bluuebunny/crossref_metadata_2025 huggingface dataset:
Long Hallucal Tendon Force Vectors and First Metatarsophalangeal Deformity After Hallux Valgus Surgery
Authors: Yu Youngtak , Choi Youngrak , Kim Minsoo
Published: December 2023

Category:

Midfoot/Forefoot

Introduction/Purpose:

Recurrence is one of the most common complications following hallux valgus surgery. Moreover, hallux varus occurs in cases of overcorrection. We aimed to quantitatively measure, using radiographic examination, the dynamics of the soft tissues that act on deformities (recurrence of valgus and occurrence of varus) after the surgery.

Methods:

This retrospective single-institution study included 60 patients (98 feet) who underwent hallux valgus surgery between 2009 and 2018. According to radiographic findings of the foot under weightbearing conditions at postoperative month 1, we examined the tendons’ pathway and calculated the forces on the first metatarsophalangeal joint, which we termed the deformity force angle (DFA). We compared whether there was a significant difference in DFAs between the groups in which deformities occurred and those in which deformities did not occur after correction. In addition, the DFA was compared to known radiographic measurements of hallux valgus recurrence (hallux valgus angle, distal metatarsal articular angle, intermetatarsal angle, and sesamoid position) to assess association with recurrence.

Results:

We observed a significant difference in the DFA between patients with and without hallux valgus recurrence (P < .001) and between those with and without hallux varus (P < .001) based on standing radiographs taken at a minimum of 6 months postoperation. For predicting the deformities, the areas under the curve were 0.863 (hallux valgus recurrence) and 0.831 (hallux varus occurrence), respectively, which was greater than other factors evaluated. The DFA values greater than 9.5 degrees and less than 5.5 degrees were associated with the recurrence of valgus and occurrence of varus, respectively.

Conclusion:

In our study, DFA was associated with hallux valgus recurrence when it exceeded 9.5 degrees and hallux varus when it was less than 5.5 degrees. Moreover, in the hallux valgus surgery we performed, a DFA from 5.5 to 9.5 degrees appeared to be a “safe zone” for preventing early deformity after surgery.
Modified Youngswick Osteotomy for Treatment of Hallux Rigidus in Athletes
Authors: Ceccarini Paolo , Novello Giovanni , Donantoni Marco , Rinonapoli Giuseppe , Caraffa Auro
Published: December 2023

Category:

Midfoot/Forefoot; Sports

Introduction/Purpose:

Hallux rigidus is a common condition that affects athletes, particularly those who engage in high-impact sports. This condition results in pain and limited range of motion in the big toe, and can significantly affect an athlete's performance. The goal of treatment is to alleviate pain, improve function, and return the athlete to their sport. There are various surgical options available for treating hallux rigidus, one of which is the Youngswick osteotomy. This procedure involves realigning the bones of the big toe to relieve pressure and improve range of motion.

Methods:

A retrospective study was conducted to evaluate the effectiveness of the modified Youngswick osteotomy in treating hallux rigidus in athletes. The study included 40 patients, with a median follow-up of 40 months. The patients were divided into two groups based on sex: 29 female and 11 male. The side affected was also recorded, with 26 patients having the condition on their right foot and 14 on their left. The grade of hallux rigidus was also recorded, with 25 patients having grade II and 15 patients having grade III.

Results:

The study found that the median preoperative American Orthopaedic Foot & Ankle Society (AOFAS) score was 39, with a range of 25-60. After the Youngswick osteotomy, the median AOFAS score improved to 81.8, with a range of 50-90. This improvement was statistically significant (p < .0001). The range of motion (ROM) of the big toe also improved after the surgery, with the median preoperative ROM being 15.4 degrees and the median postoperative ROM being 54 degrees. Subjective satisfaction with the surgery was also recorded, with 80% of patients reporting excellent results, 10% good results, 7.5% fair results, and 2.5% poor results. The study found that there was no significant difference in the results based on sex or the side affected.

Conclusion:

The results of this study suggest that the Youngswick osteotomy is an effective treatment option for hallux rigidus in athletes. The procedure significantly improves pain, range of motion, and overall function, allowing athletes to return to their sport. The results of this study provide valuable information for clinicians who are considering the modified Youngswick osteotomy for their patients with hallux rigidus. However, it should be noted that further research is needed to confirm these findings and to determine the long-term outcomes of this procedure.
Nonunion Rate of Evans Osteotomy Without Fixation Pediatric Flatfoot
Authors: Mathew Smitha E. , Gallagher Brian P. , Miles Megan , Guyton Gregory P.
Published: December 2023

Category:

Hindfoot; Other

Introduction/Purpose:

The Evans osteotomy is a calcaneal lateral column lengthening procedure commonly used to correct flatfoot deformities. Currently, there is no consensus on whether fixation is needed when performing this osteotomy. Also, large sized grafts have been found to lead to degeneration of the calcaneocuboid joint. The aim of this study was to determine the nonunion rate of an unfixed Evans osteotomy with use of an allograft wedge performed in patients undergoing flexible flatfoot reconstruction and if addition of a medial calcaneal slide osteotomy will help limit graft size.

Methods:

We retrospectively reviewed 39 pediatric patients with idiopathic symptomatic flatfoot deformity who underwent 46 unfixed Evans osteotomies with allogenic bone graft for flatfoot reconstruction between March 2013 and September 2017, with a mean follow-up of 49 (range 9.9- 243.9) weeks. Hospital record, preoperative, follow-up radiographs and complications were reviewed.

Results:

Of the 46 feet, 42(91.3%) underwent an associated medial displacement calcaneal osteotomy. Mean graft wedge size was 7.2mm(SD 1.6). Mean time to union was 10.3weeks (range, 6.7-13.9)(Table 1). There were no nonunions. There was significant improvement in all radiographic parameters at final follow-up (Table 2). Postoperative calcaneocuboid subluxation occurred in 70% of feet, with no correlation with wedge size(r=0.01,p=0.53). Magnitude of calcaneocuboid subluxation was small and only significant at 6-months (p=0.02), with regression to no significance by 1-year(p=0.3). Mean change in calcaneocuboid subluxation at final follow-up was 1.07mm(SD 2.18), with postoperative subluxation diminishing over time(Table 3). No correlation was observed between wedge size and change in lateral column length (r=0.01,p=0.45). One patient had persistent sinus tarsi pain requiring arthroscopic debridement of fibrosis and graft prominence.

Conclusion:

An unfixed Evans osteotomy for symptomatic pediatric flatfoot deformity resulted in a significant improvement in the radiographic alignment and achieved 100% union rate with minimal calcaneocuboid subluxation at final follow-up. Performing adjunctive procedures allowed the Evans procedure to be routinely limited to less than 10 mm of lengthening. Mean graft size in our cohort was smaller than that reported by other studies. While calcaneocuboid subluxation was detectable in 70% of feet, it was small in magnitude and diminished with longer postoperative follow-up.
Patient Reported and Radiographic Outcomes following the Malerba Osteotomy
Authors: Jain Akshay , Mizher Rami , El Masry Seif , Ellis Scott J. , Cody Elizabeth A.
Published: December 2023

Category:

Hindfoot; Other

Introduction/Purpose:

The Malerba calcaneal osteotomy is a step cut Z-type osteotomy with a lateral wedge resection used to treat hindfoot varus deformity. The osteotomy allows for lateral translation while the wedge resection enables lateral rotation of the calcaneal tuberosity. The technique enables a more powerful correction of hindfoot varus without excessive lateral translation of the calcaneus, which has been shown to cause tarsal tunnel syndrome. Thus far, there have been few published clinical and radiographic outcomes on the Malerba osteotomy. The purpose of this article is to report on patient reported outcome scores (PROMIS), complications, and radiographic improvement in a series of patients treated with this osteotomy.

Methods:

A prospectively collected foot and ankle registry was queried to retrospectively identify patients who underwent a Malerba osteotomy from February 2016 through January 2022. Patients were included if they were over 18 years of age, underwent a Malerba osteotomy, had preoperative and minimum 1-year postoperative PROMIS scores, and preoperative and postoperative radiographs. 40 patients met the inclusion criteria (average age 54.3 years). PROMIS scores from 6 domains including physical function, pain interference, pain intensity, global physical health, global mental health, and depression were compared preoperatively and postoperatively. Radiographic measures including talonavicular coverage angle (TNCA), calcaneal pitch (CP), and lateral talus-1st metatarsal angle (Meary’s angle) were measured and compared preoperatively and postoperatively. Complications and radiographic union were also recorded.

Results:

At a mean of 22 months, PROMIS domains including physical function, pain interference, pain intensity, global physical health, and global mental health improved significantly; the depression scale did not significantly change (Table 1). Calcaneal pitch and Meary’s angle significantly improved from 22.9 to 19.1 (p <.001) and 8.2 to 5 (p <.001), respectively. The talonavicular coverage angle did not significantly improve (p=.2). There were no delayed unions or nonunions. There was 1 case of sural neuritis but no instances of postoperative tarsal tunnel syndrome. There were 3 (8%) superficial infections treated nonoperatively and 0 deep infections. 4 patients (10%) required reoperation: 2 for removal of hardware and 2 for conversion to subtalar fusion.

Conclusion:

The Malerba calcaneal Z-osteotomy is an effective and safe method to treat adult hindfoot varus deformity. In our series, patients demonstrated an improvement in PROMIS and radiographic outcomes with minimal complications. In particular, the rate of neurologic complications was very low with only one case of sural neuritis and no cases of iatrogenic tarsal tunnel syndrome.
Post-Operative Complications after Acute Achilles Tendon Rupture Repair: A Survival Analysis of Minimally Invasive vs Open Techniques
Authors: Hendriks Joris R.H , Sharma Siddhartha , Peiffer Matthias , Ashkani-Esfahani Soheil , Waryasz Gregory , Kerkhoffs Gino M.M.J. , Kwon John , DiGiovanni Christopher W. , Guss Daniel
Published: December 2023

Category:

Sports; Ankle

Introduction/Purpose:

Acute Achilles tendon ruptures (ATRs) can be treated surgically through either open repair or minimally invasive surgical techniques (MIS). While the relative complication rates between these techniques, including wound dehiscence, re-rupture, and sural nerve injury, have been debated, many studies demonstrate no significant difference between these two approaches. In this study, we conducted a Kaplan-Meier survival analysis to compare the incidence and timing of complications between open and MIS repair of acute ATRs and examine factors that may influence these rates.

Methods:

A retrospective study was conducted to evaluate the outcomes of patients (≥18 years) who underwent surgical intervention for acute ATR within a four-week period following injury, with a minimum follow-up of three months. Data on demographic variables, type of surgical procedure (MIS or open approach), and the occurrence and timing of postoperative complications were collected. Postoperative complications were classified as venous thromboembolism (VTE), re-rupture, surgical site infecti+D2on (SSI), wound dehiscence, and sural nerve injury.The Kaplan-Meier method was employed to compare the complication rates between the MIS and open repair groups. The log-rank test was used to test the equality of survivor functions. The Cox proportional hazards model was employed to determine predictors of complications.

Results:

In total, 417 patients were included in the final analysis. The MIS group had a higher proportion of patients with tobacco use. Fifty-two complications in 50 patients were recorded (Table 1). We found no significant difference in the complication rates between the MIS and open repair groups. However, Cox proportional hazards modeling revealed that body mass index (BMI) was a significant predictor of re-ruptures (HR 1.2, 95% CI = 1.05–1.4) and that surgical delay was found to be a significant predictor of wound dehiscence (HR 1.2, 95% CI =1.01–1.3) and sural nerve injury (HR 1.2, 95% CI =1.1–1.3). A surgical delay of more than 2 weeks was noted to have a positive likelihood ratio of 2.3 for wound dehiscence and 3.1 for sural nerve injury.

Conclusion:

The results of this study indicate that MIS and open repair techniques for acute ATRs demonstrate comparable complication rates. However, patients with elevated BMI exhibit an increased risk of re-rupture. Those with surgical delay beyond two weeks have an elevated likelihood of wound dehiscence and sural nerve injury, presumptively due to associated scaring and the requisite tissue manipulation. Surgeons and patients may consider these variables when formulating a surgical treatment plan.
Prevalence of Progressive Collapsing Foot Deformity in Hallux Valgus Patients
Authors: Fayed Aly M. , Carvalho Kepler A.M. , Schmidt Eli , Ehret Amanda , Maly Connor , Lalevee Matthieu , Chrea Bopha , Easley Mark , Mansur Nacime Salomao Barbachan , de Cesar Netto Cesar
Published: December 2023

Category:

Bunion; Midfoot/Forefoot

Introduction/Purpose:

Hallux valgus (HV) and progressive collapsing foot deformity (PCFD) are very common foot and ankle conditions in the adult population. Both could potentially disrupt the tripod construct of the foot which leads to chronic pain and arthritis. Several procedures were described to address HV deformity depending on deformity characteristics. PCFD could alter the management plan for HV if they occur simultaneously. The aim of this study was to detect the prevalence of PCFD in HV patients and study the frequency of individual PCFD classes.

Methods:

In this retrospective IRB approved study, patients > 18 years old who were evaluated for symptomatic hallux valgus and had a weight bearing computed tomography (WBCT) imaging were included. Patients were considered for further analysis if they have a hallux valgus angle (HVA) > 15° or inter-metatarsal angle (IMA) > 9°. All relevant demographic data were extracted. Two fellowship trained foot and ankle orthopaedic surgeon measured the following parameters: foot and ankle offset (FAO%) (Class A), talo-navicular coverage angle (TNCA) (Class B), Meary’s angle (Class C) and middle facet subluxation (MFS%) (Class D). Cases that showed FAO% > 4.6% and MFS% > 28.7% were diagnosed as PCFD. The prevalence of PCFD classes (A,B,C and D) was calculated using threshold values for its respective radiographic marker. Descriptive statistics were performed.

Results:

Thirty-four cases were included. 16 cases were females (46.06%) and 16 (46.06%) were right side. The average age was 52.51 years (SD ± 17.75), the average BMI was 30.14 (SD ± 7.15). The average HVA was 26.82 (SD ± 9.98) and the average IMA was 15.41 (SD ± 3.53). 13 patients (38.24%) had MFS% and FAO% above the threshold values. The average FAO was 4.75% (SD ± 4.92) and the average MFS was 29.17% (SD ± 15.89). Prevalence of Class A (FAO%) was 20 (58.82%), Class B (TNCA) was 12 (35.29%), Class C (Meary’s angle) was 15 (44.12%) and Class D (MFS%) was 16 (47.06%).

Conclusion:

Progressive collapsing foot deformity is prevalent in the hallux valgus population (38.24%). Class C which indicates medial column instability was prevalent in 44.12% of the cases. Given this high prevalence of PCFD, we believe that in addition to the classic hallux valgus parameters, PCFD classes evaluation could favor a surgical approach over another such as first tarsometatarsal joint procedures over isolated distal first metatarsal procedures to correct the HV deformity and simultaneously halt PCFD progression.
The Effects of Tibialis Anterior Tenotomy on Wound Problems after Anterior Fusion Plating for Severe Ankle Arthritis
Authors: Cho Byung-Ki , Choi Seung-Myung , Kim Sunghoo , Kim Seong-Hyeon
Published: December 2023

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Because nonunion is known to be a relatively common complication following ankle arthrodesis, various fixation techniques have been introduced to enhance the stability and to improve fusion rate. With the use of anterior plate supplementation, postoperative wound problems have been frequently reported despite better fusion rate. This study was performed to determine the effects of tibialis anterior(TA) tenotomy on wound complications and functional outcomes after anterior fusion plating for severe ankle arthritis.

Methods:

Forty-six patients who underwent ankle arthrodesis using anterior fusion plate were followed for more than 3 years. TA tenotomy was performed prior to wound closure in all patients. As a control group, thirty-eight patients who underwent arthrodesis without TA tenotomy were analysed. Clinical outcomes were evaluated with Ankle Osteoarthritis Scale(AOS) and Foot and Ankle Ability Measure(FAAM). Wound complication rate, time to fusion, fusion rate, time to pain relief below 3 points in visual analog scale were evaluated.

Results:

Mean AOS and FAAM scores significantly improved to 32.6 and 69.4 points at final followup, respectively. As compared to control group (33.8 and 67.7 points), there were no significant differences in clinical outcomes. As postoperative wound complications, there were 1 case of wound dehiscence and 1 case of superficial wound infection. TA tenotomy group showed lower wound complication rate (4.3%) than control group (21.1%). While there were no significant differences in fusion rate, time to fusion, and time to pain relief between both groups, control group needed higher rate of implant removal.

Conclusion:

Ankle arthrodesis using anterior fusion plate in conjuction with TA tenotomy appears to be an effective surgical option for end-stage ankle arthritis, with higher fusion rate and less wound complication rate. Although there was no specific functional deficit related to a loss of the TA tendon, further studies are needed to determine the long-term effects of the TA tenotomy in patients with a fused ankle.
Treatment of Symptomatic Bunionette Deformity with Distal Metatarsal Metaphyseal Osteotomy with no Fixation or Strapping
Authors: Al Ramlawi Akram , Patel Dev , Ashinsky Beth G. , Vulcano Ettore
Published: December 2023

Category:

Lesser Toes; Bunion

Introduction/ Purpose:

Bunionette deformity (BD) is a painful condition of the fifth metatarsal characterized by an osseous prominence and varus deformity. The purpose of this study is to assess the clinical, functional, and radiographic outcomes of percutaneous distal metatarsal metaphyseal osteotomy (DMMO) without fixation or post-operative strapping of the foot.

Methods:

A retrospective case series was performed on 111 patients (132 feet) with symptomatic BD who underwent percutaneous DMMO of the fifth metatarsal from September 2020 to January 2022. Patient-reported clinical outcome measures, including the Foot Function Index (FFI) questionnaire, the Visual Analog Score (VAS), and overall satisfaction were collected. Four- Five intermetatarsal angle (IMA) correction, time to bone union, and complication rates were assessed in all patients.

Results:

The mean post-operative follow-up time was 24.1 months. Both radiographic parameters and patient-reported outcome measures significantly improved after DMMO procedure. The average fourth-to-fifth IMA improved from 12.2 degrees, preoperatively, to 4.4 degrees, postoperatively (p <.001). Pre-operatively, patients had a mean VAS of 7.6, which improved to 0.6 at the last follow-up (p <.001). Furthermore, The average FFI significantly decreased from 19.2 to 4.4 (p <.001). 108 out of 111 patients reported being satisfied with the outcomes of the procedure. Average bone union was achieved at 12.6 weeks post- operation, with a minimum of 12 and a maximum of 25 weeks. The complication rate was 1.5%, including one case of an asymptomatic cock-up deformity and one case of lateral fifth metatarsal shaft bone overhang pain, which resolved with an exostectomy.

Conclusion:

The results of this study suggest that percutaneous DMMO of the fifth metatarsal without internal fixation or postoperative immobilization or strapping is effective at improving radiographic alignment, pain, function, and overall satisfaction with minimal complication.
A 3D Surface Mapping-Based Morphology Study of the Cartilaginous Surfaces of the 1st TMT Joint
Authors: Oudakker Jessica , Zhu Mingjie , Kumar Aditya , Reyes Katherine Colón , Pierce Robyn M. , Wittels Stephen , Orr Caley M. , Hunt Kenneth , Myerson Mark , Li Shuyuan
Published: December 2023

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

The first tarsometatarsal (TMT) joint plays a crucial role in maintaining the stability of the midfoot and medial column. Disorders of this joint are associated with hallux valgus, hallux rigidus, flatfoot, Lisfranc injury and arthritis, and many others. It has been proven that there is a high variability in the morphology of the joint which may be related to joint stability thereby leading to certain deformities. Understanding the morphology of the articular surfaces comprising the joint is necessary. While prior studies have used XR and CT to analyze the joint[1], we present our work using 3D surface mapping to evaluate the cartilaginous articulation of the1st TMT joint.

Methods:

22 fresh-frozen cadaveric feet without trauma nor surgery or significant deformities were dissected to expose the medial cuneiform (MeC) and 1st metatarsal (MT) bones, and the articular surfaces of the 1st TMT joint. Surface mapping of the articular surfaces and the two bones was completed using an Artec Space Spider 3D scanner and Mmics. Further digital analysis was completed using GeoMagic Studio 10.

Results:

Means and Standard Deviations (SDs) of the articular surface and the bone length were summarized in Table 1. The average articular area of the 1st TMT joint was 337.26 (±63.43) mm2 on MeC, and 337.94 (±66.16) mm2 on the 1st MT, with the length of the bones measured 25.50 (±2.56) mm for MeC and 63.93 (±4.22) mm for the 1st MT. There were statistically significant linear correlation between the articular-area and the length of the bone on both sides. 1 mm bone length increase was correlated with 11.48 mm2 articular-area increase on MeC; and 10.33 mm2 articular-area increase on 1st MT. (Figure 1,2) There were three types of morphologies of the 1st TMT joint (Type 1, with 2 facets linked to each other; Type 2, with 2 facets separated; Type 3, 1 large dorsal facet and two separate smaller facets inferiorly). The facet pattern is more obvious on the 1st MT than the MeC side. (Figure 3)

Conclusion:

Previous studies of the 1st TMT morphology were done using either direct manual measurements with descriptive reporting which does not reflect the exact contour of the joint, or XR/WBCT which cannot demonstrate the cartilaginous articulation. This study used a novel technique of surface mapping which overcame the above issues. The remodeled cartilaginous articular surfaces provide foundations for further comparison study, as well as integration of 3D surface mapping with weight- bearing CT analysis, which is currently under investigation by our research group. This will provide important information for diagnosis, surgical planning, and follow-up treatment for relevant disorders.
A Prospective Evaluation of Cost and Space Utilization Following Implementation of an Intelligent Delivery Platform for Forefoot Single-use Implants and Instrumentation in the ASC Setting
Authors: Maskill John D.
Published: December 2023

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

The transition of the US healthcare system from a fee-for-service model to a value-based care model calls for a deeper evaluation of patient care in order to uphold quality and efficiency. Sterile-packed single-use instruments have been introduced as a tool to help facilities streamline operating room logistics and reduce sterilization needs and requirements thus reducing cost, time, and valuable shelf space. With the added intelligent delivery platform, procedure mapping (physician specific stocking of implants) and automatic restocking is now possible1-3. The purpose of this study was to examine the efficiencies of cost savings and reduction of shelf space required for storage of an intelligent delivery platform (Pulse Intelligent Delivery Platform, Stryker, Memphis, TN) with single-use surgery-ready forefoot implants.

Methods:

A total of 19 cases were performed during a 3-month period (August to November 2022) at a single ambulatory surgery center. Instrument tray reduction was tabulated and compared to the number of trays typically utilized using reusable instruments. Tray management time was evaluated clinically by direct observation. A cost analysis of reprocessed instrumentation trays was then performed looking at sterilization, surgical delay, and instrumentation costs per tray and then compared to pricing for the sterile instrument kits. The instrument, sterilization, and case delay costs/tray at the facility were calculated2. A comparison of space utilization was also performed between the two groups (reprocessed trays versus sterile kits).

Results:

There was a substantial decrease in the need for reusable instrument trays by 80%. 70% of cases did not require even one tray of reusable instruments to be opened. The delivery platform was shown to lower instrument tray cost per case by 74.25%. Space was also evaluated, and the sterile kits were found to have an 85.9% reduction in space when compared to the reprocessed trays2,3.

Conclusion:

A forefoot single-use surgery ready intelligent delivery platform has been shown to effectively lower overall instrument tray cost per case by 74.25% in a highly efficient ASC. In addition, an 85.9% reduction in shelf space per tray was also seen comparing reprocessed instrumentation to sterile instrument kits. Pricing is variable per facility, and sterilization and usage processes vary1-6. However, we believe that sterile kits can be more cost effective than reprocessed sets. In addition, space can be saved with the use of sterile instrument kits adding to the established benefits of the delivery platform of procedure mapping and automatic restocking1-3.
A Systematic Review of Outcomes of Total Ankle Arthroplasty with INBONE II
Authors: Ashy Cody , Reid Jared J. , Morningstar Joshua L. , Scott Daniel , Gross Christopher E.
Published: December 2023

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

The INBONE II is a fixed-bearing implant with a stemmed tibial component commonly used for total ankle arthroplasty (TAA). Despite its frequent use and previously reported outcomes within individual clinical studies, no study has systematically reviewed outcomes of TAA with this implant. The purpose of this study was to perform a systematic review of the literature and report on outcomes of TAA with the INBONE II.

Methods:

A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Databases searched included PubMed, Google Scholar, SCOPUS and CINAHL from database date of inception through February 28th, 2023. Clinical studies of INBONE II outcomes in peer reviewed journals were included. Outcomes included were survivorship, patient reported outcome measures (PROMs), and complications. Outcome results were compiled using weighted averages when possible. This review of 26 articles included 808 patients with 667 primary TAA and 141 revision TAA.

Results:

Survivorship, with failure defined as metal component revision, was 97.8% at an average follow-up of 49 months (range, 14-85.4 months) and 94.2% at an average follow-up of 25.7 months (range, 9.1-47.5) months for primary and revision TAA respectively. Complication rates for primary TAA included: 3.8% intra-operative fractures, 2.5% post-operative fractures, 1.8% deep infection, 8.0% wound complications, 1.6% rate of poly exchange, and 1.6% nerve injuries. Revision TAA complication rates included: 12.3% intra-operative fractures, 6.9% wound complications, 3.3% deep infections, and a 5.5% incidence of nerve injury. Average PROMs for primary TAA included: AOFAS American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score improved 41 points, visual analog scale (VAS) scores decreased 5.9, and patient satisfaction of 92.6%. Revision TAA PROMs were not consistently reported.

Conclusion:

This study is the largest compilation of INBONE II outcomes and survivorship. Primary and revision TAA with the INBONE II results in satisfactory improvement in PROMs and low complication rates. The overall survivorship is 97.8% and 94.2% at an average follow-up of 49 months (range, 14-85.4 months) and 25.7 months (range, 9.1-47.5) for primary and revision total ankle arthroplasty respectively. These findings support continued use of this implant in primary and revision TAA.
A Systematic Review of Tibialis Posterior Tendon Entrapment in Pilon and Trimalleolar Injuries
Authors: Mason Lyndon W. , Aamir Junaid , Syziu Anxhela
Published: December 2023

Category:

Ankle; Trauma

Introduction/Purpose:

The tibialis posterior tendon (TPT) entrapment is an uncommon complication associated with posterior malleolar and pilon fractures. If undiagnosed, TPT entrapment is associated with significant morbidity. Our aim was to perform a systematic review of all reported TPT entrapments in the literature to further understand its risks and outcomes.

Methods:

The electronic databases Scopus, PubMed, and Medline was utilised to identify the relevant publications regarding TPT entrapment in pilon and ankle fractures. Inclusion criteria: all adult studies published in English language reporting the outcome of TPT entrapment in patients with ankle injuries. To critically appraise the papers, CASP clinical appraisal tool was used.

Results:

Four retrospective studies and eight case reports were accepted in this review. Collectively there were, 489 Pilon fractures, 77 of which presented with TP entrapment (15.75%). There were 28 Tri-malleolar fractures, 12 of which presented with TP entrapment (42.86%). All the case report studies reported inability to reduce the fracture at initial presentation. The diagnosis of TPT entrapment was made in the early period in 25% of cases and delayed diagnosis in 75% of cases reported. Utilising modified Clavien-Dindo complication classification, 67% of the injuries reported GRADE IIIA complications, and the rest GRADE IIIB complications.

Conclusion:

In conclusion, TPT tendon was the commonest tendon injury associated with Pilon and Tri-malleolar ankle fractures. Early identification, utilising a clinical suspicion and CT imaging, could lead to early management of TP entrapment in these injuries which could potentially lead to better patient outcomes and reduced morbidity.
Acute Deltoid Injury in Ankle Fractures: A Biomechanical Analysis of Different Repair Constructs
Authors: Wagner Emilio , Wagner Pablo , Escudero Mario I. , Pacheco Florencia , Salinas David Andres , Godoy-Santos Alexandre Leme , Palma Felipe , Guzman-Venegas Rodrigo A. , Berral Francisco J.
Published: December 2023

Category:

Trauma; Ankle

Introduction/Purpose:

The importance of the deltoid ligament in the congruency of the tibiotalar joint is well known. The current trend is to repair it in cases of acute injuries in the context of ankle fractures, however, there is no information on how it should be reconstructed. The objective of this study was to compare different deltoid ligament repair types in an ankle fracture cadaveric model.

Methods:

16 cadaveric foot-ankle-distal tibia specimens were used to conduct the study. All samples were prepared as a supination external rotation ankle fracture model. An axial load and cyclic axial rotations were applied on every specimen using a specifically designed frame. This test was performed without deltoid injury, with deltoid injury and finally with the ligament reconstructed. The reconstruction was performed in 4 different ways (anterior, posterior, middle, combined) using 4 specimens per group. Medial clear space (MCS) was measured for each condition on simulated weight-bearing and gravity stress radiographs. Reflective markers were utilized in tibia and talus, registering through a motion analysis system the kinematics, to record the tibiotalar uncoupling. Statistical analysis was performed using the SPSS software.

Results:

In all cases, the MCS increased significantly on gravity stress radiographs after damaging the deltoid ligament. There was no increase in the MCS on load radiographs. After repair, in all cases, the MCS was normalized. Kinematically, after damage the tibiotalar uncoupling increased significantly, decreasing after repair. All repairs significantly corrected the tibiotalar uncoupling, observing a significantly increased coupling effect (increased stiffness) with the combined repair.

Conclusion:

Our results show that deltoid repair recovers the tibiotalar coupling mechanism in an ankle fracture model. We suggest that the ideal repair should aim to repair the middle aspect of the deltoid ligament. The combined repair may lead to postoperative stiffness. Clinical studies are needed to prove these results and show clinically improved outcomes.
Analysis of Clinical and Radiological Results of Total Ankle Arthroplasty According to Varus Deformity
Authors: Jeong Bi O , Jung Cheol Hyun
Published: December 2023

Category:

Ankle Arthritis

Introduction/Purpose:

This study aimed to evaluate the clinical and radiological results of total ankle arthroplasty, performed in ankle arthritis patients with varus deformity, according to the rotation and displacement types.

Methods:

Among the patients who had undergone total ankle arthroplasty using Hintegra, a 3-part prosthesis for end-stage ankle arthritis, 44 cases that were followed up for at least 1 year were included in this study. The patients were classified into either rotation or displacement type, and the clinical and radiological results of each group were analyzed. For clinical evaluation, the VAS and AOFAS ankle-hindfoot scale were used. Radiological evaluation was measured by using mechanical axis deviation (MAD), medial distal tibial angle (MDTA), talar tilt angle, tibiotalar angle (TTA), talus center migration (TCM), tibia-talar ratio (TTR), anterior distal tibial angle (ADTA) and hindfoot alignment angle (HAA).

Results:

Of the 44 cases, both the rotation and the displacement types were 22 cases each. VAS improved from 6.0±1.4 points and 6.0±1.5 points in each group before surgery to 2.0±0.9 points and 0.0±0.8 points at the final follow-up, showing a significant difference between the two groups (p < 0.001). The AOFAS scale improved from 59.5±11.0 points and 50.0±15.1 points in each group to 80.0±11.9 points and 97.0±8.0 points at the final follow-up, and the difference between the two groups was statistically significant (p=0.003). Most of the radiological indicators in each group were significantly improved. TCM was changed from 1.4±2.5mm and 6.7±2.6mm in each group before surgery to 0.8±2.2mm and 3.4±1.3mm at the last follow-up, and there was a significant difference in the displacement group (p < 0.001).

Conclusion:

Clinical and radiological improvements were obtained after total ankle arthroplasty, regardless of the deformity type. Displacement-type strains showed better clinical measures than rotational strains. The more normal the alignment of the hindfoot was, the better the clinical scale was. In patients with end-stage arthritis accompanied by medial displacement of the center of the talus, efforts to restore the normal alignment are needed.
Analysis of Patient-Reported Outcomes Following Triple Arthrodesis: A Minimum Two-Year Followup
Authors: McCrosson Matthew J. , Sanchez Thomas , Scheinberg Mila , Underwood Meghan , Young Matt , Earla Rishi , Brannigan Matthew J. , Sisk Morgan , Shah Ashish
Published: December 2023

Category:

Hindfoot

Introduction/Purpose:

Adult acquired flatfoot deformity (AAFD) is a debilitating condition that is common in the United States. Triple arthrodesis (TA) is a treatment option reserved for advanced disease. Evidence on patient outcomes following this procedure remains limited. This study aims to report patient-reported outcomes following TA via patient reported outcome measurement information systems (PROMIS). Secondary aims are to delineate any demographics or patient characteristics that significantly impact PROMIS scoring.

Methods:

In this single institution study, we identified all patients who underwent triple arthrodesis between 2014 and 2021 based on CPT coding. Patients who underwent a TA procedure for AAFD with a minimum of 24 months follow-up were eligible for inclusion in this study. Patients under the age of 18, those undergoing revision surgeries, or those with pathologies other than AAFD were excluded from this study. Patient demographics and surgical complications were collected through chart review. The Patient Reported Outcomes Measurement Information System (PROMIS) survey and Foot Function Index (FFI) scores were collected via telephone interview. PROMIS scores were analyzed with a Type III “SS” ANOVA test to stratify independent risk factors and account for confounding variables.

Results:

49 patients (43%) submitted responses to the survey. Patient outcomes were collected at an average of 5.50 years postoperatively. There were no significant differences in the rates of complications among any of the variables analyzed. The average PROMIS physical function score was 38.35, the average pain interference score was 61.52, and the average depression score was 49.82. Males and patients with prior foot and ankle procedures had significant increases in PROMIS physical function scores (p <.05). The mean FFI scores were 58.56 for pain, 60.07 for disability, and 48.07 for activity limitation. Patients > 50 years old had significantly higher FFI pain, disability, and total scores (p <.05). VAS scores decreased preoperatively to postoperatively from 5.4 to 2.6.

Conclusion:

Our study is the first to examine variables significantly impacting PROMIS, FFI and VAS scores for patients undergoing TA for AAFD. Treatment of AAFD with TA appears to be beneficial in long-term reduction of pain. This study is one of the largest to date involving patient reported outcomes following TA and can serve as a prognostic tool for physicians to use when counseling patients prior to this procedure.
Arthrodesis of the Second and Third Tarsometatarsal Joints: Comparison of Clinical Results Using Combined or Individual Plating Techniques
Authors: Ankers Thomas H. , Mason Lyndon W. , Singh Anjani , Walker Christopher R. , Sirikonda Siva
Published: December 2023

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

Arthrodesis is an effective treatment of midfoot arthritis in reducing pain and improving function. However, there is a known risk of non-union. Our aim was to compare the outcomes of individual plating versus dual plating for combined fusion of the 2nd and 3rd tarsometatarsal joints (TMTJs). Our primary outcome was bone healing and secondary outcomes include patient reported outcome measures.

Methods:

All cases underwent primary arthrodesis of the 2nd and 3rd TMTJs. Arthrodesis was performed using either a single ‘H- shaped’ plate (combined plating group) or using two separate plates (individual plating group). The outcome measures were bony union and the Manchester-Oxford Foot Questionnaire score.

Results:

Forty-five procedures were undertaken with a mean follow-up of 527 days. The combined plating group had 28 cases and individual plating group had 17 cases. There were 10 cases (35.71%) of non-union in the combined plating group and 2 cases (11.76%) in the individual plating group. Muti-variate regression analysis showed a significant relationship of non-union with use of the combined plating group (p =.047, OR 5.822). Patients who had also undergone 1st TMTJ fusion had an increase chance of union (p=.043, OR 9.896). No other factors showed significance. MOX-FQ scores were superior in the individual group at 6 months post-surgery although this significance was lost when the non- unions were excluded.

Conclusion:

This study is the first to report a difference in union between combined plating and individual plating techniques in arthrodesis of the 2nd and 3rd TMTJs. We believe that individual plates permit a more anatomical reduction and greater compression at the site of arthrodesis as compared to a dual plate technique. Achieving union results in a better functional outcome.
Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in Chondral Lesions at the Ankle as Part of a Complex Surgical Approach: 5-Year Follow-up
Authors: Richter Martinus , Zech Stefan , Meissner Stefan A. , Naef Issam
Published: December 2023

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

The aim of the study was to assess 5-year-follow-up (5FU) after Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in chondral lesions at the ankle as part of a complex surgical approach.

Methods:

In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral lesion at the ankle treated with AMIC+PBC from July 17, 2016 to May 31, 2017 were included. Size and location of the chondral lesions, the Visual-Analogue- Scale Foot and Ankle (VAS FA) and the EFAS Score before treatment and at 5FU were analysed and compared with previous 2- year-follow-up (2FU). Peripheral Blood Concentrate (PBC) was used to impregnate a collagen I/III matrix (Chondro-Gide, Wolhusen, Switzerland) that was fixed into the chondral lesion with fibrin glue.

Results:

One hundred and twenty-nine patients with 136 chondral lesions were included in in the study. The chondral lesions were located as follows (n (%)), medial talar shoulder only, 62 (46); lateral talar shoulder only, 42 (31); medial and lateral talar shoulder, 7 (10); tibia, 18 (13). The average for lesion size was 1.8 cm2, for VAS FA 45.7 and for EFAS Score 9.8. 2FU/5FU was completed in 105 (81%)/104(81%) patients with 112/111 previous chondral lesions. VAS FA improved to 79.8/84.2 and EFAS Score to 20.3/21.5 (2FU/5FU). No parameter significantly differed 2FU and 5FU.

Conclusion:

AMIC+PBC as part of a complex surgical approach led to improved and high validated outcome scores at 2FU/5FU. 2FU and 5FU did not differ.
Biomechanical Comparison of Nitinol Compression Staples vs Fully Threaded Lag Screws for Talonavicular Arthrodesis
Authors: Reddy Prati Jahnu , Schweser Kyle M. , Cook James , Garlapaty Ashwin , Manning Blaine T. , Bezold Will
Published: December 2023

Category:

Hindfoot; Other

Introduction/Purpose:

The talonavicular joint is a crucial component of the hindfoot complex. Talonavicular arthrodesis has significant effects on foot biomechanics and motion. Current techniques for talonavicular arthrodesis vary and include a variety of constructs. Despite favorable clinical results, there is a lack of data regarding the biomechanical performance of second-generation nitinol compression staples compared to screw fixation for talonavicular arthrodesis. The objective of this study was to compare nitinol compression staples with fully threaded lag screws in talonavicular fusion with respect to their clinically relevant biomechanical properties during functional testing.

Methods:

A single orthopaedic surgeon used either two nitinol compression staples (Arthrex, Naples, FL) or two fully threaded lag screws (Arthrex, Naples, FL) on cadaveric feet (n=12; 6 matched pairs) to perform surgical arthrodesis of the talonavicular joint; each pair undergoing each procedure in random order and alternating between left and right feet. Optical tracking markers were attached to the talus and navicular bone to track displacements. Specimens were loaded at 89N/sec from 30N to 445N for 1 minute. A continuous compressive load of 445N was applied while cycling from 30° plantarflexion to 15° dorsiflexion for 10 cycles. Translation data were recorded along the X, Y, Z planes. Rotation data were recorded for roll, pitch, and yaw. Significant (p < 0.05) differences were determined using paired t-Tests, comparing staple fixation versus screw fixation for each measured variable.

Results:

There were no statistically significant differences between staples and screws between translation in the X, Y, and Z planes. When comparing rotation (roll, pitch, and yaw), there were no statistically significant differences with the exception of increased roll rotation for staple fixation versus lag screw fixation during static compression testing only (p=0.009).

Conclusion:

Based on clinically relevant biomechanical properties measured during functional robotic testing of the hindfoot, nitinol compression staples are a viable option for use in talonavicular arthrodesis.
Biomechanical Evaluation of 4th Generation Minimally Invasive Distal First Metatarsal Osteotomy-Akin Osteotomy Technique on First Ray Articular Contact Properties
Authors: Reddy Sudheer C. , Schipper Oliver , Li Jihui
Published: December 2023

Category:

Bunion; Basic Sciences/Biologics

Introduction/Purpose:

Hallux valgus is a common deformity encountered, but remains a complex clinical entity. Fourth generation minimally invasive (MIS) techniques consisting of a percutaneous distal metatarsal transverse osteotomy combined with an Akin osteotomy have been utilized to address mild to severe hallux valgus deformities. Benefits of a MIS approach include improved cosmesis, faster recovery, lower opiate requirement, immediate weightbearing, and favorable outcomes relative to a traditional, open procedure. An understudied area with respect to hallux valgus correction is the effect that osteotomies can have on the articular contact properties of the first ray following correction.

Methods:

Sixteen paired cadaveric specimens were dissected to include the first ray and tested in a customized apparatus. Specimens were randomized to receive a distal transverse osteotomy translated either 50% or 100% of the width of the first metatarsal shaft. The osteotomy was performed with either a 00or 200 distal angulation of the burr relative to the shaft in the axial plane. Specimens were tested in the intact state and following the distal first metatarsal osteotomy for peak pressure, contact area, contact force and center of pressure at the first metarsophalangeal joint (MTP) and first tarsometatarsal joint (TMT). An Akin osteotomy was then performed on each specimen and peak pressure, contact area, contact force and center of pressure were recalculated.

Results:

There was a notable decrease in peak pressure, contact area, and contact force across the TMT joint with greater shifts of the capital fragment. However, at 100% translation of the capital fragment, distal angulation of the osteotomy by 200 appears to improve loading across the TMT joint. Addition of the Akin osteotomy at 100% translation also aids in increasing the contact force across the TMT joint. The MTP joint is less sensitive to changes in shifts and angulation of the capital fragment. The Akin osteotomy also leads to increased contact force across the MTP joint when the capital fragment is translated 100%.

Conclusion:

While the clinical significance is unknown, larger shifts of the capital fragment lead to greater load alterations at the level of the TMT joint than the MTP joint. Distal angulation of the capital fragment and the addition of an Akin osteotomy can aid in reducing the size of those changes. The Akin can lead to increased contact forces at the MTP joint with 100% translation of the capital fragment.