up was 5.3 months and 4.1 months in the BB and FN groups, respectively. Significantly more tenodesis failures occurred in the BB group (BB, 12%; FN, 2%, P = .042). Among all BB patients, 10% experienced failure due to cosmetic deformity, 2% required revision, and 4% had postoperative pain at the tenodesis site by latest follow-up. The 1 patient in the FN group who experienced failure presented with cosmetic deformity postoperatively.

Conclusion:

Biceps tenodesis with the use of an FN to pass the suture resulted in a significantly lower clinical failure rate compared with the use of a BB suture passer.
Children’s Geographic Proximity and Older Parents’ Depressive Symptoms in China
Authors: Liang Di , Zhang Donglan
Published: September 2017

Objective: This study examined the association between children’s proximity and older parents’ depressive symptoms, and whether living with grandchildren modified this association. Method: Study sample was from the 2011 China Health and Retirement Longitudinal Study ( N = 5,261). Elders’ depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale. Children’s proximity was measured by the geographic distance from an adult child to elders’ residence. Linear and logit regressions were performed. Results: Elders who had their nearest child living 100 km away were 9% more likely to experience severe depressive symptoms (95% CI: [1%, 16%]) than those living together with children. Among those living far away from adult children, living with a grandchild in the same household increased the likelihood of having severe depressive symptoms by 23% (95% CI: [12%, 34%]). Discussion: Relationships between children’s proximity and parents’ health were identified and modified by whether living with grandchildren.
Developing an algorithm to identify patients with intracerebral haemorrhage secondary to a macrovascular cause
Authors: Wilson Duncan , Ogungbemi Ayokunle , Ambler Gareth , Jones Ifan , Werring David J , Jäger Hans R
Published: September 2017

Introduction

Determining the cause of spontaneous (non-traumatic) intracerebral haemorrhage (ICH) is critical to guide treatment and prognosis. We investigated whether small vessel disease (SVD) in addition to clinical and other radiological findings on acute neuroimaging predicts a low risk of a macrovascular cause (e.g. an arterio-venous malformation, aneurysm or dural arteriovenous fistula).

Patients and methods

We identified patients with acute spontaneous ICH who underwent acute non-contrast CT, CT angiography (CTA) and intra-arterial digital subtraction angiography (IADSA) at our institution from January 2010 to April 2014. Logistic regression including CTA result, SVD, age, pre-ICH hypertension and ICH location was used to derive a prediction model, validated using bootstrapping.

Results

173 patients (46% female, median age 49) of whom 78 had a macrovascular cause on IADSA were included. Predictors of a macrovascular cause were: abnormal CTA (OR 67.4; p < 0.001); absence of SVD (OR 5.0; p = 0.019); and absence of pre-ICH hypertension (OR 3.4; p = 0.05). In our internally derived prediction model, the combination of CTA, SVD and pre-ICH hypertension predicted the likelihood of an underlying macrovascular cause (optimism-adjusted ROC area 0.919). Patients with negative CTA, SVD and pre-ICH hypertension have a low likelihood of an underlying macrovascular cause (1.8%).

Discussion and conclusion

A combination of CTA, SVD and pre-ICH hypertension predict the likelihood of finding a macrovascular cause in patients with acute spontaneous ICH, allowing informed decisions regarding the likely benefit and risk of IADSA.
Early Versus Delayed Weightbearing After Microfracture For Osteochondral Lesions Of the Talus
Authors: Deal James , Groth Adam , Ryan Paul
Published: September 2017

Category:

Arthroscopy

Introduction/Purpose:

Bone marrow stimulation techniques, specifically arthroscopic microfracture, have become the therapy of choice for osteochondral lesions of the talus (OLTs) less than 15 mm2 in size. Traditionally, the microfracture site is protected with a postoperative non-weightbearing period of 6-8 weeks. However, recent research has suggested postoperative early weight bearing (EWB) after microfracture may produce outcomes equivalent to delayed weight bearing (DWB). We performed a prospective, randomized trial to determine whether the results of EWB after microfracture for OLTs are equivalent to DWB.

Methods:

We randomized 37 patients (37 ankles) undergoing arthroscopic microfracture for OLTs to either EWB or DWB protocols. The EWB cohort was allowed to bear weight as tolerated two weeks after surgery, while the DWB cohort was held non-weightbearing until six weeks postoperatively. We collected demographic data, mechanism of injury, lesion size and stage, Numeric Rating System pain scores (NRS), and American Academy of Orthopaedic Surgery Foot and Ankle Questionnaire (AAOS) functional scores preoperatively, then at 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively.

Results:

There were no differences between the two cohorts in terms of patient age, mechanism of injury, lesion size, or lesion stage. The mean age at surgery was 34.1 years (range 21-50 years). 70.4% of the lesions were lateral, 22.2% were medial, and the remainder were central. The EWB group demonstrated statistically significant improvement in AAOS scores at the six week follow-up appointment. There were no significant AAOS score differences at the other time points. NRS pain scores were not significantly different at any time point. Both groups showed mild deterioration of results over time.

Conclusion:

Early weightbearing after microfracture for OLTs was associated with improved AAOS scores in the short term, without demonstrating poorer function or pain at 2 year follow up. This study supports early weightbearing after arthroscopic microfracture for osteochondral lesions of the talus.
Second-Look Arthroscopic Evaluation and Clinical Outcome after the Supramalleolar Osteotomy for the Medial Compartment Ankle Osteoarthritis
Authors: Jung Hong-Geun , Eom Joon-Sang , Lee Dong-Oh , Sun Mao Yuan , Kang Hwa Jun
Published: September 2017

Category:

Ankle, Ankle Arthritis, Arthroscopy, Hindfoot

Introduction/Purpose:

This study aimed to evaluate the clinical and radiological outcomes of asymmetric ankle osteoarthritis after supramalleolar osteotomy (SMO) without BMSP(bone marrow stimulation procedure) and confirm cartilage recovery by second look arthroscopy. The hypothesis was that SMO without BMSP for medial compartment ankle osteoarthritis would show tibio-talar articular cartilage regeneration in the medial compartment, as well as satisfactory clinical and radiological outcomes.

Methods:

We retrospectively reviewed 20 ankles of 18 consecutive patients who were followed up for over 1 year after SMO from August 2007 to February 2013. Visual analog scale (VAS) pain scores and the AOFAS ankle-hindfoot scores were used for the functional evaluations. The tibial anterior surface angles and the tibial lateral surface angles were measured on radiographs, and the ankle osteoarthritis was classified by the Takakura stage. Among the 20cases, 19 caseshad ankle arthroscopy performedprior to SMO, and second-look ankle arthroscopywas performed in 14 cases at postoperative 1 year. Tibio-talarcartilage regeneration was evaluatedaccording to the modified Outerbridge classification for the 12 cases that had undergone SMO without a bone marrow–stimulating procedure (BMSP).

Results:

The mean VAS and AOFAS scores significantly improved from 6.7 preoperatively to 1.2 postoperatively and from 60.9 preoperatively to 87.9 postoperatively, respectively (P<0.05). The mean TAS and TLS angles significantly improved from 83.5? and 76.5preoperatively to 94.4? and 80.3? postoperatively respectively (P<0.05). All preoperative TakakurastageIIIa cases and 1 case of preoperative stage IIIb improved to postoperative stage II. At 2nd look arthroscopy, articular cartilage regeneration of the medial compartment of the tibio-talar joint was observed in 10 of 12 cases (83%), whereas cartilage deterioration was not observed in any case.Cartilage grading, however, did not show correlations with clinical outcomes.

Conclusion:

SMO without BMSP for medial compartment ankle osteoarthritis demonstrated marked tibio-talar articular cartilage regeneration in the medial compartment (83%) by second look arthroscopy, as well as satisfactory clinical and radiological outcomes.
Modified Evans Osteotomy
Authors: Abd-Ella Mohamed Mokhtar
Published: September 2017

Category:

Hindfoot

Introduction/Purpose:

Lateral column lengthening is commonly used to treat foot deformities. The original Evans osteotomy was described to be done 1 to 1.5 cm proximal to the calcaneocuboid joint. A modified Evans osteotomy described by Hintermann is done in the sinus tarsi just anterior to the posterior facet. The suggested advantages of the modified osteotomy are: more stability of the anterior fragment, less probability of injuring the spring ligament, preserving the function of peroneus longus because the osteotomy is posterior to its sulcus, and a better correction. However, no studies have assessed the risk of spring ligament injury, posterior facet injury and middle facet injury. This cadaveric study was done to assess the medial exit point of the osteotomy in relation to the medial structures.

Methods:

The modified Evans osteotomy was performed by the author who is a foot and ankle consultant in 20 fresh frozen lower limb specimens. Ten were complete lower limb specimens and ten were below knee specimens. Ten were right sided and ten were left sided. After exposure and peroneal tendon retraction, the osteotomy was done by an oscillating saw in the sinus tarsi just anterior to the posterior subtalar facet in a direction perpendicular to the lateral surface of the calcaneus. After completion of the osteotomy, the talus was dissected and removed and the relation of the osteotomy to the posterior facet, middle facet, anterior facet and spring ligament was documented. The distance between the medial part of the osteotomy and the anterior end of the posterior subtalar facet was measured, as well as the distance between the medial part of the osteotomy and the posterior border of the middle facet.

Results:

The spring ligament was not injured in any specimen. The posterior facet was not injured in any specimen with an average distance of 6.45 mm between the anterior end of the its medial part and the osteotomy (range: 0-15 mm). The anterior facet was contiguous with the middle facet in six specimens. The anterior facet was not injured in any specimen. In six specimens, the osteotomy passed between the posterior and middle facets just posterior to the middle facet, and in one specimen, it passed between the anterior and middle facets. In the remaining 13 specimens, the osteotomy passed through the middle facet with an average distance of 7.07 mm between the osteotomy and the posterior border of the middle facet (range: 2-13 mm).

Conclusion:

This study proves that the modified Evans osteotomy avoids injury of the spring ligament and the posterior subtalar facet. Although it starts laterally just anterior to the posterior facet, it exits medially safely away from the medial part of the posterior facet. The middle facet has a chance of 65% to be traversed by the osteotomy, however the clinical implications of this needs further studies. Also, a comparative study between the Evans osteotomy and the modified Evans osteotomy is needed.
Deltoid Ligament Reconstruction
Authors: Aljabi Yasser , Flavin Robert , Mohammed Khalid Merghani Saleh , Francis Ara
Published: September 2017

Category:

Ankle, Sports

Introduction/Purpose:

Deltoid Ligament Reconstruction: Clinical Outcomes. The Deltoid ligament is a primary ligamentous stabilizer of the ankle joint. Deltoid ligament insufficiency has been demonstrated to decrease tibiotalar contact area by around 43%. The authors report on their clinical outcomes of repairing deltoid ligament in the acute and chronic settings.

Methods:

61 Deltoid ligament reconstructions in the acute setting and 24 in the chronic setting (of which 7 had an additional medial displacing calcaneal osteotomy) were followed up over a period of 1 year. This study was performed in St. Vincent’s University Hospital - Dublin, Republic of Ireland (Teaching hospital for University College Dublin).

Results:

100% of patients receiving deltoid ligament reconstruction in the acute setting returned to sports within 3.5 months. 1.8% had excessive scaring requiring arthroscopic debridement. In the chronic setting, 95.8% of patients returned to sports at 6 months.

Conclusion:

Deltoid ligament reconstruction is associated with favorable outcomes and return to sports.
Weightbearing Radiographs and stability in SER II - IV Ankle Fractures
Authors: Baecker Henrik , Schmid Timo , Krause Fabian , Bonel Harald Marcel , Attinger Marc
Published: September 2017

Category:

Ankle, Sports, Trauma, Radiography, Weber B Fracture

Introduction/Purpose:

SER lateral malleolar fractures are common. The assessment of the stability of the ankle fracture is crucial for decision making of treatment which is associated with the integrity of the deltoid ligament (SERII-III). Slight talar shift can lead to extensive decrease of tibio-talar contact area (Ramsey 1999). Several clinical tests have been proposed of which static weightbearing radiography is used to measure the lateral talar shift with the medial clear space to detect medial instability (SERIV). However, the correlation of a stable ankle joint under weightbearing load with the structural integrity of the deltoid ligament has not been shown yet which we want to investigate.

Methods:

17 patients with lateral malleolar fractures were investigated who underwent an MRI and weightbearing radiography examination. In the MRI, the deep deltoid ligament was assessed as intact, partial und complete rupture. The medial clear space was measured - distance between the lateral border of the medial malleolus and the medial border of the talus at the level of the talar dome (millimeter).

Results:

7 patients suffered from deep deltoid ligament rupture (4 partial; 3 complete).The medial clear space in patients with intact deep deltoid ligament was 2.96+0.41 mm in mean, in partial rupture 2.8+0.38 mm, in complete rupture 3.43+0.23 mm. When counting the complete and partial ruptures together the mean was 3.07+0.45 mm and in partial ruptures plus the intact ones 2.91+0.40 mm.

Conclusion:

Our results show no significant correlation between the medial clear space and the integrity of the deep deltoid ligament (figure1). A negative weightbearing radiograph does not exclude deep deltoid ligament rupture. This fact might indicate the importance of the intrinsic stability provided by the osseous contour of the highly congruent ankle joint. In our opinion, malleolar fracture with deep deltoid ligament rupture (SERIV) can therefore be treated conservatively as long as ankle stability is provided under physiological load.
Comparing Treatment Options for Large Talar Osteochondral Lesions
Authors: Chin Kenneth , Campbell John T. , Cerrato Rebecca , Jeng Clifford , Rutherford Tyler
Published: September 2017

Category:

Ankle, Arthroscopy, Sports

Introduction/Purpose:

The surgical treatment of large or revision osteochondral (OCD) lesions of the talus remain challenging. Currently, there are several treatment options for these patients, including: osteochondral autograft (OATS), allograft cartilage extracellular matrix (Arthrex BioCartilage), and particulated juvenile articular cartilage allograft (Zimmer DeNovo). Due to the relative rarity of these procedures, the literature comparing these three modalities is scarce. The aim of this study was to assess midterm clinical outcomes after these surgical treatments for large or revision talar OCD lesions.

Methods:

Hospital IRB approval was obtained. We reviewed surgical case logs and identified 78 total patients between 2003- 2015 for inclusion in this retrospective study. Thirty-three patients were excluded due to incomplete preoperative or postoperative outcome scoring data, and 23 patients are pending followup, leaving a cohort of N = 22 patients (5 OATS, 5 DeNovo, 12 BioCartilage). Functional outcomes preoperatively and postoperatively were evaluated using Short Form 12-item Physical and Mental Health Survey (SF12 M and SF12P) and Foot Function Index (FFI) scores, ability to return to sport or work, and the need to return to the OR for revision surgery. Data were compared using paired student’s t-test and a one way ANOVA.

Results:

Mean age was 38y with mean followup of 4.3y (range 1.1-12.5). Of 22 patients, three were revisions. Mean lesion size was (12.6x9.1x6.5 mm). All groups showed significant improvements in FFI (p < 0.05) compared to preoperative baseline. Only the BioCartilage group showed significant improvement in SF12P (37.6 vs 47.8, p<0.05). The OATS and DeNovo groups did not show a significant increase in SF12P, and none of the groups demonstrated significant improvement in SF12 M. All patients returned to work, and 8/11 (73%) athletes returned to sport. There were no significant differences between groups when comparing SF12, FFI, and return to sport/work. Revision surgery was necessary in 6/22 (28%) patients. Post-hoc power analysis revealed limited power (0.23), and effect size (f=0.32) may be due to small sample size.

Conclusion:

All three treatment methods resulted in good medium-term functional results for the treatment of large or revision talar OCD lesions. However, we were unable to distinguish significant differences between OATS, Biocartilage, and Denovo, likely due to small cohort numbers and low power. Further study is warranted with increased patient numbers to improve power and differentiate among the three treatment options, as well as provide longer clinical and radiographic follow-up.
Retrospective Analysis of Non-Union Rate Associated with Immediate Weightbearing Following A Modified Lapidus Arthrodesis
Authors: DiDomenico Lawrence , Butto Danielle
Published: September 2017

Category:

Bunion

Introduction/Purpose:

A 6-8 week non-weightbearing period post modified lapidus arthrodesis has traditionally been universally accepted. A review of the literature reports nonunion rates between 5-33% after modified lapidus with 6-8 weeks of non- weightbearing. There are only a few reports in the literature that discuss immediate weightbearing after the modified lapidus procedure. In this retrospective review, we examine the nonunion rate among patients undergoing the modified lapidus arthrodesis who were immediately weightbearing in a controlled ankle motion (CAM) boot. It is our hypothesis that the non- union rate will be comparable to the traditional post-operative protocol nonunion rate.

Methods:

In this retrospective study, we evaluated chart data on patients who underwent a modified Lapidus arthrodesis with immediate weight- bearing in a CAM boot. The goal of the study was to determine if a modified Lapidus surgical technique in conjunction with rigid internal fixation produces the necessary stability post-operatively in order to allow bony consolidation while being stressed with immediate weight bearing forces. Patients who underwent a modified Lapidus arthrodesis using either a 3 screw construct or a medially placed locking plate with an interfragmentary screw were included in the study. Patients with other adjunctive procedures that would prevent early weight bearing were not included in the investigation.

Results:

A total of 376 patients were identified with 74 patients meeting inclusion criteria. 4 patients had bilateral procedures performed at separate times for a total of 78 Lapidus procedures. 31 patients had a 3 screw construct while 43 patients had a medial locking plate with an interfragmentary screw. 15 patients admitted to using nicotine. Additionally, 7 patients had type II Diabetes Mellitus. Autogenous shear- strain relief bone graft was used in 75 of the 79 procedures.Three patients (3.8%) experienced a post-operative non-union. Interestingly, none of the patients with non-unions were smokers and only one patient was diabetic.

Conclusion:

The results of this study found a 3.8% nonunion rate. Based on these results we conclude that a modified Lapidus procedure using a long, solid interfragmentary screw with either additional screw support or a locking plate, we may permit patients to ambulate safely in a CAM boot immediately post- operative period without affecting surgical outcome.
Middle-term Clinical Evaluations of Lisfranc Ligament Anatomical Reconstruction Surgery
Authors: Hirano Takaaki , Yui Akiyama , Mitsui Hiroyuki , Maeda Shingo , Niki Hisateru
Published: September 2017

Category:

Midfoot/Forefoot

Introduction/Purpose:

We report the middle-term outcomes after performing Lisfranc ligament anatomical reconstruction surgery (LARS), using an optimal route of reconstruction based on anatomical measurements of and biomechanical experiments with cadavers.

Methods:

Subjects included 20 patients (8 female and 12 male, mean age: 35.5 years, mean follow-up period: 35 months) who were diagnosed with Lisfranc joint injury and underwent surgical treatment from 2012 to 2015. Acute case were fourteen cases, chronic cases were 6 cases. The optimal anatomical route of reconstruction was calculated from anatomical measurements obtained from 78 legs of cadavers. The Myerson’s classification and the Kaar’s classification based on stress X-rays were used to classify the injuries at the time of their occurrence. Furthermore, the Japanese Society for Surgery of the Foot (JSSF) Midfoot scale and Stein’s radiographic assessment were used for clinical evaluation postoperatively.

Results:

According to the Myerson’s classification, Type B1 was one case, Type B2 was 15 cases, Type C1 and Type C2 were each 2 cases. According to the Kaar’s classification, 17 patients had transverse-type injuries and 3 patients had longitudinal-type injury. Partial weight bearing was encouraged within 6 week and return to exercise within 12 weeks. Average JSSF scores at final follow-up were 93.8 points in both examples (85-100) respectively. Joint congruities on X ray were appropriate in most cases but admitted a little diastasis by one case of chronic and one acute case.

Conclusion:

LARS achieves both static and dynamic stability, does not require removal of the internal fixation material, and enables all patients to support a full load 8 weeks postoperatively. LARS is beneficial for maintaining anatomical reduction, preserving the joint, and shortening the post-therapy period. Our newly developed ligament reconstruction is not only able to acute injuries but also to the chronic injuries.
Ankle and Subtalar Joint Kinematics following Lateral Ligament Repair- Implications for Early Surgical Treatment
Authors: Hunt Kenneth , Anderson Nicholas , Kelley Judas , Fuld Richard , Baldini Todd
Published: September 2017

Category:

Ankle

Introduction/Purpose:

The current trend for chronic lateral ankle instability treatment is direct repair of the ATFL and/or CFL by open or arthroscopic-assisted technique. There is recent evidence suggesting improved success with acute ligament repair following high grade ankle sprains as well as on the impact of CFL injury on ankle and subtalar biomechanics. However, the impact of acute repair on ankle and subtalar joint kinematics and biomechanics is not well understood. The purpose of this study was to determine the impact of repairing the ATFL alone compared to repairing both the ATFL and CFL, on restoration of ankle and subtalar joint kinematics.

Methods:

Ten matched pairs of fresh frozen human cadaveric ankles were dissected to expose intact ATFL and CFL. Ankles were mounted to an Instron at 20° plantar flexion and 15° of internal rotation. Each ankle was loaded to body weight and then inverted from 0 to 20° for three cycles; Peak pressure and contact area were recorded in the ankle joint using a calibrated Tekscan sensor system, and linear and rotational displacement of the talus and calcaneus relative to the ankle mortise was recorded using a three-dimensional motion capture system. Ankles then underwent sequential sectioning of ATFL and CFL and were randomly assigned to ATFL-only repair using two arthroscopic Broström all-soft anchors, or combined ATFL and CFL repair. Testing was repeated after repair.

Results:

Motion capture showed a significant increase in inversion angle of both the calcaneus and talus after release of each ligament. There was significantly more inversion in the subtalar joint than the tibiotalar joint with weight-bearing inversion. There was a significant increased medial shift of the calcaneus after CFL release. Neither ATFL alone nor combined ATFL/CFL repairs restored normal ankle joint inversion. Isolated ATFL repair restored inversion of subtalar joint nearing the intact state. We found no significant difference in peak pressure or contact area in the tibiotalar joint between the intact ankle and ATFL or combined repair. However, there was a 26% decrease in peak pressure following ATFL repair, and only an 11% decrease in peak pressure following ATFL/CFL repair compared to the uninjured ankle.

Conclusion:

The addition of CFL repair does not appear to provide significant improvement compared to ATFL repair alone in the immediate repair setting. Neither group demonstrated restoration of normal talus inversion with weight-bearing inversion testing, suggesting that acute repair, without a period of ligament healing, is not sufficient to resist a weight-bearing inversion moment. While the CFL plays an important role in normal ankle mechanics, this data supports the necessity for a protection period to allow sufficient ligament-healing before weight-bearing inversion stresses are applied following surgical repair.
Comparison of Postoperative Pain Control Methods after Bony Surgery of the Foot and Ankle
Authors: Lee Gi-Soo , Kang Chan , Park Yoo Jung , Jun June Bum , Oh Byung Hak , Won Yougun
Published: September 2017

Category:

Ankle, Pain

Introduction/Purpose:

We performed a prospective study to evaluate and compare the effectiveness of postoperative pain control methods after bone surgery of the foot and ankle.

Methods:

Among the patients who underwent foot and ankle surgery from June 2014 to September 2015 with an ultrasound- guided nerve block, 84 patients who fully completed a postoperative pain survey were enrolled. An opioid patch (fentanyl patch, 25 mg) was applied in group A (30 patients), diluted anesthetic (0.2% ropivacaine, 30 ml) was injected into the sciatic nerve once, about 12 hours after the pre-operative nerve block in group B (27 patients), and periodic analgesic intramuscular injection (ketorolac (Tarasyn? R), 30 mg) was performed in group C (27 patients). Visual analog scale (VAS) pain scores at 6, 12, 18, 24, and 48 hours after surgery were checked, and complications of all methods were surveyed.

Results:

The mean VAS pain score was lower in group B, with a statistically significantly difference (p < .05) between groups A, B, and C at 12 and 18 hours after surgery. Four patients in group A suffered from nausea and vomiting, whereas no other patients complained of any complications or side effects.

Conclusion:

The ultrasound-guided injection of diluted anesthetic into the sciatic nerve seemed to be the most useful method for controlling pain in the acute phase following foot and ankle bone surgery. By injecting the diluted anesthetic once on the evening of the day of surgery, patients suffered less postoperative pain.
Comparison of Time to Operation and Efficacies of Ultrasound-Guided Nerve Block and General Anesthesia in Emergency External Fixation of Lower Leg Fractures
Authors: Lee Gi-Soo , Kang Chan , Won Yougun , Jun June Bum , Park Yoo Jung , Oh Byung Hak
Published: September 2017

Category:

Ankle, Trauma

Introduction/Purpose:

This prospective study aimed to evaluate the usefulness of ultrasound (US)-guided nerve block (NB) for emergency external fixation of lower leg fractures, by investigating real time before the operation and the clinical result according to the anesthesia method (US-guided NB or general anesthesia [GA]).

Methods:

From June 2014 to April 2016, 40 patients who underwent emergency surgery for external fixator application were enrolled in this study. We performed a randomized trial for US-guided NB and GA. We measured the lead time before the start of the operation after the decision to perform emergency surgery in both groups.

Results:

The US-guided NB group comprised 17 men and 3 women with a median age of 55.6 (33–77) years. Twelve of these patients had conditions such as diabetes mellitus, hypertension, and kidney-related diseases. Fracture types 42, 43, and 44 in the AO classification were observed in 3, 12, and 5 cases, respectively. The average time taken to emergency operation was 4.3 (2– 6.25) h. However, in the GA group, the average time taken to emergency operation was 9.4 (3–14) h. In the US-guided NB group, no cases of anesthesia failure and unstable vital signs during the operation occurred. Moreover, there were no postoperative complications related to the anesthesia method, such as aggravation of the general condition.

Conclusion:

Emergency external fixation with US-guided NB in patients with lower-extremity trauma can be implemented in less time regardless of preoperative preparation, which is a requirement in GA.
Factors Affecting Early Single Heel Raise after Repair of Achilles Tendon Rupture
Authors: Lee Moses , Suh Jin Soo , Shin Myung Jin
Published: September 2017

Category:

Sports

Introduction/Purpose:

No physical exam or clinical test can clearly predict a final course of acute Achilles tendon rupture after surgical treatment. But, in recent studies, ability to perform single-heel-raise during the early postoperative period was considered as a significant prognostic factor. Therefore, analysis of the relationship between preoperative factors and timing of the single heel raise might help to predict the prognosis and aid to establish an individualized rehabilitation plan. The purpose of this study was to analyze the factors affecting early single heel raise after surgical treatment of acute Achilles tendon rupture.

Methods:

From January 2012 to August 2015, a retrospective analysis was performed for 68 patients who met the inclusion criteria among 98 cases of surgically treated acute Achilles tendon rupture. Operative technique and rehabilitation protocol were same in all cases. The patients who were able to perform a single heel raise within 3 months postoperatively were classified into the study group and the rest was determined as the control group. During periodic outpatient observation, we evaluated Achilles tendon total rupture score (ATRS), Visual Analog Scale (VAS), and timing capable of a single heel raise. We also preoperatively measured defect size and distance between calcaneal osteotendinous junction and rupture site by ultrasound image in all cases.

Results:

No difference was found in demographic factors between the study group (23 cases) and the control group (45 cases) who performed a single heel raise later than 3 months postoperatively. There were no significant difference in defect size and distance between calcaneal osteotendinous junction to the rupture site (P=0.38, P=0.63). However, when the rupture site was divided into hyporvascular zone (from calcaneal osteotendinous junction to the rupture site: 4~7 cm) and hypervascular zone, the study group showed a significantly low hyporvascular zone rupture rate. (14/23, 41/45, P=0.003). Also, in the logistic regression analysis that included age, BMI, smoking, hyporvascular zone rupture, defect size, and operation delay, patients with hypervascular region rupture showed odds ratio of 5.3 (P=0.017) in performing a single heel raise within postoperative 3 month. ATRS score at postoperative 3 months and last f/u were significantly higher in the study group. (p<0.01)

Conclusion:

Achilles tendon rupture at hypovascular zone is a poor prognostic factor for the early single heel raise and might significantly affect the prognosis after acute Achilles tendon rupture operation.
Is there a Relationship between Bone Morphology and Injured Ligament on Imaging Studies and Laxity on Ankle Stress Radiographs?
Authors: Lee Seung Yeol , Kwon Soon-Sun , Park Moon Seok , Sung Ki Hyuk , Koo Seungbum , Kim Sung Jin , Sangyeop Shin , Choi Hyun , Chun Sangho , Lee Kyoung min
Published: September 2017

Category:

Ankle, Sports

Introduction/Purpose:

We hypothesized that the bony configuration of the ankle could also be associated with ankle stress radiographs, in addition to ligament injury of the ankle. Therefore, this study aimed to investigate the relationship between bone morphology and injured ligament on imaging studies and laxity on ankle stress radiographs in patients with lateral ankle instability.

Methods:

In total, 115 patients who had undergone ankle MRI, ankle radiography, and stress radiography were included. Distal tibial articular surface angle, bimalleolar tilt, medial and lateral malleolar relative length, medial malleolar slip angle, anterior inclination of the tibia, and fibular position were measured on ankle radiographs. Tibiotalar tilt angle and anterior translation of the talus were measured on ankle stress radiographs. Degree of ligament injury was evaluated on ankle MRIs. Multiple regression analysis was performed using the following independent variables: age, sex, and factors significantly associated with ankle stress view on univariate linear regression analysis.

Results:

Age (p = 0.041), sex (p = 0.014), degree of anterior talofibular ligament injury (p < 0.001), and bimalleolar tilt (p = 0.016) were correlated with tibiotalar tilt angle (Table). Younger patients demonstrated a larger tibiotalar tilt angle than older patients, and the angle decreased by 0.07° per year of age. Tibiotalar tilt angle in female patients was 2.2° larger than that in male patients. Fibular position and degree of posterior talofibular ligament injury were factors significantly related to anterior translation of the talus.

Conclusion:

Differences in patient characteristics might predispose ankle stress radiograph results. Comparison of both ankles on stress radiographs is superior to applying fixed numerical values to the injured side, in order to reduce the influence of patient factors.
Safe Zone for the Plantar Portal
Authors: Maeda Shingo , Hirano Takaaki , Yui Akiyama , Mitsui Hiroyuki , Niki Hisateru
Published: September 2017

Category:

Arthroscopy

Introduction/Purpose:

Open surgery of the sole of the foot requires an extensive amount of soft tissue to be dissected. In recent years, various types of endoscopic surgery for the sole of the foot have been reported, making it possible to dynamically evaluate and treat plantar lesions with a small skin incision and minimal dissection. However, there have also been reports of complications involving plantar nerve injury. A good knowledge of the plantar nerve anatomy is crucial for safe endoscopic surgery of the sole. We aimed to anatomically dissect the soles of cadaveric feet to investigate the safe zones for plantar portals.

Methods:

We studied 36 feet of 24 cadavers. The soft tissue of the sole was dissected, and the relationships between the plantar nerve and flexor digitorum longus tendon, flexor hallucis longus tendon and peroneus longus tendon were studied. The plantar nerve course was digitally imaged and uploaded into Image J software to determine the nerve position. The back of the calcaneus, the medial side of the base of M (Metatarsal) 1, the medial side of the head of M1, the lateral side of the head of M5, and the proximal tip of M5 were plotted and defined as A, B, C, D, and E respectively on Image J. The nerve courses were plotted on AB, BE, and CD, and the percentage at which they were positioned on the line segment was calculated. Next, the bifurcation positions of each nerve were plotted and measured to the defined line segments.

Results:

No major differences were noted in the course of the medial plantar nerve and lateral plantar nerve. The medial plantar nerve and lateral plantar nerve ran between B and E, at 32.4% ± 4% and 61.2%± 5.1% respectively from B. No plantar arteries were found to run between the medial plantar nerve and lateral plantar nerve on BE. Taking mean and standard deviation values into account, no neurovascular structure existed from 36.4% to 56.1% along a line between the medial aspect of the base of M1 to the proximal tip of M5. The flexor digitorum longus tendon and peroneus longus tendon passed through the deep layer of this region.

Conclusion:

We believe this region to be a safe zone for creating plantar endoscopic portal. The plantar central portal can be created at the center of the sole. An approach from the plantar central portal to the flexor digitorum longus tendon, flexor hallucis longus tendon, and peroneus longus tendon with the plantar lateral portal, posteromedial portal, and toe portal allows for a greater range of vision and treatment options and may further advance endoscopic surgery of the sole.
Comparison of open reduction and internal fixation versus closed reduction and percutaneous fixation for medial malleolus fractures
Authors: Matson Andrew , Barchick Stephen , Adams Samuel
Published: September 2017

Category:

Ankle, Trauma

Introduction/Purpose:

Open approaches are often used for the operative treatment of medial malleolar (MM) fractures. Compared to percutaneous approaches, open approaches may entail an increased risk of operative morbidity, postoperative pain, wound complications, and reoperation for hardware removal. However, inherent to minimally invasive or percutaneous techniques is incomplete fracture visualizationwhich may hinder acceptable reduction. In this study, we aimed to compare patients treated with closed reduction and percutaneous fixation (CRPF) to those patients treated with traditional open reduction and internal fixation (ORIF). We hypothesized that the two groups would be similar with regard to patient factors, injury variables, and outcomes.

Methods:

The study group consisted of 184 consecutive patients who met inclusion criteria and were treated with operative fixation of a MM fracture from 2011-2015 at a single institution. Forty underwent CRPF and 144 underwent ORIF. Patient demographics, injury characteristics, treatment methods, and outcome variables were recorded through review of patient charts, radiographs, and operative reports.

Results:

Patient variables were similar between groups except for years of age, which was greater on average in the CRPF group (55 vs. 48, p = 0.03). The CRPF treatment group had a higher rate of initial open injury (22% vs. 7%, p<0.01), a lower rate of MM fracture comminution (12% vs. 29%, p = 0.03), and a higher rate of provisional external fixation (35% vs. 14%, p<0.01). There was no statistically significant difference observed between the CRPF and ORIF groups with regard to outcomes including: nonunion (2% vs. 3%), malunion (10% vs. 5%), time to union (10 weeks, each), removal of hardware (8% vs. 14%), or wound complications (0% vs. 4%).

Conclusion:

Both CRPF and ORIF resulted in acceptable radiographic outcomes and low complication rates for the treatment of MM fractures. Compared to the ORIF group, patients in the CRPF group on average were older and more often had comminution, open fractures, and provisional external fixation.
MRI evaluation with severity of ankle osteoarthritis
Authors: Mitsui Hiroyuki , Hirano Takaaki , Yui Akiyama , Maeda Shingo , Niki Hisateru
Published: September 2017

Category:

Ankle Arthritis

Introduction/Purpose:

Takakura-Tanaka classification is effective as an X-ray evaluation method for determining the severity of and treatment strategy for ankle osteoarthritis (OA). Concerning OA, MRI is gaining attention as a tool for examining the condition of the articular cartilage over X-ray findings. However, there are few reports on the relationship between MRI and X- ray findings in ankle joints. We assessed MRI findings of ankle OA at each stage of Takakura-Tanaka classification to investigate the effects of bone and articular cartilage.

Methods:

We studied the localization of Bone Marrow Edema (BME) partitioned articular surface by MRI in 22 regions at the talocrural, talocalcaneal, talonavicular, and calcaneocuboid joints of 46 feet of 45 patients who had a diagnosis of ankle OA in our hospital. Furthermore, we compared the radiological findings with the localization of BME.

Results:

By MRI, the area where BME was seen is located in the anterior medial part of the talocrural joint. Pointedly, 60% of BME was confirmed on the tibial side of the talocrural joint. In addition, as the Takakura-Tanaka classification advanced, the identification of BME tended to increase on the anterior of the talus and the medial malleolus articular surface.

Conclusion:

We found on MRI that the localization of BME was identified by Takakura-Tanaka classification in osteoarthritis of the foot. On the other hand, there are some cases of OA without BME that were identified by X-ray in this study. In the future, there is a possibility that the severity of OA can be classified into more inclusive classifications by MRI. We intend to combine the severity of ankle OA with MRI findings and Takakura-Tanaka classification together.