bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum Lipopolysaccharide‐Binding Protein Levels and the Incidence of Cardiovascular Disease in a General Japanese Population: The Hisayama Study
Authors: Asada Masako , Oishi Emi , Sakata Satoko , Hata Jun , Yoshida Daigo , Honda Takanori , Furuta Yoshihiko , Shibata Mao , Suzuki Kosuke , Watanabe Hiroshi , Murayama Norihito , Kitazono Takanari , Yamaura Ken , Ninomiya Toshiharu
Published: October 2019

Background

Epidemiological studies have reported a link between serum LBP (lipopolysaccharide‐binding protein) levels and lifestyle‐related diseases. However, there have been no longitudinal studies investigating the association of serum
LBP
levels and the incidence of cardiovascular disease (
CVD
) in general populations.

Methods and Results

A total of 2568 community‐dwelling Japanese individuals 40 years and older without prior
CVD
were followed for 10 years (2002–2012). Serum
LBP
levels were divided into quartiles (quartile 1: 2.20–9.68 μg/mL; quartile 2: 9.69–10.93 μg/mL; quartile 3: 10.94–12.40 μg/mL; quartile 4: 12.41–24.34 μg/mL). The hazard ratios (
HR
s) and their 95%
CI
s for the incidence of
CVD
were computed using a Cox proportional hazards model. During the follow‐up period, 180 individuals developed
CVD
. The age‐ and sex‐adjusted cumulative incidence of
CVD
increased significantly with higher serum
LBP
levels (
P
for trend=0.005). Individuals with higher serum
LBP
levels had a significantly greater risk of the development of
CVD
after adjusting for conventional cardiovascular risk factors (quartile 1: HR, 1.00 [reference]; quartile 2: HR, 1.04 [95% CI, 0.60–1.78]; quartile 3: HR, 1.52 [95% CI, 0.92–2.51]; and quartile 4: HR, 1.90 [95% CI, 1.17–3.09];
P
for trend=0.01). This association remained significant after additional adjustment for homeostasis model assessment of insulin resistance (
P
for trend=0.01). However, when additional adjustment was made for high‐sensitivity C‐reactive protein, the association was attenuated to the nonsignificant level (
P
for trend=0.08).

Conclusions

The present findings suggest that higher serum
LBP
levels are associated with increased risk of the development of
CVD
in the general Japanese population. Low‐grade endotoxemia may contribute to the pathogenesis of
CVD
through chronic systemic inflammation.
Mortality Risk in Acute Ischemic Stroke Patients With Large Vessel Occlusion Treated With Mechanical Thrombectomy
Authors: Katsanos Aristeidis H. , Malhotra Konark , Goyal Nitin , Palaiodimou Lina , Schellinger Peter D. , Caso Valeria , Cordonnier Charlotte , Turc Guillaume , Magoufis Georgios , Arthur Adam , Alexandrov Andrei V. , Tsivgoulis Georgios
Published: October 2019

Background

Recent randomized controlled clinical trials have provided solid evidence that mechanical thrombectomy (
MT
) coupled with best medical therapy (
BMT
) improve functional outcomes of acute ischemic stroke patients with large vessel occlusion compared with
BMT
alone. However, they provided inconclusive evidence on the benefit of
MT
on mortality.

Methods and Results

We evaluated the association of
MT
+
BMT
compared with
BMT
with the risk of 3‐month mortality using aggregate data from all available randomized controlled clinical trials. We also sought to identify potential predictors on the mortality risk and performed univariate meta‐regression analyses. Our literature search identified 11 eligible randomized controlled clinical trials, including a total of 2460 patients. The pooled rates of 3‐month mortality were 15% (95%
CI
:12%–19%) and 19% (95%
CI
:16%–23%), respectively, in the
MT
+
BMT
and
BMT
groups. In the overall analysis
MT
+
BMT
was associated with a significantly lower risk for 3‐month mortality compared with
BMT
(risk ratio=0.83, 95% CI:0.69–0.99;
P
=0.04), without heterogeneity across included studies (I
2
=3%,
P
for Cochran Q=0.41). No evidence of publication bias was present in funnel plot inspection and Egger statistical test (
P
=0.762). In meta‐regression analyses no moderating effect on the aforementioned association was detected with patient age (
P
=0.254), sex (
P
=0.702), admission systolic blood pressure (
P
=0.601), admission glucose (
P
=0.277), onset‐to‐groin puncture time (
P
=0.985), administration of intravenous alteplase before
MT
(
P
=0.804),
MT
under general anesthesia (
P
=0.735), and successful reperfusion following
MT
(
P
=0.663).

Conclusions

Our meta‐analysis provides evidence that
MT
+
BMT
reduces the risk of 3‐month mortality compared with
BMT
alone. This association appears not to be moderated by individual patient or procedural characteristics.
Two Leading Modes of Wintertime Atmospheric Circulation Drive the Recent Warm Arctic–Cold Eurasia Temperature Pattern
Authors: Ye Kunhui , Messori Gabriele
Published: October 2019

The wintertime warm Arctic–cold Eurasia (WACE) temperature trend during 1990–2010 was characterized by accelerating warming in the Arctic region, cooling in Eurasia, and accelerating autumn/winter Arctic sea ice loss. We identify two atmospheric circulation modes over the North Atlantic–northern Eurasian sector that displayed strong upward trends over the same period and can explain a large part of the observed decadal WACE pattern. Both modes bear a close resemblance to well-known teleconnection patterns and are relatively independent from variability in Arctic sea ice cover. The first mode (PC1) captures the recent negative trends in the North Atlantic Oscillation and increased Greenland blocking frequency, while the second mode (PC2) is reminiscent of a Rossby wave train and reflects an increased blocking frequency over the Urals and north Asia. We find that the loss in the Arctic sea ice and the upward trends in PC1 and PC2 together account for most of the decadal Arctic warming trend (>80%). However, the decadal Eurasian cooling trends may be primarily ascribed to the two circulation modes alone: all of the cooling in Siberia is contributed to by PC1 and 65% of the cooling in East Asia by their combination (the contribution by PC2 doubles that by PC1). Enhanced intraseasonal activity of the two circulation modes increases blocking frequencies over Greenland, the Ural region, and north Asia, which drive anomalous moisture/heat flux toward the Arctic and alter the downward longwave radiation. This also weakens warm advection and enhances advection of cold Arctic airmasses towards Eurasia.
A Comparison of Two Methods Using Thorpe Sorting to Estimate Mixing
Authors: Smith Jerome A.
Published: October 2019

Some high-resolution CTD data collected in the spring of 2017 are analyzed using Thorpe sorting and scale analyses, including both the commonly used “Thorpe scale” method and a lesser-used method that is based on directly estimating the “available overturn potential energy” (AOPE): the difference between potential energies of the raw versus sorted density profiles in a mixing “turbulent patch.” The speed of the profiler varied, so the spatial (vertical) sampling is uneven. A method is developed and described to apply the Thorpe scaling and the AOPE approaches to such unevenly sampled data. The AOPE approach appears to be less sensitive to the (poorly constrained) estimate of the “background” buoyancy frequency N. Although these approaches are typically used to first estimate the dissipation rate εK of turbulent kinetic energy, the real goal is to estimate the diffusivity of density Kρ and hence the net alteration of the density profile by mixing. Two easily measured dimensionless parameters are presented as possible metrics of the “age” or “state” of the mixing patch, which might help to resolve the question of how the total turbulent energy and dissipation are apportioned between kinetic and potential components and hence how much of the measured AOPE ends up changing the background stratification. A speculative example as to how this might work is presented.
Julius Wellhausen goes to Copenhagen: Towards a more progressive commentary on Exodus
Authors: Whiting Simeon
Published: October 2019

This article explores how commentaries on Exodus have engaged with the documentary hypothesis and alternative theories of pentateuchal composition. Despite new and compelling theories as to how and when the Pentateuch was composed arising over the last thirty years, commentators on Exodus have shown very limited engagement with these ideas. Resulting from this, both conservative and revisionist positions are becoming ever-more entrenched, commentaries are imposing unnecessary and detrimental limits on themselves and confessing readers of commentaries are being sold short. Following an outline of the most prominent theories of pentateuchal composition, three recent commentaries on Exodus are examined, in terms of their engagement with Wellhausen’s theory and selected alternatives. I next focus on three particular effects of commentaries’ limited engagement with revisionist scholarship, before suggesting a new way forward for an Exodus commentary.
CD103+ T and Dendritic Cells Indicate a Favorable Prognosis in Oral Cancer
Authors: Xiao Y. , Li H. , Mao L. , Yang Q.C. , Fu L.Q. , Wu C.C. , Liu B. , Sun Z.J.
Published: October 2019

T cells and dendritic cells (DCs) that are positive for the tissue-resident marker CD103 play a vital role in antitumor immunity. In this study, multiplexed immunohistochemistry was applied to stain CD103 and the T-cell marker CD8 as well as the DC marker CD11c on formalin-fixed, paraffin-embedded oral squamous cell carcinoma (OSCC) tissues. Then, the density of CD103+CD8+ and CD103+CD11c+ tumor-infiltrating lymphocytes (TILs) in the intratumoral and stromal regions was calculated, and the correlation of CD103+CD8+ TIL and CD103+CD11c+ TIL density with OSCC patient prognosis was analyzed. The results revealed that CD103+CD8+ TILs and CD103+CD11c+ TILs were abundant in the stromal region and that increased stromal CD103+CD8+ TIL and intratumoral CD103+CD11c+ TIL density indicated a favorable prognosis. Moreover, we freshly isolated TILs from OSCC samples and performed flow cytometry to verify that CD103+CD8+ TILs display a tissue-resident memory T-cell (Trm) phenotype, and we discriminated CD103+CD11c+ TILs from tumor-associated macrophages.
Tackling negative thinking in the classroom
Authors: Minahan Jessica
Published: October 2019

Almost a third of adolescents have struggled with an anxiety disorder during their childhood, yet teachers are often unsure how to help students with anxiety. Anxiety is characterized by rumination and negative or distracting thoughts, so teachers can help by disrupting those negative thoughts. Jessica Minahan provides a series of practical strategies for helping students recognize their inaccurate negative thoughts and replace them with more positive thoughts. For instance, teachers might help students see that only one part of a daunting task is actually difficult or that experiences students previously dreaded turned out to not be so bad. Over time, with the daily support of their teachers, students can learn to think more accurately, allowing them to develop a more positive self-concept and fully engage in the classroom.
A 10% Increase in Step Rate Improves Running Kinematics and Clinical Outcomes in Runners With Patellofemoral Pain at 4 Weeks and 3 Months
Authors: Bramah Christopher , Preece Stephen J. , Gill Niamh , Herrington Lee
Published: October 2019

Background:

Aberrant frontal-plane hip and pelvis kinematics have been frequently observed in runners with patellofemoral pain (PFP). Gait retaining interventions have been shown to improve running kinematics and may therefore be beneficial in runners with PFP.

Purpose:

To investigate whether a 10% increase in the running step rate influences frontal-plane kinematics of the hip and pelvis as well as clinical outcomes in runners with PFP.

Study Design:

Case series; Level of evidence, 4.

Methods:

Runners with PFP underwent a 3-dimensional gait analysis to confirm the presence of aberrant frontal-plane hip and/or pelvis kinematics at baseline. A total of 12 participants with frontal-plane hip and/or pelvis kinematics 1 standard deviation above a reference database were invited to undergo the gait retraining intervention. Running kinematics along with clinical outcomes of pain and functional outcomes were recorded at baseline, 4 weeks after retraining, and 3 months. Gait retraining consisted of a single session where step rate was increased by 10% using an audible metronome. Participants were asked to continue their normal running while self-monitoring their step rate using a global positioning system smartwatch and audible metronome.

Results:

After gait retraining, significant improvements in running kinematics and clinical outcomes were observed at 4-week and 3-month follow-up. Repeated-measures analysis of variance with post hoc Bonferroni correction ( P < .016) showed significant reductions in peak contralateral pelvic drop (mean difference [MD], 3.12° [95% CI, 1.88°-4.37°]), hip adduction (MD, 3.99° [95% CI, 2.01°-5.96°]), and knee flexion (MD, 4.09° [95% CI, 0.04°-8.15°]) as well as significant increases in self-reported weekly running volume (MD, 13.78 km [95% CI, 4.62-22.93 km]) and longest run pain-free (MD, 6.84 km [95% CI, 3.05-10.62 km]). Friedman test with a post hoc Wilcoxon signed-rank test showed significant improvements on a numerical rating scale for worst pain in the past week and the Lower Extremity Functional Scale.

Conclusion:

A single session of gait retraining using a 10% increase in step rate resulted in significant improvements in running kinematics, pain, and function in runners with PFP. These improvements were maintained at 3-month follow-up. It is important to assess for aberrant running kinematics at baseline to ensure that gait interventions are targeted appropriately.

Registration:

NCT03067545 (ClinicalTrials.gov identifier)
Utility of Bioabsorbable Fixation of Osteochondral Lesions in the Adolescent Knee: Outcomes Analysis With Minimum 2-Year Follow-up
Authors: Schlechter John A. , Nguyen Shawn V. , Fletcher Katie L.
Published: October 2019

Background:

Osteochondral lesions (OCLs) of the knee, whether occurring secondary to osteochondritis dissecans or a traumatic osteochondral fracture, are commonly encountered in the pediatric and adolescent population. Given the potential for healing in this population, coupled with adequate surgical reduction and stability of OCL fixation, an opportunity exists to avoid a major restorative procedure and the associated substantial costs and potential morbidity.

Purpose:

To analyze the outcomes of bioabsorbable fixation of OCLs in the adolescent knee at a minimum of 2 years.

Study Design:

Case series; Level of evidence, 4.

Methods:

An institutional review board–approved retrospective review was performed of patients younger than 18 years who underwent bioabsorbable fixation of an OCL of the knee with a minimum 2-year follow-up. Patient demographics, operative details, and postoperative clinical findings were detailed and recorded. All cases were performed by a single surgeon.

Results:

There were 38 patients treated surgically for an OCL between 2009 and 2016. Of these, 38 patients (mean age, 14.7 years) were evaluated at a mean of 59 months. OCL fixation consisted of a mean of 1.4 bioabsorbable screws and 1.5 darts. At final follow-up, mean pre- and postoperative Tegner scores were 6.6 and 6.4, respectively, while Lysholm and Pediatric International Knee Documentation Committee scores were 89.8 and 88.1, respectively. A total of 6 patients underwent secondary procedures postoperatively. One patient required a secondary procedure related to OCL fixation, which was secondary to a proud implant. The other secondary procedures included second-look arthroscopic surgery for pain after an injury postoperatively, planned anterior cruciate ligament reconstruction, staged medial patellofemoral ligament reconstruction, and manipulation under anesthesia for arthrofibrosis (n = 2). None of the 32 patients required a revision cartilage procedure at the time of final follow-up.

Conclusion:

The use of bioabsorbable implants in the adolescent knee appears to be a safe and efficacious treatment with good functional outcomes at long-term follow-up and a low revision rate. Additional long-term multisurgeon and multicenter trials with a larger cohort are needed to further elucidate the role of bioabsorbable fixation of an OCL in the adolescent knee.
Opioid Consumption and Time to Return to Work After Percutaneous Foot and Ankle Surgery
Authors: Chan Jimmy J. , Guzman Javier Z. , Chen Kevin K. , Chan Jesse C. , Vulcano Ettore
Published: October 2019

Category:

Hindfoot, Lesser Toes, Midfoot/Forefoot

Introduction/Purpose:

Orthopaedic surgeons are the 5th highest prescriber for narcotics in the USA. Foot and ankle procedures can be amongst some of the more painful procedures in orthopedics. A recent study demonstrated that patient underwent open foot and ankle surgeries averaged 27.2 tablets of narcotics with 37% of patients unwilling to stop at 3-month post-operative visit. Percutaneous techniques for foot and ankle procedures were recently approved in the U.S., which allow for significantly smaller incisions and minimal soft tissue disruption, which may potentially decrease post-operative pain and allow faster recovery. The purpose of this study is to assess the total opioid consumption and time for return to work following percutaneous foot and ankle surgery.

Methods:

In this prospective cohort study, 50 consecutive patients underwent percutaneous foot surgery (bony procedures with or without soft tissue work) by a single surgeon. All surgeries were outpatient procedures and performed under general anesthesia with a long-acting popliteal nerve block. All patients were prescribed 30 tablets of 5 mg oxycodone, 50 tablets of 500 mg acetaminophen, and 9 tablets of 600 mg ibuprofen post-operatively for pain control. All patients were given a log sheet to record number of pain medications taken during the first 14 post-operative days. The log sheet and leftover pills were collected and counted to confirm the amount of pain medication used at 2-week post-operative visit. Time return to work was also recorded in subsequent follow-up appointment.

Results:

All 50 patients returned their log sheet at 2-week post-operative visit. Mean age was 47.1 years. N=36 (72%) were forefoot surgeries, N=2 (4%) midfoot, N=9 (18%) hindfoot, and N=3 (6%) combined. Average oxycodone tablets taken during the first 14 days after surgery was 3.3 tablets. By the 14th day, no patient was taking any narcotic medication. The average return to work was 18.9 days post-operatively. Patients with forefoot surgery averaged 2.2 tablets of oxycodone with return to work at 10.4 days. Midfoot surgery patients averaged 3.5 tablets with return to work at 33 days. Hindfoot surgery patients averaged 5.3 tablets with return to work at 38.9 days. Combined foot surgery patients averaged 11 tablets with return to work at 54.3 days.

Conclusion:

This study demonstrated that percutaneous foot and ankle surgery has significant reduction and cessation in narcotic consumption post-operatively when compared to the reported values with open procedures in current literature.
The Hallux Metatarsophalangeal Capsule: An Anatomic Study with Respect to Percutaneous Hallux Valgus Correction
Authors: Chin Kenneth M. , Richardson Nicholas S. , Campbell John T. , Jeng Clifford L. , Christian Matthew W. , Cerrato Rebecca A.
Published: October 2019

Category:

Bunion

Introduction/Purpose:

Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux MTP proximal capsular origin on the metatarsal neck is critical for surgeons in planning and executing extra-capsular corrective osteotomies. A cadaveric study was undertaken to further study this anatomic relationship.

Methods:

Ten nonpaired fresh-frozen frozen cadaveric specimens were used for this study. Careful dissection was performed, and the capsular origin of the hallux MTP joint was measured from the central portion of the metatarsal head in the medial, lateral, dorsal, plantarmedial, and plantarlateral dimensions.

Results:

The ten specimens had a mean age of 77 years, five female and five male. The mean distances from the central hallux metatarsal head to the MTP capsular origin was 15.2 mm dorsally, 8.4 mm medially, 9.6 mm laterally, 19.3 mm plantarmedially, and 21.0 mm plantarlaterally.

Conclusion:

The MTP capsular origin at the hallux metatarsal varies at different anatomic positions. Knowledge of this capsular anatomy is critical for orthopaedic surgeons when planning and performing minimally invasive distal metatarsal osteotomies for the correction of hallux valgus.
Postoperative Aspirin Use and Its Effect on Bone Healing in the Treatment of Ankle Fractures
Authors: Hunter Allison , Pitts Charles , Montgomery Tyler , Anderson Matthew , Wilson John T. , Buddemeyer Katherine , McGwin Gerald , Johnson Michael
Published: October 2019

Category:

Ankle, Trauma

Introduction/Purpose:

There is hesitancy to administer nonsteroidal anti-inflammatories (NSAIDs) within the postoperative period following fracture care due to concern for delayed union or nonunion. However, aspirin (ASA) is routinely used for chemoprophylaxis of deep vein thrombosis (DVT) and is gaining popularity for use after treatment of ankle fractures. We examine the incidence of nonunion of operative ankle fractures and risk of DVT in patients who did and did not receive postoperative ASA. We hypothesize that time to clinical and radiographic union and the risk of DVT are no different.

Methods:

A retrospective chart review was performed on all patients treated between 2008 and 2018 for ankle fractures requiring operative fixation by three Foot and Ankle fellowship trained orthopaedic surgeons at a single institution with a minimum of 3 months follow up. Demographics, preoperative comorbidities, and postoperative medical and surgical complications were compared between patients who did and did not receive ASA postoperatively. For both groups, union was evaluated by clinical exam as well as by radiograph.

Results:

506 patients met inclusion criteria: 152 received ASA and 354 did not. Radiographic healing at 6 weeks was demonstrated in 95.9% (94/98) and 98.6% (207/210) respectively (p-value .2134). There was no significant difference in time to radiographic union between groups. The risk of postoperative DVTs in those with and without ASA was not significantly different (0.7% (1/137) vs 1.2% (4/323), respectively; p-value .6305).

Conclusion:

Postoperative use of ASA does not delay radiographic union of operative ankle fractures or affect the rate of postoperative DVT. This is the first and largest study to examine the effect of ASA on time to union of ankle fractures.
2019 J. Leonard Goldner Award Winner: A Novel Intraoperative Technique Seeding Morselized Bone Tissue into Pediatric Blood Culture Bottles Improves Microbiological Diagnosis in Patients with Foot and Ankle Osteomyelitis
Authors: Ledermann Gerardo , Klaber Ianiv , Urrutia Julio , Ponce Pablo Mery , Filippi Jorge
Published: October 2019

Category:

Basic Sciences/Biologics, Diabetes

Introduction/Purpose:

Bone infection in the foot is a challenging pathology that frequently leads to amputation and major disability. Agent identification and antimicrobial susceptibility-guided therapy is the key for a successful treatment. Standard culture methods for bone tissue have demonstrated poor sensitivity. It has been reported that synovial fluid culture sensitivity is enhanced when seeded into pediatric blood culture bottles (PBCB), however, its performance for bone infection has yet to be determined. The aim of this study was to evaluate a novel method to obtain and process infected bone tissue using PBCB and comparing it with the standard technique.

Methods:

Patients admitted at a single university hospital with foot osteomyelitis between 2008 and 2017 were recruited prospectively. The diagnosis was made by clinical, laboratory and imaging findings. A representative sample of infected bone tissue was obtained for each patient and simultaneously processed using the standard technique for solid tissue cultures (SCM) and a morselized bone sample that was seeded into a PBCB (BacT/ALERT® PF). Culture sensitivity and number of agents detected for each technique were compared using the McNemar and the Mann Whitney tests respectively.

Results:

Over the period studied, 107 patients fitted the inclusion criteria. Of these, 63 patients had a diabetic-related infection. The causative agent was identified in 60.7% using the SCM and in 97.2% using PBCB (p < 0.001). We detected a mean of 1.05 bacteria species using SCM and 1.67 using PBCB (p<0.01). PBCB retrieved 1 bacterial species in 50.5% of the samples and 2 or more bacterial species in 46.7%. The SCM detected 1 bacterial species in 29% of the samples and 2 or more bacterial species in 31.7%.

Conclusion:

In this cohort, culture technique using morselized bone tissue seeded in PBCB identified the causative agent in a significantly larger percentage than SCM. Additionally, this method identified a larger number of agents. These findings demonstrate that this novel, simple and reproducible technique for culturing bone tissue samples allows a better microbiological diagnosis, without additional intraoperative risks, compared with standard methods.
Comparison of Visual Analog Pain Score Reported to Physician vs Nurse in Postoperative Foot and Ankle Patients
Authors: McBride Trevor , Martin Kevin , Wilke Aaron Joseph , Chisholm Jamie
Published: October 2019

Category:

Patient Reported Outcome Measures

Introduction/Purpose:

The relativity of pain adds to the increasing ambiguity of deciding proper treatment procedures. Reliable and validated patient reported outcome measures have attempted to solve this problem, but there are still flaws due to the subjective nature of pain. This study is the third part to two previous studies that found both operative and new nonoperative patients overemphasize their pain scores when reporting to the treating physician as compared to a nurse. This current study aims to examine if this phenomenon holds true with orthopedic postoperative patients. The importance of this study is to observe this phenomenon, as to better understand subjective pain scores. We hypothesize there will be no differences in postoperative patients’ pain scores when reporting to a treating physician versus a nurse.

Methods:

This study is a retrospective cohort of consecutive postoperative foot and ankle patients treated by a single surgeon. The patients were asked to rate their pain intensity by the nursing staff and then by the surgeon using a standard horizontal visual analog scale (VAS) 0 to 10, from “no pain” to “worst pain” at 2, 6, and 12 weeks postoperatively. Differences in reported pain levels were analyzed within each clinic visit.

Results:

Two hundred and one patients each with 3 follow up encounters were included in our cohort. The mean 2, 6, and 12- week postoperative VAS scores reported to the physician were 2.85, 2.04, and 2.33 respectively; in comparison, the scores reported to the nurse were 2.52 (p=0.0005), 1.77 (p=0.002), and 2.02 (p=0.005) respectively. There was no significant relationship between time and type of provider.

Conclusion:

This study found that postoperative patients report their pain more consistently to physicians and nursing staff with no clinically significant differences noted. These findings stand in stark contrast to our two previous studies which noted new and preoperative patients reported significantly higher VAS scores to the physician. The reason for reporting inconstancies is unclear, but postoperatively patients no longer need to emphasize their impairments or injury. Postoperatively, they also have a defined time interval and more acute recollection of their pain potentially leading to more consistency in reporting.
Effect of Ankle Position during Anterior Talofibular Ligament Reconstruction on Ankle Kinematics, Laxity, and In-situ Force
Authors: Sakakibara Yuzuru , Teramoto Atsushi , Shoji Hiroaki , Kamiya Tonmoaki , Watanabe Kota , Yamashita Toshihiko
Published: October 2019

Category:

Ankle, Basic Sciences/Biologics

Introduction/Purpose:

Anatomical anterior talofibular ligament (ATFL) reconstruction is a standard surgical treatment for chronic lateral ankle instability. The optimal position during ATFL reconstruction is still uncertain. The purpose of this study was to investigate the effect of ankle position during ATFL reconstruction on ankle kinematics, laxity, and in-situ force on the graft.

Methods:

Twelve fresh-frozen cadaveric ankles were evaluated. First, ankle specimens were subjected to passive plantarflexion (PF)-dorsiflexion (DF) movement, from 15° DF to 30° PF, using a 6-degrees-of-freedom robotic system. Then, 60 N of anterior- posterior (AP) load, 1.7 Nm of inversion-eversion (IV-EV) torque, and 1.7 Nm of internal-external rotation (IR-ER) torque were applied to the ankle. During testing, 3-dimensional paths of the ankle were recorded simultaneously. In-situ forces on the ATFL and reconstructed graft were calculated using the principle of superposition. A repeat experiment was designed with intact (intact), ATFL transection, and ATFL reconstruction conditions, using 3 different flexion angles (Group A: 0°, Group B: PF 15°, Group C: PF 30°).

Results:

In ATFL transection condition, the talus was significantly translated anteriorly with internal rotation during PF-DF motion, compared to that in intact condition. In addition, laxity in AP, IV-EV, and IR-ER conditions was significantly greater than in intact condition. In each ATFL reconstruction group, kinematics and laxity showed no significant difference compared to that in intact condition. In intact condition, in-situ force was maximal at PF 30° (19.0±12.0 N). The in-situ force on the reconstructed graft in Group A, B, and C at PF 30° was 50.0±12.4 N, 33.7±13.0 N, and 21.9±7.5 N. The in-situ force in Group A and B was significantly greater than in intact condition. The in-situ force in Group C was not significantly different compared to that in intact condition (Figure 1).

Conclusion:

Ankle position during ATFL reconstruction affected in-situ force on the reconstructed graft. ATFL reconstruction at PF 30° is recommended to avoid excessive in-situ force on the reconstructed graft.
Consumer Prices for Surgical Management of End-Stage Hallux Rigidus
Authors: Smyth Niall A. , Krishnan Vaishnavi , McCormick Johnathon R. , Kaplan Jonathan R. , Aiyer Amiethab A.
Published: October 2019

Category:

Midfoot/Forefoot, Healthcare economics

Introduction/Purpose:

Hallux rigidus is the most prevalent arthritic condition of the foot. Treatment of end-stage disease traditionally consists of a first metatarsophalangeal joint (MTPJ) arthrodesis, however the use of a synthetic cartilage implant is becoming more common. With the high prevalence of disease and implementation of new treatment modalities, healthcare consumers should be aware of the costs associated with management. The purpose of this study was to determine access to the cost and variability in price of first MTPJ arthrodesis and synthetic cartilage implantation.

Methods:

Forty academic centers were contacted using a standardized patient script. The patient was a 59-year-old female who had failed conservative treatment of hallux rigidus. Each institution was contacted up to three times in an attempt to obtain a full bundled operative quote for a first MTPJ arthrodesis and synthetic cartilage implantation.

Results:

Twenty centers (50%) provided a quote for first MTPJ arthrodesis and 15 centers (38%) provided a quote for synthetic cartilage implantation. Only 14 centers (35%) were able to provide a quote for both procedures. The mean bundled price for MTPJ arthrodesis was $21,767 (range, $8,417 – $39,265). The mean bundled price for synthetic cartilage implantation was $21,546 (range, $4,903 – $74,145). There was no statistically significant difference between the bundled price for first MTPJ arthrodesis and synthetic cartilage implantation.

Conclusion:

There was limited availability of consumer prices for first MTPJ arthrodesis and synthetic implantation, therefore impeding healthcare consumers’ decision making. There was a wide range of quotes for both procedures, indicating potential cost savings.
Talocalcaneal Coalition Resection with Corrective Osteotomies in Symptomatic Adolescents
Authors: Abd-Ella Mohamed Mokhtar
Published: October 2019

Category:

Hindfoot

Introduction/Purpose:

Resection of a symptomatic talocalcaneal coalition in an adolescent without correction of the planovalgus deformity aggravates the problem because the tight peroneal tendons and triceps surae pull the heel into more valgus after release of the subtalar joint. This study aims to evaluate the clinical results of resection of symptomatic talocalcaneal coalition in adolescents with simultaneous correction of the planovalgus deformity using combined bony and soft tissue procedures.

Methods:

In 24 feet in 21 adolescents (age 13 to 17) with symptomatic talocalcaneal coalition and planovalgus deformity, resection of the coalition was performed together with simultaneous medial displacement calcaneal osteotomy, lateral column lengthening, Cotton osteotomy if needed, gastrocnaemius recession, and peroneal tendon fractional lengthening. Follow up evaluation was done using the AOFAS hindfoot score and subjective patient satisfaction. Complications and reoperation were reported.

Results:

After a minimal follow up of one year (range 1 to 5 years), the results were classified excellent in 12 feet, good in 8 feet, and fair in four feet using the AOFAS hindfoot score. Subjective patient satisfaction was graded excellent in 14 feet, good in 6 feet and fair in four feet. Two patients underwent subsequent subtalar fusion with subsequent improvement and satisfaction. Other complications included superficial wound problems in 5 feet, and talar incomplete fracture during coalition resection which was fixed in one foot.

Conclusion:

Resection of a symptomatic talocalcaneal coalition with simultaneous correction of pes planovalgus deformity is a good option for management of such problem in adolescents.
Postoperative Complications Following Ankle Fractures in the Geriatric Population: A Case Series
Authors: Anderson Matthew , Jha Aaradhana J. , Naranje Sameer M. , Viner Gean C. , McKissack Haley , Hsu Alan , Chinnakkannu Karthikeyan , McGwin Gerald , Shah Ashish B. , Moraes Leonardo V. M.
Published: October 2019

Category:

Ankle, Trauma

Introduction/Purpose:

Ankle fractures are among the most common orthopedic injuries. While open reduction and internal fixation (ORIF) is the standard treatment for displaced ankle fractures in younger patients, there is controversy regarding the optimal management of these injuries among geriatric patients due to the high prevalence of comorbidities. Closed manipulation leads to poor long-term functional outcomes, with high rates of malunion and non-union in all populations as well as higher mortality in patients over 65 years of age. However, surgical management in the elderly carries rates of complications as high as 20-40%. The purpose of this study was to investigate risk factors for healing complications following ORIF of ankle fractures in patients greater than 75 years of age.

Methods:

All patients 75 years of age and older undergoing open reduction and internal fixation of ankle fractures at a single institution from 2008 to 2018 were identified. Patients with polytrauma and/or pilon fractures were excluded. Patient medical records were reviewed to obtain information regarding details about the injury, surgery, and follow-up as well as patient demographics and comorbidities. Radiographs from post-operative clinic visits were examined by a foot and ankle certified orthopedic fellow for each patient and the time for complete union was recorded as well as any delayed union or malunion. Fisher’s exact tests were used to compare post-operative complications (wound infection, wound dehiscence, sepsis, deep vein thrombosis, revision surgery, and malunion/nonunion) among those with and without specific comorbidities.

Results:

Patients with other comorbidities had a statistically significant increased risk of revision surgery (p<0.0001). Additionally, those who used illicit drugs had statistically significant increased risk of sepsis (0.0213). Revision surgeries included syndesmotic screw removal, a standard procedure which does not necessarily imply presence of complication.

Conclusion:

Elderly patients are susceptible to various postoperative complications. Substance abuse is associated with revision surgery, while the presence of other comorbidities collectively is associated with sepsis. To optimize postoperative management, surgeons should be aware of patient comorbidities and exceptionally attentive at follow-up examinations for these patients.
Posterior Talofibular Ligament: The Relationship between its Length and Talar Morphometric Profiles
Authors: Angthong Chayanin , Rajbhandari Prasit
Published: October 2019

Category:

Ankle, Sports

Introduction/Purpose:

Posterior talofibular ligament is one of the lateral ligamentous complex of the ankle. However, little is known about its anatomic profile especially on the relationship between its length and the morphometric profiles of talus. The present was to analyze the correlations between PTFL length and the talar morphometric profiles in the cadaveric specimens. The PTFL variation was also reported in this study.

Methods:

A total of twenty four cadaveric ankles as twelve matched pairs of ankle were collected in this study. All ankles were measured with a Vernier caliper which provided the data for further analysis regarding the PTFL length and the talar morphometric profiles. The data was calculated to demonstrate the relationship between PTFL length and the morphometric profiles of talus. There was a cadaveric ankle which was not used in the study due to its absence of PTFL.

Results:

An average length of PTFL was 23.9+/-6.9 mm. In overall, an average talar length (TaL) was 53.5 millimeters (mm). An average talar dome height (TaH) was 31.2 mm. An average talar body width (TaW) was 41.3 mm. The average anterior trochlear width (TrAW), middle trochlear width (TrMW), posterior trochlear width (TrPW), and trochlear length (TrL) were 31.8, 31.2, 28.3, and 30.7 mm. Based on twenty three ankles, the paired samples T-test showed the significantly negative correlations between PTFL length and TrL (Pearson’s r correlation coefficient: -0.432; P-value: 0.039). Other correlations were in negative values but P-values > 0.05. There were 16 ankles (84.2%) with 1 PTFL band and 3 ankles (15.8%) with 2 bands from 19 ankles with complete data.

Conclusion:

The present study may be a first study which delineates the relationship between PTFL length and the morphometric profiles of talus. The PTFL length was negatively correlated with talar size especially on the trochlear length of talus.
Can Weightbearing CT Scans Be Used to Diagnose Subtalar Joint Instability? A Cadaver Study
Authors: Barg Alexej , Weinberg Maxwell W. , Davidson Nathan P. , Burssens Arne , Hintermann Beat , Saltzman Charles L. , Krähenbühl Nicola
Published: October 2019

Category:

Hindfoot, Trauma

Introduction/Purpose:

Accurate assessment of subtalar joint stability is difficult. Weightbearing CT (WBCT) scans have increased in popularity among foot and ankle surgeons as it offers an accurate representation of hindfoot joint alignment under weightbearing conditions. However, the clinical utility of this imaging modality to diagnose subtalar joint instability has yet to be investigated. The purpose of this study was to assess the impact of load and torque application on the assessment of subtalar joint instability when using WBCT scans. We hypothesized that load and torque application would improve the ability to identify subtalar joint instability.

Methods:

Fourteen paired male cadavers (tibial plateau to toe-tip) were included. A radiolucent frame held specimens in a plantigrade position while non-weightbearing and weightbearing CT scans (with and without torque application) were taken. First, intact ankles (Native) were scanned. Second, one specimen from each pair underwent interosseous talo-calcaneal ligament (ITCL) transection (Condition 1A), while the contralateral underwent calcaneo-fibular ligament (CFL) transection (Condition 1B). Third, the lesions were reversed on the same specimens and the remaining intact ITCL or CFL was transected (Condition 2). Finally, the deltoid ligament was transected in all ankles (Condition 3). Two radiographic measurements were performed on the level of the ankle joint (talar tilt [TT], anterior talar translation [ATT]), while the subtalar tilt (STT) was measured at the anterior, middle, and posterior plane of the subtalar joint. Inter- and intra-observer agreement calculations were additionally performed.

Results:

Weight did not impact most measurements, while the majority of measurements differed significantly within each condition after torque application. Measurements performed at the level of the subtalar joint were more reliable and better predictors for subtalar joint instability compared to measurements performed at the level of the ankle joint. Discrete ITFL, combined ITFL/ CFL, and combined ITFL/ CFL/ deltoid ligament injuries had significantly different STT values than native ankles (Figure 1).

Conclusion:

Measurements to assess the stability of the subtalar joint should primarily be performed at the level of the subtalar joint rather than at the level of the ankle joint when using WBCT scans. Torque application is crucial for identifying subtalar joint instability, while the application of load should be avoided. Future clinical studies will therefore face substantial technical challenges should they attempt to determine the clinical utility of WBCT scans for assessment of subtalar joint instability.
Flexible Fixation for Ligamentous Lisfranc Injuries
Authors: Briceño Jorge , Stupay Kristen L. , Moura Bruno , Velasco Brian , Kwon John Y.
Published: October 2019

Category:

Midfoot/Forefoot

Introduction/Purpose:

Surgical outcomes of Lisfranc injuries depend on achieving an anatomical and stable reduction. Severity of injury defines the best treatment option and surgical techniques vary from internal fixation to arthrodesis. While effective, limitations of commonly used metal implants include iatrogenic articular cartilage damage, implant breakage and need for implant removal. Additionally, these surgical techniques do not preserve tarsometatarsal (TMT) joint motion. This report demonstrates a novel, easy and inexpensive surgical technique to stabilize TMT joint instability utilizing “flexible fixation” utilized in a case series of 8 patients.

Methods:

A dorsal approach over the second metatarsal is performed in a standard fashion, after careful dissection and direct visualization of the joint, the TMT joint is anatomically reduced and stabilized with k-wires avoiding damage of the cartilage. Two 2.7 or 3.5 screws with washers are placed from dorsal to plantar in the base of the metatarsal and in the respective tarsal bone to serve as posts. A non-absorbable #2 FiberWire (Arthrex, Naples, Florida) is looped 3 to 5 times in a Figure-of-8 fashion around the screws beneath the washers, tensioned, knotted and secured by tightening the screws. Repeat fluoroscopic stress views are performed to ensure stability of the TMT joint.

Results:

N/A

Conclusion:

For selected patients with Lisfranc injuries demonstrating no significant comminution or gross instability, flexible fixation using sutures is a promising technique due its potential benefits over trans-articular screws or bridge-plating techniques. This technique is inexpensive, avoids iatrogenic cartilage damage and subsequent removal of hardware.
Regional Genetic Responses of Porcine Talar Articular Cartilage to Impact Injury
Authors: Bryant Evan (Hank) , Mansour Kailey , Huang C.Y. Charles , Kaplan Jonathan R. , Aiyer Amiethab A.
Published: October 2019

Category:

Ankle Arthritis

Introduction/Purpose:

The ankle is at greatest risk for post-traumatic osteoarthritis (PTOA) in comparison to the hip or knee. Adaptive changes to the cartilaginous topography may be a marker for where cartilage damage poses the greatest risk of development of osteoarthritis. The objective of this study was to elucidate the mechanism of PTOA by analyzing the changes in regional genetic expression of inflammatory markers after impact injury in an ex-vivo porcine model.

Methods:

Talus bones were recovered from 5 porcine ankles. A drop tower was used to induce injury by dropping a 1000 g weight from a height of 15 cm on the talus. Following the injury the bone was cultured for 24 hours. Four 6-mm cartilage plugs were harvested from the inferior aspect of each talus bone and a small slice of each plug was used for cell imaging. The remaining cartilage plugs were flash frozen with liquid nitrogen and stored at -80°C for ribonucleic acid (RNA) extraction and analysis of gene expression. Expression of inflammatory and catabolic genes (IL1-ß, TNF-a, ADAMTS-5, ADAMTS-4, MMP-3 and MMP-13) was compared among the samples obtained from the non-impacted and impacted sites of the anterior and posterior regions. Student t-test was performed to examine the differences between the control (non-impact) and impacted samples from each region and between the control samples from the anterior and posterior regions.

Results:

The current porcine impact model demonstrated significant up-regulation of several inflammatory cytokines and metalloproteinases by impact force. Among the genes tested, TNF-a, ADAMTS-4, and MMP-3 showed increased expression at impact sites (p<0.05) compared to non-impact sites in the posterior region (Figure 1) whereas no differences were found in the anterior region. Interestingly, the non-impacted samples in the anterior region exhibited significantly higher expression of TNF-a, ADAMTS-4, MMP-3 and ADAMTS-5 than those of the posterior region (p<0.05).

Conclusion:

The results of the current ex-vivo porcine impact study demonstrate significant up-regulation of inflammatory and catabolic genes 24 hours after porcine talus bone impaction. These findings highlight the relevance of regional differences in post- traumatic ankle inflammation; the posterior region of porcine talar articular cartilage demonstrated increased sensitivity in response to injury. The anterior region illustrated greater resistance to injury, showing less gene up-regulation compared to the posterior region of the same ankle. These findings suggest that location of cartilage injury may play a crucial role in the development of inflammatory response, chondrocyte apoptosis, and subsequent osteoarthritis of the ankle.