bluuebunny/crossref_metadata_2025 huggingface dataset:
Biphasic Bioresorbable Scaffold (TruFit Plug®) for the Treatment of Osteochondral Lesions of Talus
Authors: Marcellini Lorenzo , Cave Elvira Di , Versari Pierluigi , Luzon David
Published: September 2017

Category:

Ankle, Ankle Arthritis

Introduction/Purpose:

The ideal treatment of osteochondral lesions of the talus (OLT) is debatable. The TruFit plug has been investigated as a potential treatment method for osteochondral defects. This is a biphasic scaffold designed to stimulate cartilage and subchondral bone formation. The purpose of this retrospective study was to investigate the long-term functional and MRI outcomes of the TruFit Plug for the treatment of OLT.

Methods:

We evaluated 12 consecutive patients treated from March 2007 to April 2009 for OLT. Clinical examination included the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score and the visual analog scale (VAS) for pain. MRI scans were optained pre-treatment and at last follow-up. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used to assess cartilage incorporation.

Results:

Mean follow-up was 7.5 years (range, 6.5 to 8.7 years). The average age was of 38.6 years (range, 22 to 57 years). The sex ratio between males and females was 3:1 (9 males, 3 females). The mean AOFAS score improved from a preoperative score of 47.2 ± 10.7 to 84.4 ± 8 (p< 0.05). According to the postoperative AOFAS scores 1 case obtained excellent results, 9 were classified as good, and 2 were fair. VAS score improved from a preoperative value of 6.9 ± 1.4 points to 1.2 ± 1.1 points at last follow-up (p< 0.05). The MOCART score for cartilage repair tissue on postoperative MRI averaged 61.1 points (range, 25-85 points).

Conclusion:

The long-term results suggest that the technique of Trufit Plug for OLT is safely and demonstrates good post- operative scores including improvement of pain and function, with discordant MRI results. However, randomized controlled clinical trials comparing TruFit Plug with an established treatment method are needed to improve synthetic biphasic implants as therapy for osteochondral lesions.
Cross Sectional Area of the Achilles Tendon in a Prospective Cohort of an Elite Military Population
Authors: Martin Kevin , Dawson Laura , Wake Jeffrey
Published: September 2017

Category:

Ankle, Hindfoot

Introduction/Purpose:

The prevalence of Achilles tendon pathology is common in many sports and daily activities. From ruptures to overuse injuries resulting in tendonopathies, AT dysfunction can result in disability and reduced productively. Continued research that increases our knowledge base of normal Achilles tendon properties can improve our ability to reduce and prevent future AT injuries. In this study, we examined the cross-sectional area (CSA) of the Achilles tendon (AT) at multiple levels in an asymptomatic population of elite American military service members that participate in greater than 20 hours of intense training per week.

Methods:

We conducted a prospective cohort study composed of 41 active duty United States Army Rangers. The Rangers are a specialized infantry organization that participates in extensive military training and rigorous combat missions. The service members were voluntarily recruited to participate while deployed in a combat theater. All subjects were members of the Ranger Regiment participating in greater than 20 hours of intense bipedal non-sport weekly training with no history of AT pathology. In a standing position, each subject had bilateral Achilles insertion marked along with additional skin markings made at 2 cm, 4 cm, and 6 cm above the AT insertion. At all four levels, the AT was measured in the coronal and sagittal plains using ultrasound.

Results:

In 41 subjects, a total of 82 Achilles tendons were examined. The mean age of the cohort was 26 years, 70 inches tall, with a mean weight of 187 pounds. The mean sagittal thickness of the AT at the insertion was 4.3 mm, 2 cm above the insertion is was 4.3 mm, 4 cm above the insertion is was 4.2 mm, and at 6 cm above the insertion it was 4 mm. In the coronal plain was 19.1 mm, 14.3 mm, 13.5 mm, and 14.4 mm respectively. The cross-sectional area was calculated at each respective level: 0.65 cm2, 0.48 cm2, 0.44 cm2 and 0.45 cm2. The non-dominant ankle was slightly larger at each level but was not found to be statistically significant.

Conclusion:

These results provide the mean sagittal and coronal diameters of the Achilles tendon as measured by ultrasound throughout the watershed area of a young active adult male population. Our data also suggest that increased non-sport activity may not increase the cross-sectional area of the Achilles tendon. Identifying the normal diameter at multiple levels throughout the most commonly injured area can potentially improve the provider’s ability to identify early disease processes and apply targeted interventions to help slow or prevent progression and possible rupture.
MOCART Score is Not a Feasible Tool for the Assessment of Osteochondral Lesions of the Talus
Authors: Martinelli Nicoló , Albano Domenico , Prati Alberto Bianchi Castagnone , Antonino Giacalone , Malerba Francesco , Sconfienza Luca
Published: September 2017

Category:

Ankle, Sports, Radiographic assessment

Introduction/Purpose:

To evaluate the applicability and reproducibility of the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score for morphological evaluation of osteochondral lesions of the talus (OLT) repaired using the autologous matrix-induced chondrogenesis (AMIC) technique.

Methods:

Two radiologists (R1-R2) and two orthopaedic surgeons (O1-O2) independently reviewed 26 MRI scans of the ankle performed on 13 patients (6 females, 7 males; age: 38.9±15.9, range 14-63) with OLT repaired using the AMIC technique between November 2011 and July 2015 at our institution. Out of 13, 7 were treated with biomimetic osteochondral scaffold implantation, while 6 were treated with bone-marrow derived cell transplantation. The MRI scans were performed at 6 and 12 months after treatment. For inter- and intra-observer agreement evaluation for each variable of the MOCART score we used Cohen’s kappa coefficient. Progression of MOCART score between 6 and 12 months evaluation was assessed using the Wilcoxon test.

Results:

The inter-observer agreement between R1-R2 ranged from poor (adhesions, k=0.124) to almost perfect (subchondral bone, k=0.866), while between O1-O2 ranged from absent (effusion, k=-0.190) to poor (surface, k=0.172). The intra-observer agreement of R1 ranged from poor (signal intensity, k=0.031) to substantial (subchondral lamina, k=0.677), while that of O1 ranged from absent (subchondral bone, k=-0.061) to substantial (surface, k=0.663). There was a statistically significant increase of MOCART score between 6-month and 12-month evaluation of R1 (Z=-2.672; P=0.008), R2 (Z=-2.721; P=0.007) and O1 (Z=- 3.034; P=0.002). Conversely, the increase of MOCART score between the 6-months and 12-months evaluation of O2 was not statistically significant (Z=-1.665; P=0.096).

Conclusion:

MRI certainly has a crucial role in the follow-up of surgical repaired OLT but the MOCART score does not seem to be sufficiently reliable and reproducible to be applied for this purpose.
Influence of Depression and Anxiety on Hallux Valgus Surgical Outcomes
Authors: McDonald Elizabeth , Shakked Rachel , Sutton Ryan , Raikin Steven , Lynch Mary-Katherine
Published: September 2017

Category:

Bunion, Midfoot/Forefoot

Introduction/Purpose:

Depression and anxiety can negatively affect outcomes after orthopaedic surgery. The relationship of depression/anxiety with patient outcomes after hallux valgus surgery is not well-studied. The purpose of this study is to evaluate our cohort of patients undergoing hallux valgus surgery and determine whether depression and/or anxiety correlate with different pain and satisfaction levels. We hypothesize that patients with depression/anxiety will have greater subjective dysfunction pre- operatively and less satisfaction after surgery when compared to those patients without depression/anxiety.

Methods:

This retrospective study included adult patients that had undergone surgical treatment for hallux valgus over a 2-year period. Basic demographic data was collected as well as baseline visual analog scale (VAS), SF-12 mental component, and VR-12 mental component. History of depression and/or anxiety and medications were recorded. All patients were called by phone to administer a 3-question survey at least 9 months after surgery. Data from 267 patients were available for analysis. The average patient age was 51.7 years and there were 232 females (87%). 233 patients (87%) completed preoperative functional scores, and 187 patients (70%) were reached by phone at an average of 21 months post-operatively for a satisfaction survey. Pairwise Wilcoxon tests with correction for multiple tests, unpaired student’s t tests, and a multivariate regression analysis were performed to analyze the data.

Results:

Of the 267 patients included in the study, 70 patients (26%) reported a history of depression and/or anxiety. Patients with a history of depression/anxiety had similar baseline demographics compared to patients without depression/anxiety including nearly 90% female sex and about 20 months post-operative follow-up (see Table 1). The group with depression/anxiety was older (55.9 years versus 50.2 years, p = 0.003), and a greater proportion of cases had severe deformity (27% versus 16%, p = 0.47). Patients with depression/anxiety scored significantly lower on baseline SF-12 and VR-12 mental scores; VAS was also lower but this was not statistically significant. Post-operative VAS and satisfaction with surgery and post-operative pain level were not statistically different between groups.

Conclusion:

Although patients with hallux valgus and depression/anxiety may have lower baseline mental scores and higher pain levels, their outcomes after bunion surgery are similar to those patients without depression/anxiety. The group of patients with depression/anxiety had a greater percentage of severe deformities as compared to the unaffected group yet maintained similar outcomes. Depression/anxiety may affect outcomes after certain orthopaedic procedures, however this study failed to show significantly inferior outcomes in this population of patients after hallux valgus surgery.
Return to Driving After Foot and Ankle Surgery
Authors: McDonald Elizabeth , Shakked Rachel , Pedowitz David , Winters Brian , Daniel Joseph , Raikin Steven
Published: September 2017

Category:

Ankle, Ankle Arthritis, Arthroscopy, Bunion, Sports

Introduction/Purpose:

The time frame for safe return to driving is an important question amongst physicians and patients following orthopaedic surgery of the right lower extremity. There is no universally validated foot and ankle psychometric test that confirms patients’ ability to safely return to driving after surgery. The purpose of the study is to report a novel, validated survey that can be used to confirm safe return to driving after orthopaedic surgery of the right foot and ankle.

Methods:

Patients that had undergone right achilles rupture repair, total ankle arthroplasty, and hallux valgus correction by four fellowship-trained foot and ankle surgeons were prospectively included over a trial period of 4 months. A four-question survey (see Figure 1) was administered at the 6 week post-operative office visit. Breaking reaction time (BRT) was then assessed using the Reaction Time Tester, Model RT-2 S (Advanced Therapy Products, Glen Allen, VA). A passing BRT for safe return to driving was considered 0.850 seconds. Statistical analysis was performed and Cronbach’s alpha was calculated to determine validity of the survey relative to BRT results. One hundred and twenty-two patients were included with ages ranging from 21 to 76 years (average 45 years).

Results:

One hundred and nine (89%) of 122 patients achieved a braking time of 0.850 seconds or less. Using time-to-event analysis, 95% of patients passed at 7.6 weeks. With a “strongly agree” or “agree” response to question 4, the survey predicts a 96% certainty of passing the BRT. At first, validating the psychometric test across all three procedures resulting in a poor Cronbach’s a of 0.6. When question 3 was removed from statistical analysis, the Cronbach’s alpha was 0.76 and the psychometric test was validated for all studied procedures. Upon calculating a composite score from the 3-question survey, the optimum threshold for a passing braking time was at least 10 points resulting in a very good AUC score of 0.948.

Conclusion:

This novel, three-question driving readiness survey can accurately predict a passing breaking reaction test. This provides foot and ankle surgeons with a valuable tool to objectively determine if a patient can safely return to driving after achilles repair, total ankle arthroplasty, and hallux valgus correction. Further study is required to determine whether patients who come to clinic weeks before their standard post-operative follow up appointment with the belief that they are ready to drive also pass the BRT. Additional validation of the survey would be valuable across other foot and ankle procedures.
Novel Technique for Fixation of Medial Malleolus Fractures
Authors: Meeks Brett , Kiskaddon Eric , Boin Michael , Patel Tejas , Laughlin Richard , Prayson Michael
Published: September 2017

Category:

Ankle, Trauma

Introduction/Purpose:

The traditional method for fixation of medial malleolar fractures has been with partially threaded (PT) lag screws extending beyond the physeal scar. Recent studies have shown fully threaded (FT) bicortical fixation in the tibial metaphysis provides superior biomechanical, radiographic and clinical outcomes. Risks with the bicortical technique include drill bit breakage, as well as injury to structures lateral to the tibial metaphysis if the far cortex is overdrilled. We hypothesized that far endosteal fixation, without penetration of the far cortex, would provide increased biomechanical strength compared to traditional PT lag screw fixation, while minimizing the risks associated with bicortical fixation.

Methods:

Twelve matched pairs of cadaver ankles were harvested and an oscillating saw was used to make an osteotomy at a 45- degree angle to the axilla. The medial malleolus was then re-approximated and held in the correct orientation using two kirschner wires. A 2.7 mm drill bit was used to drill a unicortical pilot hole perpendicular to the osteotomy. The left ankle was used for all PT 3.5 mm cancellous screws and all screw lengths were 45 mm. For the contralateral ankle, the 2.7 mm drill bit was used to drill to the lateral tibial cortex. The depth gauge was then used and five millimeters was added to the measured number to achieve endosteal purchase with the appropriate FT screw. Screw lengths varied in size from 55-70 mm. Screws were then placed using a torque measuring screw driver and final torque was recorded. Finally, radiographs were taken to confirm appropriate placement.

Results:

Average torque for unicortical PT cancellous screws was 5.02 inch-pounds with a standard deviation of 2.34. Average torque for all FT cortical screws was 7.63 inch-pounds with a standard deviation of 3.86 (Fig. 1A). A paired student’s t-test was performed comparing both fixation methods and the measured P-value was <0.01. Visual and radiographic inspection revealed no displacement of the fracture site using the FT endosteal screw (Fig. 1C).

Conclusion:

Our results indicate superior biomechanical torque with far endosteal fixation as compared to a traditional PT lag screw, while minimizing risks associated with bicortical fixation. This novel technique may provide added strength with minimal risk in vivo. Further clinical studies comparing radiographic results and outcomes of far endosteal fixation versus bicortical fixation are needed to ascertain the value of this fixation technique for medial malleolus fractures.
Opioid Consumption Following Foot and Ankle Surgery
Authors: Merrill Haley , Neufeld Steven , Buchanan Matthew , Cuttica Daniel , Dean Daniel , Mottla Jay
Published: September 2017

Category:

Ankle, Bunion, Hindfoot, Lesser Toes, Midfoot/Forefoot

Introduction/Purpose:

Orthopaedic surgeons frequently prescribe pain medications during the postoperative period. The efficacy of these medications at alleviating pain after foot/ankle surgery and the quantity of medication required (and conversely, the quantity of medication leftover) are unknown.

Methods:

All patients that underwent foot/ankle surgery during a three month period and met inclusion criteria were surveyed at their first postoperative visit (4-10 days after surgery). Information collected from the patients included gender, number of narcotic tablets remaining in the bottle, satisfaction with pain control, and willingness to surrender leftover narcotics to a Drug Enforcement Administration (DEA) disposal center. These data were collected prospectively. Additional data, including utilization of a perioperative nerve block, type of procedure (bony vs non-bony), and anatomic region of procedure, were collected by review of the medical record. All data were analyzed in a retrospective fashion.

Results:

A total of 47 surveys were filled out over the course of 4 weeks. Eighty-five percent of patients were either extremely satisfied or satisfied with their pain control. Ninety-six percent of patients had short acting opioids leftover, and 94% of patients had long acting opioids leftover. On average, there were 27 short acting and 11 long acting narcotic pills leftover at the first postoperative visit (4-10 days after surgery). Of those with leftover narcotic medications, 72% were willing to surrender them to a DEA disposal center.

Conclusion:

Most patients undergoing foot/ankle surgery had both short and long acting narcotic pain pills leftover at the first postoperative visit (4-10 days after surgery). While it is unknown how many patients continue to require narcotics after the first week from surgery, most patients said they would be willing to surrender any leftover opioid medications to a DEA disposal center. In the future, perhaps patients should be given information on the location of the nearest disposal center when given prescriptions for narcotics.
Percutaneous K-Wires Fixation of Displaced Intra-articular Calcaneal Fractures (A Novel Technique)
Authors: Mesregah Mohamed
Published: September 2017

Category:

Hindfoot

Introduction/Purpose:

The operative treatment of calcaneal fractures has been a controversial topic. Open reduction and internal fixation is associated with a high incidence of postoperative soft tissue complications. Closed reduction and percutaneous K-wires fixation was used to preserve soft tissue. The aim of our study is to evaluate the outcome of closed reduction and percutaneous K-wires fixation of displaced intra-articular calcaneal fractures.

Methods:

Twenty two displaced intra-articular calcaneal fractures were treated by closed reduction and percutaneous K-wires fixation. The clinical evaluation was based on Maryland Foot Score. According to Sander’s Classification, Eleven fractures were type II, nine were type III and two were type IV. Bimanual compression across the calcaneus was applied to reduce the calcaneal width. A Schanz screw was inserted into the calcaneal tuberosity and was forcibly pushed downwards to elevate the depressed fragment. Two parallel 2 mm K-wires were placed from the posterior inferior corner of the calcaneus across the posterior facet and into the talar body. The reduction of the articular surface was maintained by two crossing subchondral 2 mm K-wires. If the reduction was not satisfactory, a 1-2 cm long transverse incision was used just below the tip of the lateral malleolus. A small tipped periosteal elevator was introduced to elevate the depressed fragment before K-wire fixation.

Results:

The mean follow up period was 7.68 months. The clinical outcome revealed 18 fractures (81.8%) of satisfactory (14 excellent and 4 good), and 4 patients (18.2%) of unsatisfactory results (4 fair and 0 poor). The mean time of radiological union was 11.86 (range 10 – 14) weeks. One patient had pin tract infection. One patient developed heel widening.

Conclusion:

Closed reduction and percutaneous K-wires fixation of calcaneal fractures minimizes the soft tissue complications and postoperative scar formation. The mini approach for elevation of the depressed posterior facet restores the articular surface and decreases late subtalar arthritis.
Retrospective analysis of 5 years results of first metatarsophalangeal joint arthroplasty, Single surgeon series
Authors: Mohammed Khalid Merghani Saleh , Aljabi Yasser , Francis Ara , Flavin Robert
Published: September 2017

Category:

Bunion

Introduction/Purpose:

First Metatarsophalangeal joint (MTPJ) osteoarthritis is a common forefoot disease. It leads to joint surface destruction and erosions limiting function and causing pain. The disease can be classified to mobile and non mobile or traumatic and atraumatic disease. The gold standard for treatment of stage III and IV remains MTPJ arthrodesis. In this case series we demonstrate MTPJ arthroplasty in mobile MTPJ with stable first interphalangeal joint (IPJ) can achieve short and medium-term results that are comparable to arthrodesis with high satisfaction rate.

Methods:

Retrospective analysis of 48 MTPJ arthroplasties performed by single surgeon in the period between 2011 to 2016. Patient were included if they had mobile first MTPJ osteoarthritis in the absence of IPJ hypermobility. The Surgical procedure included resurfacing the 1st metatarsal head using Arthrosurface® Hemicap implant and Extensor Digitorum Brevis (EDB) graft on the phalangeal surface of the joint. Radiological parameters collected using weight bearing x-rays prior to surgery, immediate radiological correction after surgery, 6 month and 2 years radiological analysis following the index surgery. Physiotherapy data were collected by senior physiotherapist prospectively during the time of postoperative rehabilitations and it included AOFAS and VAS scores.

Results:

48 patients underwent 1st MTP joint arthroplasty using Arthrosurface® Hemicap implant for the metatarsal head with EDB graft on the phalangeal aspect. 44 patients had primary OA of the 1st MTP joint, 4 were conversion of MTPJ arthrodesis to arthroplasty and 3 were treated for non-union of MTP joint arthrodesis. Average postoperative ROM in the sagittal plane was 30 degrees and no valgus deformity in the coronal plane. 3 Patients (0.68%) had residual pain following the surgery due to soft tissue impingement and required further surgical intervention. 1 patient remained dissatisfied after the revision surgery.

Conclusion:

In short to medium-term follow up, the first MTP joint arthroplasty with Arthrosurface® implant and EDB graft provides an excellent functional outcome in the management of moderate to severe OA. In some selected cases this can be an option for treatment of patient with failed arthrodesis or patients requiring the reversal of the arthrodesis due to other issues.
Intramedullary Nail Fixation of the Fibula as a Treatment Alternative of Ankle Fractures in a High Risk Patient Population
Authors: Moody Christian , Weatherby Brian
Published: September 2017

Category:

Trauma

Introduction/Purpose:

Traditional plate osteosynthesis for ankle fractures in a high risk patient population can predispose to complications as a result of the necessary soft tissue dissection and periosteal stripping. Complication rates among patients with multiple comorbidities has been shown to be as high as 30% in those who undergo traditional plate and screw fixation. 1 An alternative fixation construct, thought not widely used or recognized in the American literature is the locking intramedullary fibular nail. Intramedullary nails offer the theoretical advantages of stable fixation while utilizing smaller, percutaneous incisions and no periosteal stripping. The purpose of this study is to analyze the outcomes and complications of high risk patients who underwent ankle surgery using the intramedullary fibular nail.

Methods:

The medical records of all high risk patients who underwent ankle fracture fixation with a locking intramedullary fibular nail from 1/2011 through 6/2015 at our institution were reviewed. Fracture patterns included unstable lateral malleolar, bimalleolar, and trimalleolar fractures. Patients were considered high risk if they had medical comorbidities at the time of injury that have been shown in current literature to increase surgical complication risk. These comorbidities include neuropathy, uncontrolled diabetes, peripheral vascular disease, congestive heart failure, etc. We recorded patient demographics, fracture type, period of post-op NWB, time until discharge, time to weight bearing, complications, tourniquet time, size and length of nail implanted, and estimated blood loss. Attempts were made to contact all patients to complete a follow-up questionnaire regarding their satisfaction.

Results:

Twenty-two high risk patients with 23 ankle fracture were included. The average age was 64.8 years (SD 10.2, range 41- 82). The average follow up was 5.7 months (SD 5.7, range 2-30). There were no surgical site infections, wound complications, or non-unions. Two (8.7%) required a return to the operating room for symptomatic screw removal. The average tourniquet time was 35.8 minutes (SD 20.1, range 0-72) and the average operative time was 49.3 minutes (SD 14.3, range 25-70) respectively. The Olerud & Molander average score was 77.9 (SD 17.7, range 40-100). Fourteen of the twenty two patients could be contacted for a follow up questionnaire and 13 of the 14 (93%) said they were either very satisfied (64%) or satisfied (29%) with their injury outcome.

Conclusion:

The locking intramedullary fibular nail provides an alternative fixation technique that allows for protection of soft tissue, stable fracture fixation and satisfactory outcomes in the high risk patient population.
Rheumatoid forefoot reconstruction in the non-rheumatoid patient
Authors: Nixon Devon , McKean Richard , Klein Sandra , Johnson Jeffrey , McCormick Jeremy J.
Published: September 2017

Category:

Lesser Toes, Midfoot/Forefoot

Introduction/Purpose:

Residual pain and recurrent deformity following forefoot surgery can cause significant disability. In patients with rheumatoid arthritis, first metatarsophalangeal (MTP) joint arthrodesis with lesser metatarsal head resection – often referred to as a rheumatoid forefoot reconstruction – has been shown to be a reliable operation for pain relief and deformity correction. Limited data, however, has been published on outcomes of the same forefoot reconstruction operation in the non- rheumatoid patient. Here, we review our experience with this procedure in patients without rheumatoid disease, hypothesizing improved clinical and radiographic outcomes following surgery.

Methods:

Following chart review and surveying billing codes, we retrospectively identified patients from 2007-2015 without a diagnosis of rheumatoid arthritis who underwent first MTP arthrodesis with lesser metatarsal head resection (rheumatoid forefoot reconstruction). Phone surveys were then conducted to assess clinical outcomes including pain and satisfaction scores. Preoperative and postoperative radiographs were reviewed for 1, 2 intermetatarsal angle (IMA), hallux valgus angle (HVA), 2nd MTP angle (MTP-2), and lesser MTP alignment (in both sagittal and axial planes). Postoperative radiographs were also assessed for radiographic union.

Results:

We identified 14 non-rheumatoid patients (16 feet) who underwent forefoot reconstruction – of those, 13 patients (15 feet) were successfully contacted via follow-up phone survey. Mean postoperative follow up was 42.3 (range: 12-76) months from surgery to phone interview. Mean postoperative satisfaction scores were 9.1 (out of 10), and no patients required further surgery after forefoot reconstruction. Pain scores significantly decreased from 6.2 preoperatively to 2.0 postoperatively (P<.001). Radiographic parameters (IMA, HVA, MTP-2, and lesser MTP alignment in the sagittal plane) all improved with surgery (P<.05). All 16 feet achieved union of the first MTP arthrodesis.

Conclusion:

With decreased pain, high satisfaction rates, and improved radiographic parameters, first MTP arthrodesis coupled with metatarsal head resection (rheumatoid forefoot reconstruction) is a viable surgical option for non-rheumatoid patients who have failed prior attempts at forefoot reconstruction or have chronic forefoot pain with deformity.
Sleep Quality, Pain Catastrophization, and Orthopedic Health Literacy
Authors: Noback Peter , Seetharaman Mani , Tantigate Direk , Rosenwasser Melvin , Vosseller J. Turner , Strauch Robert
Published: September 2017

Category:

Ankle

Introduction/Purpose:

Evidence increasingly indicates the importance of orthopedic health literacy, sleep quality, and a propensity for pain catastrophization in orthopedic patient outcomes. Using previously validated questionnaires including the Literacy in Musculoskeletal Problems (LiMP), Pain Catastrophization Scale (PCS), and the Pittsburgh Sleep Quality Index (PSQI), this study investigated the relationship between these factors and common functional outcome instruments including the Disability of Arm, Shoulder, and Hand (DASH) and the Foot and Ankle Outcome Score (FAOS).

Methods:

245 patients in outpatient clinics of one foot and ankle surgeon and three hand surgeons were approached. Inclusion criteria required age greater than 18, English proficiency, and a newly presenting chief complaint. Enrolled patients completed a demographics form, LiMP, PCS, PSQI, and the DASH or FAOS based on extremity. Clinical history was reviewed retrospectively. DASH and FAOS scores were normalized to the same scale (0 – 100, best to worst) and termed “functional survey” (FS). Correlations were calculated between FS scores, subjective questionnaires, and demographic/clinical information. For the variables of race and education level, one-way ANOVA analysis was conducted to determine if FS scores differed based on these variables. Variables that were significantly correlated with FS score were entered into a multivariate linear regression analysis to assess their effect on FS score.

Results:

231 patients (131 hand/wrist, 100 foot/ankle) were enrolled and completed all questionnaires. ANOVA analysis found that there were no significant differences in FS scores based on education or race (p > 0.05). Multivariate regression analysis was conducted with FS score as the dependent variable, and factors that were significantly correlated with FS score, including PCS, PSQI Global Score, visit type (trauma vs. non-trauma), and insurance type (private vs. public) as the independent variables. Health literacy was not significantly correlated with OS score. Results from this analysis can be found in Table 1. The model significantly (p < 0.05) accounted for 19.2% of variation in OS score.

Conclusion:

There is a strong correlation between tendency to catastrophize pain, sleep quality, and FS score. Every 1 unit increase in the PSQI/PCS corresponds with a 1.8/0.38 point increase in FS score; indicating higher functional disability. Given the strong correlation at baseline, such factors as poorly controlled tendency to catastrophize pain may confound functional outcomes. No significant correlation was noted between health literacy and FS scores. This suggests that an increased level of orthopedic knowledge does not affect perception of functional disability. However, our results show that sleep quality and catastrophic thinking may confound functional outcome scores.
Comparison of Treatment between Distal Tibial Osteotomy without Fibular Osteotomy and Tibiotalar Arthrodesis for Medial Ankle Arthritis in Older Individuals
Authors: Nozaka Koji , Kashiwagura Takeshi , Kura Hideji
Published: September 2017

Category:

Ankle Arthritis

Introduction/Purpose:

Advanced to end-stage ankle osteoarthritis in highly active older individuals has traditionally been treated using tibiotalar arthrodesis. Distal tibial osteotomy without fibular osteotomy, a type of joint preservation surgery, has garnered attention in recent years, but patient satisfaction has yet to be compared between the two treatments.

Objective:

To compare distal tibial osteotomy and tibiotalar arthrodesis for ankle osteoarthritis (stage IIIb and above under the Takakura classification) in older individuals.

Methods:

Subjects and Method: A total of 35 patients aged>60 years old who showed medial ankle arthritis were examined. Patients were either treated with tibiotalar arthrodesis (n=18) or distal tibial osteotomy (n=17). The patients’ mean age was 72.1 years (range, 60–81 years) in the tibiotalar arthrodesis group and 67.2 years (range, 60–80 years) in the distal tibial osteotomy group. For distal tibial osteotomy, a circular external fixator was used in all cases. Osteotomy was performed after performing synovectomy and microfracture surgery using ankle arthroscopy. At the time of fixation with a circular external fixator, foot ring (calcaneal) fixation was also performed. In addition, joint distraction was performed, and distraction arthroplasty was also simultaneously performed.

Results:

The mean preoperative VAS score was 8.2 for tibiotalar arthrodesis (TA) and 8.0 for distal tibial osteotomy (DTO). The mean postoperative VAS score was 1.9 for TA and 1.7 for DTO. The mean preoperative AOFAS score was 40.1 for TA and 43.1 for DTO. The mean postoperative AOFAS score was 86.2 for TA and 90.0 for DTO. The mean preoperative SF-36 physical component score was 30.5 for TA and 38.5 for DTO. The mean preoperative SF-36 mental component score was 33.5 for TA and 37.5 for DTO. The mean postoperative SF-36 physical component score was 42.5 for TA and 56.4 for DTO. It was significantly higher with the DTO (p<0.05).

Conclusion:

The mean postoperative SF-36 mental component score was 44.0 for TA and 59.7 for DTO. It was significantly higher with the DTO (p<0.05).Superior SF-36 scores were obtained for DTO compared to TA. The fact that the Japanese lifestyle involves tatami mats was thought to have contributed to the superiority of DTO in patient satisfaction.
Screw in Lisfranc Ligament
Authors: Panchbhavi Vinod , Sierra Stephen
Published: September 2017

Category:

Trauma

Introduction/Purpose:

The Lisfranc ligament is an interosseous ligament connecting the medial cuneiform with the second metatarsal. Current treatment of displaced Lisfranc injury is rigid fixation using a transarticular screw. The purpose of this study was to observe the amount of ligamentous disruption with the placement of a transarticular screw from the second metatarsal to the medial cuneiform.

Methods:

This cadaveric study included a total of 15 preserved cadavers and 23 feet. Blunt dissection down to bone, with removal of soft tissue, was performed on each foot for visualization of the Lisfranc joint. A guide-wire was inserted in a dorsolateral to plantar medial direction from the base of the second metatarsal into the medial cuneiform. Then over the guide- wire a 40 mm, 4.0 partially threaded, cannulated screw was inserted. The Lisfranc ligament was then carefully identified with more dissection. The screw was then removed. Separation of the second metatarsal from medial cuneiform was performed by transecting the dorsal, Lisfranc (interosseous), and plantar ligaments. Digital photographs of the Lisfranc ligament, medial cuneiform and second metatarsal articular surfaces were recorded and measurements were taken.

Results:

Of the 23 feet, the screw came in contact with the Lifranc ligament in 20 feet. The screw fully penetrated the ligament in 7 feet, partially disrupted it in 4 feet, and had <1 mm of contact in 9 feet. In 3 feet, there was no contact with the ligament with an average distance of 1.5 mm.

Conclusion:

Our results reveal the amount of disruption a transarticular screw, placed in a dorsolateral to plantar medial direction, will have on the Lisfranc ligament. Although the screw came into contact with the ligament in 20 out of 23 feet, only 13 feet had partial disruption or minimal contact and 3 feet had no contact at all. This is clinically relevant because ligamentous damage due to insertion and/or presence of screw in anatomic location of the ligament may interfere with its healing.
The NFL Combine as a Predictor of On-field Success
Authors: Parekh Selene , Patel Akul
Published: September 2017

Category:

Sports

Introduction/Purpose:

The NFL scouting combine is utilized annually by NFL franchises for prospect evaluation. It consists of a series of physical tests, medical evaluation, and intelligence exam (the Wonderlic). The relationship between physical measures such as vertical jump height and subsequent on-field performance has not been adequately explored in the medical literature. Such information could be useful for athletes training for a career in football or for athletes returning from injury seeking to maximize their chance of subsequent on-field success. The purpose of this study is to see if physical characteristics, as measured in the combine, are correlated with subsequent on-field performance.

Methods:

Physical testing performance at the combine for all NFL positions from 2006 to 2013 was obtained from a publically available NFL draft scout website. NFL performance data for all players (n=1306) who entered the combine was obtained from the commercial website Pro Football Reference. Pearson’s linear correlation coefficients were utilized to analyze relationships between combine physical and intelligence test measurements and subsequent on-field performance for each offensive and defensive position. On-field performance was measured using a wide variety output statistics. Examples include yards per carry or reception and yards per attempt for offensive positions and sacks and tackles per game for defensive positions.

Results:

A number of combine measures were statistically significantly associated with improved on-field NFL performance (p<0.05). These measures differed per position and for offensive and defensive players and varied in correlation strength. For example, quarterbacks and running backs with faster forty-yard dash speeds were associated with better NFL rushing statistics.

Conclusion:

Certain physical characteristics, as measured in the NFL combine, are associated with improved on-field performance in the NFL. Further studies are needed to discern the relationship between the NFL combine and subsequent on- field performance.
Functional Impairment of Patients Undergoing Surgical Correction for Charcot Foot
Authors: Pinzur Michael , Schiff Adam , Kroin Ellen
Published: September 2017

Category:

Diabetes

Introduction/Purpose:

Investigations using the Medical Outcomes Study Short Form 36 Healthy Survey (SF-36) and the American Orthopaedic Foot and Ankle Society Diabetic Foot Questionnaire (AOFAS-DFQ) have demonstrated a poor quality of life in patients with Charcot Foot arthropathy. The Short Musculoskelatal Function Assessment (SMFA) questionnaire has been widely used in patients with a broad range of musculoskeletal disorders.

Methods:

Twenty-five consecutive patients undergoing surgical correction for diabetes-related Charcot Foot Arthropathy of the midfoot completed the Short Musculoskeletal Functional Assessment (SMFA) prior to undergoing surgery. There were 16 males and 9 females. The average BMI was 37.35 (range 25.83-50.22), and the average Hemoglobin A1C was 7.54 (range 5.3-10.1) prior to surgery.

Results:

All twenty-five patients exhibited significant impairment in all six domains of the SMFA (p<0.0001) as compared to the normative data. There was a high correlation between each of the six domains of the SMFA, even after correcting for BMI.

Conclusion:

Charcot foot severely impairs quality of life in impacted patients beyond the impact of morbid obesity. This impairment equally impacts all of the functional and emotional domains measured with the SMFA as compared with population norms. This investigation provides an excellent benchmark for measuring the impact of surgical correction. In addition, the SMFA appears to be a valid tool for evaluating this complex patient population.
Ankle morphometry based on computerized tomography
Authors: Plaass Christian , Claassen Leif , Stukenborg-Colsman Christina , Yao Daiwei , Daniilidis Kiriakos , Ettinger Sarah , Nowakowski Andrej
Published: September 2017

Category:

Ankle

Introduction/Purpose:

Understanding the morphometry of the ankle joint is crucial to improve total ankle replacement (TAR). Despite improvements of the implant material TAR did not reach comparable success rates to total hip or knee arthroplasty. Recent studies queried whether current designs match with the articular geometry. The present study was performed to evaluate the ankle morphometry and thereby gain information about the joint axis.

Methods:

We analyzed 96 high-resolution CT-scans of complete caucasian cadaver legs. Using the software Mimics and 3-Matic (Materialize) 22 anatomic parameters of the talocrural joint were assessed, including the length, width and surface area of the tibial and talar bearing areas. Additionally the radii of the bearing areas, the medial distal tibial angle and the height of the talar dome were determined. Therefore we analyzed defined sagittal, axial and frontal planes.

Results:

The radius of the central trochlea tali was 44.6 ± 4.1 mm (mean ± SD). The central trochlea tali arc length was 40.8 ± 3.0 mm and its width was 27.4 ± 2.5 mm. Additionally we determined 47.0 ± 4.4 mm for the tibial sagittal radius, 27.6 ± 3.0 mm for the tibial arc length and 27.4 ± 2.5 mm for the central tibial width.

Conclusion:

The present study describes the three-dimensional morphometry of the caucasian ankle joint. Our results might be considered for the development of total ankle replacements.
Is Ankle Arthritis More Disabling than Midfoot Arthritis and 1st MTPJ Arthritis?
Authors: Ramaskandhan Jayasree Ramas , Siddique Malik
Published: September 2017

Category:

Ankle Arthritis, Midfoot/Forefoot

Introduction/Purpose:

There is wide array of outcome tools available for assessment of level of pain and symptoms in osteoarthritis, there are less disease and region specific outcome measures to evaluate the level of disability caused by arthritis in ankle, mid foot arthritis (including Talo-navicular joint, Calcaneo-cuboid joint and tarso metatarsal joints) and 1st Metatarso phalangeal joints. We aimed to measure the level of disability incorporating elements of physical, mental and social well-being using patient reported outcome measures as recommended by the International classification of Functioning, disability and health (ICF)

Methods:

This is a prospective data series, patients with arthritis of ankle, mid foot or 1st MTPJ who were diagnosed in new patient clinic were asked to take part in this survey. They completed a questionnaire consisting of MOX-FQ (Manchester Oxford Foot Questionnaire), EQ-5D (General Health Status) and FAOS (Foot and Ankle Outcome Scores). Patients were grouped in to 3 groups (Group A - ankle arthritis. Group B - midfoot arthritis (either Talo navicular, Calcaneo-cuboid or TMT joint); Group C - arthritis of 1st Metatarso-phalangeal joint of the foot). The results of summary scores were calculated for responses to individual questions and compared between the groups. Demographic factors were included in the statistical analysis carried out using SPSS Version 22, Illinois. Results are reported as follows

Results:

There were 26 patients in (Group A); 12 patients in (Group B) and 19 patients in (Group C). There was no difference in mean age of patients between groups (p>0.05) For components in MOX-FQ, there was no difference in pain scores (p=0.353) between the groups. For difficulty with walking/standing, Group A patients reported significantly worse scores (77 ± 19.4) when compared to Group C (53.7 ± 35.5). There was no difference in scores between groups for social function component of MOX- FQ (p=0.487). For EQ-5D, although Group C patients reported higher scores they failed to achieve statistical significance (p>0.05). For FAOS, Group A patients reported significantly lower scores for pain and symptoms, ADL, ability to take part in Sports/Recreation (p=0.008) and Quality of Life (p=0.003).

Conclusion:

In conclusion, although patients with ankle arthritis, mid foot arthritis and 1st MTP joint arthritis report similar level of disability in terms of general health and social function, patients with ankle arthritis reported higher level of disability in terms of pain, difficulty with standing/ Walking, ability to do Activities of Daily living, ability to take part in recreational activities and overall Quality of Life.
Calcaneal Osteotomies in the treatment of Hindfoot Deformities
Authors: Sahranavard Bahman , Shah Ashish , de Cesar Netto Cesar , Araoye Ibukunoluwa , Hudson Parke , Cone Brent , Johnson Michael , Jones Caleb , Pinter Zachariah , Lee Sung
Published: September 2017

Category:

Hindfoot

Introduction/Purpose:

Calcaneal osteotomy is a common procedure for hindfoot deformities correction. Screw fixation is the most common technique used to stabilize these osteotomies. The clinical decision regarding the number of screws used is frequently based on the surgeon’s experience without sufficient data regarding outcomes and complications. The aim of this study was to compare the outcomes and complications of one versus two screws fixation technique of sliding calcaneal osteotomies.

Methods:

We reviewed 190 patients (112 female, 78 male) who underwent corrective calcaneal osteotomy for hind-foot angular deformity between 2010-2016. The average age was 48.4 years (18-83), and mean follow-up was 28 weeks (4-150). We divided patients into two groups, according to the number of screws used in the osteotomy fixation (one or two). 85 osteotomies were fixed by one screw and 105 by two screws. We compared both groups regarding incision type, positioning and type of the screws (headed or headless) and complications (non-union, infection, hardware related heel pain).

Results:

The average time for radiographic union was similar between the groups, around 5.6 weeks (4-10 weeks). Non-unions were not found. The overall Incidence of complications was not significant different in the one screw group compare two screw group (12.7% x 8%, p-value 0.465). Infection rate was similar in both groups (4.7% vs 3.5%, p-value 0.674). There was not significant difference of hardware related heel pain between two groups (15.2% vs 8.5%, p-value 0.149). Similarly, no difference in incidence of hardware related symptoms between patients who used headed screw when comparing with headless screws.

Conclusion:

Our study compared results in the use of one screw versus two screws fixation technique for sliding calcaneal osteotomies. We found similar time for union. Base of date there was no significant difference of complications, infection, and hardware related heel pain between patients who used one screw when comparing two screws fixation technique for corrective calcaneal osteotomy.