bluuebunny/crossref_metadata_2025 huggingface dataset:
Histological Findings Upon Patients Undergoing Revision Surgery after AMIC of the Talus
Authors: Krause Fabian , Anwander Helen , Schaefer Birgit
Published: January 2022

Category:

Ankle Arthritis

Introduction/Purpose:

Failure after AMIC (autologous matrix-induced chondroplasty) of the talus is relatively rare and ranges between 2-6%. The purpose of the study was to analyze the histologic quality of the repair cartilage and potentially identify the mode of failure in 3 patients that underwent revision surgery after primary AMIC procedures.

Methods:

Out of 48 patients treated with AMIC for OLT between 2012 and 2018 at our institution, three patients (6.2%, average age 27.3 years) required revision surgery for various reasons. During revision, repair cartilage was evaluated about integration with the surrounding healthy cartilage and firmness, and specimen were taken for histologic assessment.

Results:

Only one patient that had, next to revision AMIC, a lateral ligament reconstruction for a secondary supination sprain, improved clinically after revision surgery (patient no.3). Despite repair SMOT (no.1) or deltoid ligament repair (no.1), the two other patients did not benefit from revision. Supposed reasons for ongoing symptoms were progressive posttraumatic arthritis (no.1 and 2) and neuropathic pain (no.2). Three types of soft connective tissues could be identified: (i) non-vascularized fibrocartilaginous tissue (patient no. 1-3), (ii) fibrous tissue (patient no. 1 and 2), and (iii) hyaline like cartilage (patient no. 3).

Conclusion:

Overall, data support the theory that patients with hyaline or hyaline-like repair cartilage tend to better clinical outcome over time. However, the growth of hyaline or hyaline-like repair cartilage appears to require ligamentous stability, neutral or even offloading hindfoot alignment, and absence of arthritis.
Percutaneous Bunionette Correction without Fixation: Clinical Results and Radiographic Evaluations Including Rotation of Metatarsal Head and Sagittal Angular Change of Fifth Metatarsal
Authors: Kurashige Toshinori
Published: January 2022

Category:

Lesser Toes

Introduction/Purpose:

Bunionette has been treated as an analogy of hallux valgus, and the surgical techniques are similar. However, only the anteroposterior image is generally evaluated pre- and postoperatively. There are few studies that evaluated on the lateral radiograph, and to the best of our knowledge, no study that evaluated changes in rotation of fifth metatarsal head. In percutaneous bunionette correction using a burr, shortening of fifth metatarsal and elevation of metatarsal head are inevitable. In addition, there is also the possibility of rotational change of metatarsal head without fixation.

Methods:

We evaluated 18 consecutive feet performed percutaneous bunionette correction without internal fixation. Mean age was 54.9 years. Mean follow-up was 10.1 months at least six months followup. On anteroposterior weightbearing radiograph, we measured the fifth metatarsophalangeal angle (MPA), fourth and fifth intermetatarsal angle (IMA), the fifth metatarsal head width (MHW), the lateral deviation angle (LDA) of the fifth metatarsal, and fifth metatarsal shortening. On the lateral weightbearing radiograph, we measured the lateral inclination angle (LIA) of the fifth metatarsal, the fifth distal metatarsal height (DMH), mid metatarsal height (MMH), proximal metatarsal height (PMH), and plantar bowing angle (PBA). To evaluate the rotation of the fifth metatarsal head, we devised a new original method measured at the medial tubercle location (MTL). Preoperatively and at the most recent follow-up visit, we applied the Japanese Society for Surgery of the Foot (JSSF) lesser scale and visual analogue pain scale (VAS).

Results:

Except for MTL, DMH and PMH, all parameters showed significant changes postoperatively.MPA, IMA and LDA reduced from 17.3 degrees to 6.4 degrees, from 9.9 degrees to 4.5 degrees, and from 2.3 degrees to -10.0 degrees, respectively. Shortening of fifth metatarsal was 2.5 mm. Despite not performing partial head resection, MHW decreased from 12.1mm to 11.4 mm. LIA decreased from 9.2 degrees to 6.1 degrees. MMH decreased from 11.6 mm to 10.9 mm. PBA decreased from 7.0 degrees to -1.3 degrees. Union was obtained at 6.9 weeks. MTL reduced from 3.4 to 2.8 but not significantly. However, MTL changed in 15 of 18 feet (83.3%) postoperatively. JSSF lesser scale improved from 66.7 to 97.8 points. VAS also improved from 3.6 to 1.0. One foot had a delayed union and an occasional pain.

Conclusion:

Percutaneous bunionette correction without fixation could achieved good clinical and radiographic results comparable with previously published outcomes of open and percutaneous surgery with fixation with less complication. The procedure could be adapted to different types of bunionette deformity. In this surgical method, bunionette is corrected in three dimensions.
Percutaneous Surgery for Interdigital and Lateral Fifth Toe Corns
Authors: Kurashige Toshinori
Published: January 2022

Category:

Lesser Toes

Introduction/Purpose:

Lateral fifth toe corns (LFC) form as a result of extrinsic pressure from footwear. Interdigital corns (IDC) form over the condyles of the phalanx between the toes, and can be soft and very painful in most cases. When conservative treatment fails, surgical treatment is indicated. Partial condylectomy for interdigital cornsis difficult because of the narrow webspace and risk of painful postoperative scar. No prior study has been published on percutaneous surgery for lateral fifth toe and interdigital corns, with the exception of some publications on the explanation of the technique.

Methods:

We performed percutaneous partial condylectomy for six toes in five patients with one LFC and five IDCs. The mean age was 71 years. The mean follow-up period was 16.2 months. All feet, except for one malalignment case after second proximal phalanx fracture, had both hallux valgus and bunionette. A small incision was made distal to the corn to allow the insertion of the entire cutting surface of a burr to avoid skin damage. The periosteum was removed from the eminence by a small rasp and provided an adequate working area. The bone eminence was then removed with 2-5 or 2-8 mm burrs. For hallux valgus and proximal phalanx malalignment after fracture, we also corrected them percutaneously. In some cases, the Japanese Society for Surgery of the Foot (JSSF) lesser toes scales and self-administered foot evaluation questionnaire (SAFE-Q) were evaluated pre- and postoperatively.

Results:

There was no complication, except for one valgus deformity in the second proximal interphalangeal joint after partial condylectomy. At the final follow-up visit, all patients had no recurrence of corns and no symptoms, and were very satisfied with the results during the follow-up period of one year. In case of IDC, JSSF lesser toes scale improved from 45 points to 100 points at the final follow-up. All SAFE-Q subscores were improved with regard to 'Pain and pain-related' sensations from 36.7 to 99.6, 'Physical functioning and daily living' from 54.5 to 100, 'Social functioning' from 37.5 to 100, 'Shoe-related' from 25 to 100, and 'General health and well-being' from 25 to 95. The visual analog scale of pain improved from 7 to 0.4.

Conclusion:

The percutaneous procedure consisted of partial condylectomy with correction of associated deformities achieved good results without major complications and recurrence over the one year follow-up period.
Radiographic and Clinical Results of Minimally Invasive Chevron Akin Osteotomy for Moderate to Severe Hallux Valgus Deformities
Authors: Kurashige Toshinori
Published: January 2022

Category:

Bunion

Introduction/Purpose:

Some authors reported the results from the third-generation minimally invasive chevron Akin osteotomy (MICA) to treat mild to moderate hallux valgus recently. However, there have been few studies evaluating the results of MICA for moderate to severe hallux valgus. The purpose of this study was to evaluate the radiographic and clinical results of MICA for correction of moderate to severe hallux valgus.

Methods:

A prospective review of 30 patients (40 feet) that underwent MICA for moderate to severe hallux valgus was conducted. The 28 feet (70%) were classified as severe deformity (hallux valgus angle (HVA) >= 40°and/or first intermetatarsal angle (IMA) >= 18°). Mean followup was 18.6 months. On the anteroposterior weightbearing radiographs, HVA, IMA, lateral shape of metatarsal head (round sign), tibial sesamoid position, and first metatarsal shortening were measured. On the lateral weightbearing radiographs, inclination angle of first metatarsal was measured. American Orthopaedic Foot & Ankle Society hallux metatarsophalangeal-interphalangeal (AOFAS) scores and Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were evaluated preoperatively and at the most recent follow-up.

Results:

Mean HVA reduced from 39.3° to 12.8°and mean IMA reduced from 18.6° to 8.4° postoperatively. Incidence of positive round sign of metatarsal head reduced from 57.5% to 5%. Tibial sesamoid position improved from 6.7 to 4.7 using Hardy's classification. Average first metatarsal shortening was 2.8mm. Inclination angle did not changed significantly, from 20.5°to 21.1°. Mean AOFAS score improved from 65.3 points to 97.9 points. All SAFE-Q subscores also significantly improved postoperatively. There were 5 complications required surgeries: 2 metatarsal screw removals and 3 bone eminence resections. There were some other complications including 3 under-correction cases and one numbness for at least 6 months.

Conclusion:

MICA could improve moderate to severe hallux valgus both radiographically and clinically. Accordingly, our results suggest that this procedure provides an effective means of correcting hallux valgus regardless of severity of deformity.
Correlation of Stress Radiographs to Injuries Associated with Lateral Ankle Instability
Authors: Lause Gregory E. , Sy Joshua , Lopez Andrew , Deal J. Banks , Lustik Michael , Ryan Paul M.
Published: January 2022

Category:

Ankle; Sports

Introduction/Purpose:

Stress radiographs have demonstrated superior efficacy in the evaluation of ankle instability. The purpose of this study is to determine if there is a degree of instability evidenced by stress radiographs that is associated with pathology concomitant with ankle ligamentous instability.

Methods:

A retrospective review of 87 consecutive patients aged 18-74 who had stress radiographs performed at a single institution between 2014 and 2020 was performed. These manual radiographic stress views were then correlated with MRI and operative findings.

Results:

A statistically significant association was determined for the mean and median stress radiographic values and the presence of peroneal pathology (p=0.008 for tendonitis and p= 0.020 for peroneal tendon tears). A significant inverse relationship was found between the presence of an osteochondral defect and increasing degrees of instability (p=0.043).

Conclusion:

Stress radiographs may assist the surgeon in clinical decision making.
Additional Inferior Extensor Retinaculum Augmentation after All-Inside Arthroscopic Anterior Talofibular Ligament Repair for Chronic Ankle Instability is Not Necessary
Authors: Lee Sung Hyun
Published: January 2022

Category:

Ankle; Arthroscopy; Sports

Introduction/Purpose:

Although several arthroscopic surgical techniques for the treatment of chronic ankle lateral instability (CAI) have been introduced recently, the effect of inferior extensor retinaculum (IER) augmentation remains unclear. The purpose of this study was to compare the clinical outcomes after arthroscopic anterior talofibular ligament (ATFL) repair according to whether additional IER augmentation was performed or not.

Methods:

Between 2016 and 2018, we performed a retrospective review of consecutive patients who underwent arthroscopic ATFL repair surgery for CAI. The mean age of the patients was 35.2 years (range, 19-51 years), and the mean follow-up period was 32.6 months (range, 24-48 months). Patients were divided into two groups according to the surgical technique used for CAI: Arthroscopic ATFL repair (group A, n = 37), and arthroscopic ATFL repair with additional IER augmentation (group R, n = 45). The Pain Visual Analog Scale, American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome score (FAOS), and the Karlsson Ankle Functional Score were measured as subjective outcomes, and posturographic analysis was performed using a Tetrax device as an objective outcome. Radiologic outcome evaluations were performed preoperatively and at 2 years postoperatively using stress radiographs and axial view MRI.

Results:

Out of 101 patients, 19 (18.5%) were excluded based on the exclusion criteria, and 82 patients were evaluated. We identified a total of six re-tears (7.3%) based on postoperative MRI evaluation. All patients who had ATFL re-tear on MRI (8.1% [3/37] in group A, and 6.7% [3/45] in group R) demonstrated recurrent CAI with functional discomfort and anterior displacement > 3 mm compared to the intact contralateral ankle. All clinical scores and posturography results were improved after surgery in both groups (P < 0.001). However, there were no significant differences in the clinical results and radiologic findings between the two groups.

Conclusion:

The clinical and radiologic outcomes of patients with CAI improved after all-inside arthroscopic ATFL repair. However, additional IER augmentation after arthroscopic ATFL repair did not guarantee better clinical outcomes.
Proximal Phalanx Osteotomy in Percutaneous Correction of the Lesser Toe Deformities: A Cadaver Study
Authors: Leucht Anna-Kathrin , Wiewiorski Martin J. , Dalmau-Pastor Miki , Pellegrino Alexandro
Published: January 2022

Category:

Lesser Toes

Introduction/Purpose:

The correction of lesser toe deformities has been traditionally performed in an open fashion. With minimal-invasive foot surgeries becoming increasingly popular, correction of lesser toe deformities via percutaneous soft-tissue procedures and osteotomies is frequently performed. The aim of this study was to evaluate the site of percutaneous proximal phalanx osteotomy of the lesser toes in relation to the metatarsophalangeal joint line when performed without fluoroscopy guidance.

Methods:

In this experimental cadaver study, the metatarsophalangeal joints of the lesser toes of 20 cadaver samples (=80 toes) were palpated. A plantar skin stab incision was made just distal to the joint line without fluoroscopic control. Plantar closing osteotomies of the proximal phalanx were performed with a Shannon burr. Adorsoplantar view was taken with fluoroscopy. The location of the osteotomy and the relative distance from the metatarsophalangeal joint line was evaluated.

Results:

The majority (78/80; 97.5 %) of the osteotomies were localized in the metaphyseal region. No osteotomy violated the metatarsophalangeal joint.

Conclusion:

Percutaneous osteotomy of the proximal phalanx of the lesser toes guided by palpation without using the image intensifier is a safe procedure and does not violate the metatarsophalangeal joint.
Ankle/Hindfoot Arthrodesis as a Salvage Procedure for Failed Total Ankle Arthroplasty
Authors: Lim Jung-Won , Song Won Tae , Jung Hong-Geun , Im Jemin
Published: January 2022

Category:

Ankle; Hindfoot

Introduction/Purpose:

High failure rate after total ankle arthroplasty (TAA) in 10-year follow-up has been reported, ranging from 10 to 20%. Massive bony destruction after TAA often caused by periprosthetic osteolysis, implant subsidence or loosening, or periprosthetic infection, and it would be considerable challenge to many orthopedic surgeons. In some cases, it is difficult to perform revision arthroplasty. For failed TAA, ankle/hindfoot arthrodesis can be performed as a salvage procedure. In this study, we evaluate the clinical and radiologic outcomes of the ankle/hindfoot arthrodesis in patients with failed TAA.

Methods:

Ankle/hindfoot arthrodesis was performed in 10 ankles with failed TAA from October 2003 to March 2019 (at least 6- month follow-up). As for the clinical evaluation, visual analogue scale (VAS) pain scores, and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores were assessed. Postoperative complications such as skin necrosis, surgical site infection (SSI), or non-union were reviewed through medical records. Radiographs including CT images at last follow-up were assessed to confirm bone union.

Results:

The average follow-up was 49.1 months (range, 7-89). There were 6 cases performed with tibiotalocalcaneal (TTC) arthrodesis, and 4 cases with ankle arthrodesis. The operations were performed at mean postoperative 46.6 months (range, 8- 178) from index TAA. Allo-femoral head structural bone graft was used in 9 cases, and auto proximal tibia cancellous bone graft was used in 5 cases. Mean VAS pain score decreased from 7.6 pre-operatively to 2.2. AOFAS score increased from 15.6 to 42.0 (subjective assessment only; maximum score=68). 3 revision surgeries had been performed after initial arthrodesis (1 case for SSI, 2 cases for non-union), and bone union was obtained in 2 cases (1 case of SSI, 1 case of non-union).

Conclusion:

Ankle/hindfoot arthrodesis after failed TAA can be optimal surgical option for the patients with massive bony destruction which compromises revision arthroplasty. It acts as a salvage procedure for failed TAA and could yield favorable outcome.
Comparison of the Outcome of the 3-Component Salto Total Ankle Arthroplasty for Ankle with Preoperative Varus, Valgus and Neutral Alignment in End-Stage Osteoarthritis
Authors: Lim Jung-Won , Jung Hong-Geun , Im Jemin
Published: January 2022

Category:

Ankle; Ankle Arthritis

Introduction/Purpose:

As the popularity of total ankle arthroplasty (TAA) increases, indication of TAA also expands. Recently, the ankles more than 20° of varus or valgus deformity in the coronal plane are treated with TAA. However, severe varus or valgus deformity should be corrected in the coronal plane to avoid residual mal-alignment that leads to instability, insert wear, and clinical failure. In this study, we compare the clinical and radiologic outcome of the Salto mobile bearing 3-component total ankle prosthesis for ankles with preoperative varus, neutral, and valgus alignment.

Methods:

TAA was performed in 101 consecutive ankles (99 patients) by a single surgeon using 3-component Salto total ankle implant from June 2014 to October 2019. A prospectively collected database was used to identify all patients who underwent primary TAA with a minimum 1-year follow-up. We classified the enrolled ankles as neutral, varus, or valgus groups. More than 10° of tibial anterior surface angle, talta tilt angle, tibial axis-talar dome angle, talar dome-ground surface angle (TD-GSA), or tibio- calcaneal angle was defined as varus or valgus groups. All patients were followed up at postoperative three months, six months, at one year and yearly thereafter. Clinical outcome scoring was done pre-operatively and post-operatively. American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot functional score, pain VAS, satisfaction score and clinical range of motion (ROM) were collected along with weight-bearing radiographs of the ankle. Post-operative coronal alignment of the component were evaluated with radiographs.

Results:

The average follow-up was 21.6 months (range, 12-71). Preoperatively, there were 63 ankles (62%) with varus deformity, 27 ankles (27%) with neutral alignment, and 11 ankles with valgus deformity. In preoperative varus group, 13 ankles (21%) were performed with concomitant lateral sliding calcaneal osteotomy, and 23 ankles (37%) with deltoid release. No additional procedures for the correction of ankle and hindfoot deformity were performed in preoperative neutral and valgus groups. VAS pain score and AOFAS score were significantly improved in all groups (p < 0.05). Overall satisfaction rate was 88%. After TAA, there were no significant radiologic alignment among the groups (3.9° (range, 0.7°~9.7°) in varus group, 4.1° (range, 0.4°~6.8°) in neutral group, and 2.2° (range, -0.4°~4.4°) in valgus group; p > 0.05).

Conclusion:

There was no significant difference in outcome among the varus, neutral, and valgus groups postoperatively in the TAA series using single Salto 3-componenet implant. Postoperative neutral alignment was achieved in all ankles. For favorable long-term outcomes, coronal alignment should be corrected with proper additional procedures in TAA.
Characterization of Motor Performance in 200 Normal Ankles Through Isokinetic Evaluation
Authors: Mansur Nacime S. , Fonseca Lucas , Maciel Eduardo S. , Inojossa Thiago , Netto Cesar de Cesar , Astur Diego C.
Published: January 2022

Category:

Ankle; Sports

Introduction/Purpose:

The isokinetic test has been used diffusely as a way to evaluate the functional results after the rehabilitation of musculoskeletal injuries. In the ankle, in particular, most studies are related to lateral ligament injuries and Achilles tendon's injuries. However, different protocols are used and a lack of normative values is observed in the literature. The aim of this work is to perform a global isokinetic evaluation on healthy ankles in order to propose reference values for future patients.

Methods:

We evaluated 100 participants (200 ankles) using the Biodex 3 System for the eversion, inversion, dorsiflexion and plantar flexion movements of the ankle. The sample consisted of individuals aged 20-60 years, with an active life and practice of recreational physical activity (non-athlete) and without previous injuries. Five repetitions for strength (N / m) and work (J) at a speed of 30° / sec and 10 repetitions for power (W) at a speed of 120° / sec were performed in our protocol. Agonist / antagonist ratio and the Muscle Deficiency Index, which globally assesses the balance between the sides for each movement, were also evaluated, as well as the demographic variables. Different statistical analyzes were performed for each parameter.

Results:

The mean age was 38.5 years and BMI 25.8 (CI 2.7 and 0.8 respectively). The non-dominant side was consistently stronger (higher peak torque) in all movements (p <0.001 -). The mean values obtained for force in each movement were 29.9N / m (CI 1.4) for eversion, 34.8N / m (CI 1.6) for inversion, 48.6N / m (2.0) for dorsiflexion and 140.2 N / m (CI 6.1) for plantar flexion. There was no correlation between age or BMI with the maximum torque (N / m). The ratio of eversors / inverters was 88.8% (CI 3.1) and that of dorsiflexors / plantar flexors was 36.1% (1.3). The Muscle Deficiency Index showed a balance between the sides for each movement (p 0.062), with an average global difference of less than 10% between them (eversion 8.66 [CI 3.17], inversion 4.2 [3, 48], dorsiflexion 3.41 [3.04] and plantar flexion 5.18 [2.51].

Conclusion:

As far as we know, this is the largest isokinetic assessment of normal ankles ever performed. The sample, although not stratified, was considered homogeneous (coefficient of variation <50%), which allows to propose several normative values for a non-athlete population in the isokinetic evaluation. It would be interesting to compare these data in the future with the functional results in patients after the treatment of certain injuries.
Deltoid Ligament Arthroscopic Repair in Ankle Fractures: Case Series
Authors: Mansur Nacime S. , Lemos Andre Vitor , Baumfeld Daniel , Sanchez Gustavo T. , Raduan Fernando C. , Prado Marcelo P. , Nery Caio A.
Published: January 2022

Category:

Ankle; Trauma

Introduction/Purpose:

Diagnosis and treatment of ankle medial ligament lesions in malleolar fractures has always been a matter of controversy. Even when deltoid involvement is clear, the direct repair of this structure is not a consensus. Recently, deltoid reparation through an arthroscopic technique was described aiming to potentialize better clinical results and minimize complications. We intend to demonstrate safety and functional results of operated ankle fractures that had an arthroscopic deltoid repair.

Methods:

This is a retrospective study in patients diagnosed with ankle fractures associated with acute deltoid injuries submitted to malleolar fixation and deltoid arthroscopic repair between June 2016 and January 2020. All patients were evaluated for pain and function according to the Visual Analogue Scale (VAS) and the American Orthopaedic Foot & Ankle Society Score (AOFAS) at a minimum of 6 months in follow-up.

Results:

Between January 2016 and January 2020, 20 ankles with fractures or dislocations were operated and the deltoid ligament rupture was repaired arthroscopically. A mean follow-up of 14.45 months (6-48) was observed, and patients presented an average AOFAS of 93.5 (SD 7.25) and a VAS of 0.75 (SD 1.05). Three minor complications were noticed and no signs of medial chronic instability, loss of reduction or osteoarthritis were observed.

Conclusion:

The repair of the deltoid complex and the low morbidity of the arthroscopic technique used may improve the clinical outcomes of these patients. Additional studies, with a prospective and comparative methodology are required to sustain this proposal.
Arthroscopic Reduction and Internal Fixation of Talus Fractures: An All-Inside Soft-Tissue Preserving Technique
Authors: Martin Kevin D. , Groth Adam T.
Published: January 2022

Category:

Ankle; Hindfoot; Trauma

Introduction/Purpose:

Talus fractures, although rare, can lead to devastating complications of posttraumatic osteoarthritis (PTA), mal-union, non-unions and avascular necrosis (AVN). The timing and method of fixation has been controversial, especially for open and extruded fractures. The purpose of this study is to present short term outcomes using a posterior talus arthroscopic reduction internal fixation (TARIF) technique.

Methods:

We performed a retrospective study on 12 consecutive patients undergoing primary posterior arthroscopic reduction internal fixation for talus fractures from August 2020 to January 2021. All cases were performed completely arthroscopically, utilizing a posterior approach and cannulated screws. Patient demographics, fracture pattern, perioperative complications, and radiographic findings were collected.

Results:

The mean age of our cohort was 37.3 years (range, 19-75), including 6 males and 6 females, with 58% utilizing nicotine. Motor vehicle accidents accounted for 58% of injuries, followed by falls and gunshot wounds. Fracture location included 7 body fractures, 5 neck fractures Hawkins type 2 (1), 3 (3), and 4 (1). Five fractures were open injuries, 2 of which had vascular injuries that underwent irrigation and debridement followed by external fixation. Intraoperatively, all patients had 2-3 anterior to posterior 3.5mm cannulated headless screws placed with a mean tourniquet time of 87 minutes (range, 0 - 88). Postoperatively, all fractures had the articular surface restored to within 2mm on radiographs. No patients required antibiotics and no debridement's were performed. No acute AVN has been recorded.

Conclusion:

Our short-term results indicate posterior arthroscopic reduction internal fixation of talus fractures are safe and able to restore the articular surfaces. It also suggests that an all-inside soft-tissue preserving technique may reduce short term complications.
The UK Foot and Ankle COVID-19 National (FAlCoN) Audit – Regional Variations in COVID-19 Infection and National Foot and Ankle Surgical Activity
Authors: Mason Lyndon W. , Malhotra Karan , Mangwani Jitendra
Published: January 2022

Category:

Other; Ankle; Ankle Arthritis; Arthroscopy; Basic Sciences/Biologics; Bunion; Diabetes; Hindfoot; Lesser Toes; Midfoot/Forefoot; Trauma

Introduction/Purpose:

Aims: This paper details the impact of COVID-19 on foot and ankle activity in the UK. It describes regional variations and COVID-19 infection rate in patients undergoing foot and ankle surgery before, during and after the first national lock-down.

Methods:

Patients & Methods: This was a multicentre, retrospective, UK-based, national audit on foot and ankle patients who underwent surgery between 13th January and 31st July 2020. Data was examined pre- UK national lockdown, during lockdown (23rd March to 11th May 2020) and post-lockdown. All adult patients undergoing foot and ankle surgery in an operating theatre during the study period included from 43 participating centres in England, Scotland, Wales and Northern Ireland. Regional, demographic and COVID-19 related data were captured.

Results:

6644 patients were included. In total 0.53% of operated patients contracted COVID-19 (n=35). The rate of COVID-19 infection was highest during lockdown (2.11%, n=16) and lowest after lockdown (0.16%, n=3). Overall mean activity during lockdown was 24.44% of pre-lockdown activity with decreases in trauma, diabetic and elective foot and ankle surgery; the change in elective surgery was most marked with only 1.73% activity during lock down and 10.72% activity post lockdown as compared to pre-lockdown. There was marked regional variation in numbers of cases performed, but the proportion of decrease in cases during and after lockdown was comparable between all regions. There was also a significant difference between rates of COVID- 19 and timing of peak, cumulative COVID-19 infections between regions with the highest rate noted in South East England (3.21%). The overall national peak infection rate was 1.37%, occurring during the final week of lockdown

Conclusion:

National surgical activity reduced significantly for all cases across the country during lockdown with only a slow subsequent increase in elective activity. The COVID-19 infection rate and peaks differed significantly across the country.
The UK Foot and Ankle COVID-19 National Audit – Rate of COVID-19 Infection and 30 Day Mortality in Foot and Ankle Surgery in the UK
Authors: Mason Lyndon W. , Mangwani Jitendra , Malhotra Karan
Published: January 2022

Category:

Diabetes; Other

Introduction/Purpose:

The primary objective was to determine the incidence of COVID-19 infection and 30-day mortality in patients undergoing foot and ankle surgery during the global pandemic. Secondary objectives were to determine if there was a change in infection and complication profile with changes introduced in practice.

Methods:

Design: Multicentre retrospective national audit. Setting: UK-based study on foot and ankle patients who underwent surgery between the 13th January to 31st July 2020 - examining time periods pre- UK national lockdown, during lockdown (23rd March to 11th May 2020) and post-lockdown. Participants: All adult patients undergoing foot and ankle surgery in an operating theatre during the study period included from 43 participating centres in England, Scotland, Wales and Northern Ireland. Main Outcome Measures: Variables recorded included demographics, surgical data, comorbidity data, COVID-19 and mortality rates, complications, and infection rates.

Results:

6644 patients were included. In total 0.52% of operated patients contracted COVID-19 (n=35). The overall all cause 30- day mortality rate was 0.41%, however in patients who contracted COVID-19, the mortality rate was 25.71% (n=9); this was significantly higher for patients undergoing diabetic foot surgery (75%, n=3 deaths). Matching for age, ASA and comorbidities, the OR of mortality with COVID-19 infection was 11.71 (95% CI 1.55 to 88.74, p=0.017). There were no differences in surgical complications or infection rates prior to or after lockdown, and amongst patients with and without COVID-19 infection. After lockdown COVID-19 infection rate was 0.15% and no patient died of COVID-19 infection.

Conclusion:

COVID-19 infection was rare in foot and ankle patients even at the peak of lockdown. However, there was a significant mortality rate in those who contracted COVID-19. Overall surgical complications and post-operative infection rates remained unchanged during the period of this audit. Patients and treating medical personnel should be aware of the risks to enable informed decisions.
The Anatomic Reconstruction for Chronic Lateral Ankle Instability Utilizing Absorbable Synthetic Graft (ATLAS Procedure): Description and Short Term Follow Up
Authors: McKenna Bryon J. , Malloy McCoy Antonio M. , McKenna Bryon J. , Rushing Calvin J. , Hyer Christopher F. , Berlet Gregory C. , Tewilliager Tyler
Published: January 2022

Category:

Ankle

Introduction/Purpose:

The traditional modified Brostrom-Gould has long been the procedure of choice for addressing chronic lateral ankle instability. However, more robust techniques including anatomic reconstruction are favored for larger deformity, poor tissue quality and revision surgery. Given the inherent disadvantages of allograft and non-elastic synthetic materials, material science has sought to impact the graft choice providing alternative load sharing, permeable materials with high strength. Our institution has performed anatomic lateral ligament stabilization, termed the 'ATLAS' procedure, using a novel synthetic graft (Artelon, Marietta, GA) with anecdotal success in recent years. In this study, we present our surgical technique and early experience.

Methods:

A retrospective cohort review was performed, evaluating the failure rate, complications and radiographic changes in anatomic alignment. A review of all patients undergoing the ATLAS procedure was performed, a total of 27 patients were included. The study included only those patients with at least 1 year follow up from the procedure.

Results:

Only one patient had symptoms of early failure of the procedure, while none of the patients required a revision procedure. The most common complication was minor wound dehiscence (11.1%). Overall, our short-term results with this procedure were excellent.

Conclusion:

We conclude that the ATLAS procedure is a predictable and effective lateral ligament reconstruction technique with no donor site morbidity, no donor tissue transmission risk, low risk of over-constraint and accomplished with a predictable technique.
Safe and Effective Anterior Ankle Arthroscopy with A 2-mm Diameter Operative System
Authors: Stornebrink Tobias , Altink Nienke , Appelt Daniel , Wijdicks Coen A. , Stufkens Sjoerd A. , Kerkhoffs Gino
Published: January 2022

Category:

Ankle; Arthroscopy; Basic Sciences/Biologics

Introduction/Purpose:

The purpose of this study was to assess whether all significant structures in the ankle could be visualized and surgically reached during 2-mm diameter operative arthroscopy, without inflicting iatrogenic damage.

Methods:

A novel, 2-mm diameter arthroscopic system was used to perform a protocolled arthroscopic procedure in 10 fresh- frozen, human donor ankles. Standard anteromedial and anterolateral portals were utilized. Visualization and reach with tailored arthroscopic instruments of a protocolled list of articular structures were recorded and documented. A line was etched on the most posterior border of the talar and tibial cartilage that was safely reachable. The specimens were dissected and distances between portal tracts and neurovascular structures were measured. The articular surfaces of talus and tibia were photographed and inspected for iatrogenic damage. The reachable area on the articular surface was calculated and analysed.

Results:

All significant structures were successfully visualized and reached in all specimens. The anteromedial portal was not in contact with neurovascular structures in any specimen. The anterolateral portal collided with a branch of the superficial peroneal nerve in one case, but did not cause macroscopically apparent harm. On average, 96% and 85% of the talar and tibial surfaces was reachable respectively, without causing iatrogenic damage.

Conclusion:

2-mm diameter operative arthroscopy provides safe and effective visualization and surgical reach of the anterior ankle joint. It may hold the potential to make ankle arthroscopy less invasive and more accessible.
Patient-Reported Outcomes after Long-Term Follow-Up of Lisfranc Injuries Treated with Open Reduction Internal Fixation
Authors: Walton David M. , Semaan Derek J. , Shah Ronit , Robbins Christopher , Holmes James R. , Talusan Paul G.
Published: January 2022

Category:

Midfoot/Forefoot; Trauma

Introduction/Purpose:

Lisfranc injuries are thought to contribute to debilitating outcomes in polytrauma patients. Due to the relative rarity of Lisfranc injuries, consistent long-term follow-up is a challenge and clinical outcomes are difficult to assess in this patient population. As a result, there exists a need for further investigation into patient-related clinical outcomes after Lisfranc injury. The purpose of this study was to collect long-term clinical outcome data following Lisfranc injuries using PROMIS Physical Function (PROMIS-PF) and Visual Analogue Scale-Foot and Ankle (VAS-FA).

Methods:

A chart review was performed to identify all patients who had surgical treatment of an acute Lisfranc injury at our institution from 2005 to 2014. Of forty-five patients identified, we were able to recruit nineteen for a follow-up clinic visit consisting of a physical exam, administration of questionnaires addressing pain and medication usage, radiographs, and completion of outcome surveys including PROMIS-Physical Function and Visual Analogue Scale-Foot and Ankle.

Results:

There were 14 female and 5 male patients enrolled in the study with a mean time of 6.25 years from the time of injury. Within this cohort, the mean PROMIS-PF score was 52.4+-8.2 and the mean VAS-Foot and Ankle Score was 76.6+-22.3. The risk factors of age, gender, BMI, smoking status, depression, and time from injury showed no statistically significant association with PROMIS-PF or VAS-FA scores using p<0.05 (Table 1).

Conclusion:

We report satisfactory long-term patient-reported outcomes using PROMIS-PF and VAS-FA independent of several risk factors. However, the small sample size and observational nature of our study contributed to the lack of significance in the data and limit our ability to further infer which patients would be expected to do worse postoperatively.
Clinical spectrum of blunted foveal contour
Authors: Muns Sofía M. , Villegas Victor M. , Schwartz Stephen G.
Published: January 2022

Foveal hypoplasia is the absence of a foveal depression and the presence of the ganglion cell layer in the foveola. A spectrum of clinical characteristics, including normal or variably decreased visual acuity, has been described in patients with blunted foveal contours. Multiple systemic and ophthalmologic conditions including albinism, aniridia, nanophthalmos, prematurity, and fovea plana have been associated with this anomaly. This article illustrates select clinical conditions characterized by a blunted foveal contour. Given the heterogeneity of findings, a thorough medical history and detailed physical and ocular examinations are usually sufficient for the clinician to make the correct diagnosis.
Dendritic cell-mediated chronic low-grade inflammation is regulated by the RAGE-TLR4-PKCβ1 signaling pathway in diabetic atherosclerosis
Authors: Zhao Liding , Li Ya , Xu Tian , Lv Qingbo , Bi Xukun , Liu Xianglan , Fu Guosheng , Zou Yunzeng , Ge Junbo , Chen Zhaoyang , Zhang Wenbin
Published: January 2022

Background

The unique mechanism of diabetic atherosclerosis has been a central research focus. Previous literature has reported that the inflammatory response mediated by dendritic cells (DCs) plays a vital role in the progression of atherosclerosis. The objective of the study was to explore the role of DCs in diabetes mellitus complicated by atherosclerosis.

Methods

ApoE−/−mice and bone marrow-derived DCs were used for in vivo and in vitro experiments, respectively. Masson’s staining and Oil-red-O staining were performed for atherosclerotic lesion assessment. The content of macrophages and DCs in plaque was visualized by immunohistochemistry. The expression of CD83 and CD86 were detected by flow cytometry. The fluctuations in the RNA levels of cytokines, chemokines, chemokine receptors and adhesions were analyzed by quantitative RT-PCR. The concentrations of IFN-γ and TNF-α were calculated using ELISA kits and the proteins were detected using western blot. Coimmunoprecipitation was used to detect protein–protein interactions.

Results

Compared with the ApoE−/−group, the volume of atherosclerotic plaques in the aortic root of diabetic ApoE−/−mice was significantly increased, numbers of macrophages and DCs were increased, and the collagen content in plaques decreased. The expression of CD83 and CD86 were significantly upregulated in splenic CD11c+DCs derived from mice with hyperglycemia. Increased secretion of cytokines, chemokines, chemokine receptors, intercellular cell adhesion molecule (ICAM), and vascular cell adhesion molecule (VCAM) also were observed. The stimulation of advanced glycation end products plus oxidized low-density lipoprotein, in cultured BMDCs, further activated toll-like receptor 4, protein kinase C and receptor of AGEs, and induced immune maturation of DCs through the RAGE-TLR4-PKCβ1signaling pathway that was bound together by intrinsic structures on the cell membrane. Administering LY333531 significantly increased the body weight of diabetic ApoE−/−mice, inhibited the immune maturation of spleen DCs, and reduced atherosclerotic plaques in diabetic ApoE−/−mice. Furthermore, the number of DCs and macrophages in atherosclerotic plaques was significantly reduced in the LY333531 group, and the collagen content was increased.

Conclusions

Diabetes mellitus aggravates chronic inflammation, and promotes atherosclerotic plaques in conjunction with hyperlipidemia, which at least in part through inducing the immune maturation of DCs, and its possible mechanism of action is through the RAGE-TLR4-pPKCβ1signaling pathway.
Long noncoding RNA XIST regulates brown preadipocytes differentiation and combats high-fat diet induced obesity by targeting C/EBPα
Authors: Wu Chunyan , Fang Shu , Zhang Huijian , Li Xiaoqiang , Du Yuejun , Zhang Yudan , Lin Xiaochun , Wang Ling , Ma Xiaoqin , Xue Yaoming , Guan Meiping
Published: January 2022

Background

Activation of brown adipose tissue (BAT) increases energy expenditure, which makes it an attractive therapeutic strategy for obesity. LncRNAs play an important role in adipocyte differentiation and regulation. Here we assessed the effect of lncRNA XIST on brown preadipocytes differentiation and metabolic regulation.

Methods

XIST expression levels were detected in human perirenal (peri-N) and subcutaneous adipose tissues (sub-Q), brown preadipocytes and 3T3-L1 preadipocytes. XIST overexpression and knockdown experiments were performed in brown preadipocytes. XIST overexpression mouse model was established by plasmid injection through tail vein.

Results

In human adipose tissues, XIST expression was significantly higher in female than in male individuals. In vitro, XIST expression was significantly up-regulated during brown adipocyte differentiation. XIST knockdown inhibited differentiation of brown preadipocytes, while overexpression of XIST promotes brown preadipocytes to fully differentiation. RNA Binding Protein Immunoprecipitation (RIP) experiment revealed that XIST could directly bind to C/EBPα. In vivo, XIST overexpression prevents high-fat diet induced obesity and improves metabolic dysorder in male mice.

Conclusion

Our results suggest that XIST combats obesity through BAT activation at least partly by combination with transcription factor C/EBPα.
Efficacy profile of noninvasive vagus nerve stimulation on cortical spreading depression susceptibility and the tissue response in a rat model
Authors: Liu Tzu-Ting , Morais Andreia , Takizawa Tsubasa , Mulder Inge , Simon Bruce J. , Chen Shih-Pin , Wang Shuu-Jiun , Ayata Cenk , Yen Jiin-Cherng
Published: January 2022

Background

Noninvasive vagus nerve stimulation (nVNS) has recently emerged as a promising therapy for migraine. We previously demonstrated that vagus nerve stimulation inhibits cortical spreading depression (CSD), the electrophysiological event underlying migraine aura and triggering headache; however, the optimal nVNS paradigm has not been defined.

Methods

Various intensities and doses of nVNS were tested to improve efficacy on KCl-evoked CSD frequency and electrical threshold of CSD in a validated rat model. Chronic efficacy was evaluated by daily nVNS delivery for four weeks. We also examined the effects of nVNS on neuroinflammation and trigeminovascular activation by western blot and immunohistochemistry.

Results

nVNS suppressed susceptibility to CSD in an intensity-dependent manner. Two 2-minute nVNS 5 min apart afforded the highest efficacy on electrical CSD threshold and frequency of KCl-evoked CSD. Daily nVNS for four weeks did not further enhance efficacy over a single nVNS 20 min prior to CSD. The optimal nVNS also attenuated CSD-induced upregulation of cortical cyclooxygenase-2, calcitonin gene-related peptide in trigeminal ganglia, and c-Fos expression in trigeminal nucleus caudalis.

Conclusions

Our study provides insight on optimal nVNS parameters to suppress CSD and suggests its benefit on CSD-induced neuroinflammation and trigeminovascular activation in migraine treatment.
Malignant rhabdoid tumor of the liver in a middle-aged woman: a case report and literature review
Authors: Ye Haikun , Liu Zirong , Zhang Yamin
Published: January 2022

Background

Extrarenal malignant rhabdoid tumor (EMRT) is a rare and high-mortality malignant tumor, which is more common in infants and rarely seen in adults. We firstly report a case of liver malignant rhabdoid tumor (MRT) with a loss of SMARCB1 gene (alias INI1, SNF5, BAF47) expression in a middle-aged woman, and preliminarily summarize the clinical characteristics and discuss its potential treatment of liver MRT by reviewing 55 cases reported in the past.

Case presentation

We report a 40-year-old woman who was admitted to our hospital for right epigastric pain. Previously, the patient was treated with liver hematoma in another hospital until she came to our hospital for abdominal pain again. In our hospital, we performed surgical treatment on her and the pathology diagnosed EMRT with negative expression of SMARCB1. After surgery, the patient underwent genetic testing, but failed to screen for sensitive targeted or conventional chemotherapy drugs, and she did not receive further treatment. Due to lack of timely diagnosis and effective chemotherapy drugs, tumor recurrence and metastasis occurred one year after surgery. Then the patient chose traditional Chinese medicine for treatment. And the metastatic tumors had still progressed after one year of treatment, but the patient didn’t have obvious discomfort symptoms.

Conclusions

Liver MRT is a highly aggressive tumor with high metastatic potential and poor prognosis. It lacks specific symptoms and signs and is easy to be ignored and misdiagnosed. The mortality rate is extremely high as there is no effective treatment. But most tumors are accompanied by SMARCB1 deficiency, which may offer new research directions for cancer therapeutics. For the present, early detection, early diagnosis and early resection remain the key to improve the prognosis of patients.