bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and Patient Reported Outcomes Following Peroneus Brevis Reconstruction with Hamstring Tendon Autograft
Authors: Chrea Bopha , Eble Stephanie K. , Day Jonathan , Hansen Oliver B. , O'Malley Martin J. , Ellis Scott J. , Drakos Mark C.
Published: January 2022

Category:

Ankle; Other

Introduction/Purpose:

Peroneal tendon injuries are a common cause of lateral ankle pain and instability. While the use of hamstring autograft has been proposed as a viable surgical option for peroneus brevis reconstruction, reported outcomes with this technique are limited in the literature. We present patient-reported and clinical outcomes for patients who underwent peroneus brevis reconstruction with hamstring autograft.

Methods:

Thirty-one patients were retrospectively identified who underwent peroneus brevis reconstruction with hamstring autograft for peroneal tendinopathy between February 2016 and May 2019. All patients who had a peroneus brevis reconstruction were included and all concomitant procedures were noted. Patient-Reported Outcomes Measurement Information System (PROMIS) surveys were prospectively collected preoperatively and at a minimum of 1 year postoperatively (average 24.25, range 12-52.70) months. Retrospective chart review was performed to evaluate the incidence of postoperative complications and reoperations at an average of 30.23 (range, 14.62-53.72) months.

Results:

When evaluating pre and postoperative patient-reported outcome surveys (n=26; 84%), on average patients reported improvement in every PROMIS domain evaluated, with significant improvement in Physical Function (+5.99; p=0.006), Pain Interference (-8.11; p<0.001), Pain Intensity (-9.02; p<0.001), and Global Physical Health (+7.29; p=0.001). Three patients reported persistent pain at a minimum of 1 year postoperatively of which 2 required re-operation. No patient reported persistent pain or discomfort at the harvest site of the hamstring autograft.

Conclusion:

Patients undergoing peroneus brevis reconstruction with hamstring autograft experienced excellent patient- reported and clinical outcomes. Few postoperative complications were observed, and patients reported improvements across all patient-reported outcome domains, with significant improvements for pain and function domains. Reconstruction with hamstring autograft represents a viable surgical option in the setting of peroneal tendinitis or tears.
Presence of Complications in the Transition of a Bone Transport to a Definite Internal Fixation System without Pin Holiday: Case Report
Authors: Clarke Gonzalo Fernandez , Morales Eduardo Fuentes , Pacheco Florencia , Clarke Gonzalo Fernandez , Cataldo Mauricio , Fernández Ignacio , Duran Humberto
Published: January 2022

Category:

Trauma; Other

Introduction/Purpose:

Bone transports are an alternative in the treatment of severe injuries of lower extremities. They are generally associated to axis problems, delayed bone union in the docking site and pin infection. There is no evidence in the need of having a window period between the transport system and the definite internal fixation. Objetive: Describe the complications seen in a group of 6 patients that went through a tibial bone transport with circular external fixator and posterior internal fixation without pin holiday.

Methods:

Restrospective and decriptive study of 6 patient that went through tibial bone transport between 2012-2019, in a level 1 trauma center. Inclusion criteria considered patients >18 years old, with intra or extramedular internal fixation systems. We registered different parameters including patients comorbilities, transport time, transport index, type of internal fixation used and complications during the time of observation and treatment. We registered our clinical evaluation and both laboratory and imagenologic exams.

Results:

100% of patients were men, with an average of 35.8 years old (22-48 yo). 66% of injuries compromised distal tibia, 83% considered open fractures. Average transport length was 7.43 centimeters (3-11cms) in 3.5 months (1.3-6 months), with average follow up of 52 months (24-72months). Tibial transport index in our study was of 1,2month/cm. The main complication in our study was bone consolidation delay in the docking site (50%), and 33% presented deep infection, all of them in the open fracture group.

Conclusion:

Pin holiday has been justified by the reduction in pin site infection. In our series there where no pin site infection cases, and only two deep infections which were associated with an important soft tissue injury that required free flap coverage.
Clinical Outcomes of Nano Arthroscopy in the Office Setting for the Treatment of Anterior Ankle Impingement
Authors: Colasanti Christopher , Mercer Nathaniel P. , Garcia Jeremie , Stornebrink Tobias , Kerkhoffs Gino , Dahmen Jari , Kennedy John G.
Published: January 2022

Category:

Ankle; Arthroscopy

Introduction/Purpose:

The hypothesis was that IONA would provide the patient with a unique experience of their pathology and facilitate their rapid recovery through an awareness of their own condition, and that using IONA would accelerate recovery to sports-specific activities compared to the literature using standard arthroscopic procedures.

Methods:

This was a retrospective cohort study investigating patients who underwent IONA for anterior ankle impingement between 2019 and 2020. Clinical outcomes were evaluated using the following methods preoperatively and at final follow-up: The Foot and Ankle Outcome Scores (FAOS) and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Pain Intensity domains. A five-point Likert scale regarding patient satisfaction was evaluated at final follow-up. Wilcoxon signed-rank test was performed to compare preoperative and postoperative outcome scores.

Results:

Thirty-one patients were included in this study, which included eighteen males and thirteen females with a mean age of 41.7 +- 15.5 years (range, 17-69 years) and a mean body mass index (BMI) of 27.3 +- 5.7 kg/m2 (range, 19.37-41.5). The mean follow-up time was 12. +- 1.9 months (range, 11-15 months). There were 27 patients who participated in sports activity prior to IONA-arthroscopy procedure. Of those, 26 patients (96%) returned to their sports activities. The median time to return to sports was 3.9 weeks (range, 1.5 to 12 weeks). Patients reported an overall positive experience with a mean rating scale of 9.71 +- .8 (range, 6 to 10). Twenty-seven patients (87%) reported the highest rating (10/10) for overall positive experience and felt that seeing their procedure in real-time aided in their understanding of their underlying pathology. Lastly, twenty-nine patients (94 %) expressed willingness to undergo the same procedure again.

Conclusion:

The current study demonstrates that IONA treatment of anterior ankle impingement results in significant pain reduction, a low complication rate, and excellent patient-reported outcomes with high rates of return to work/sport. Additionally, IONA for anterior ankle impingement leads to high patient satisfaction with a significant willingness to undergo the same procedure again.
Risk Factors for Nonunion in Pediatric Lateral Column Lengthening (Mosca) Procedures
Authors: Conklin Michael J. , Strom Shane F. , Seidenstein Alexandra H. , Andrews Nicholas A. , Halstrom Jared R. , Doyle John S. , Shah Ashish
Published: January 2022

Category:

Hindfoot

Introduction/Purpose:

The Evans/Mosca procedure remains the most utilized extra-articular osteotomies for correction of pes planus. This desired lengthening is created by inserting a graft in the anterior aspect of the calcaneus through a complete transverse osteotomy. Failure of conservative methods, particularly for rigid pes planus, is a primary consideration for surgical management. Complications of the Evans procedure include delayed union, nonunion, malunion, subluxation of the calcaneocuboid joint, and persistent lateral column pain. Our study analyzes risk factors for development of non-union.

Methods:

After IRB approval 120 patients charts and 157 feet were analyzed for incidence of non-union which was defined by clinical and radiographic evidence of absence of union >6 months. Delayed union was diagnosed if there was clinical evidence of healing without complete union at >6 months. Exclusion criteria included age >18 and revision lateral column lengthening. Patients' medical records were reviewed for basic demographics, complications, and surgical technique.

Results:

The cohort consisted of 75 females (47.8%) and 82 males (52.2%). The median age was 12 with an interquartile range (IQR) of 3. A total of 6 patients (3.7%) had wound complications or nerve injury. Nonunion occurred in 7 of 157 feet (4.5%) with 2 of 157 feet (1.3%) experiencing delayed union. The median age for patients with nonunion was significantly higher than those who achieved union (13.2 (IQR 2.75) vs. 11.2 (IQR 3) respectively). The fixation construct used was associated with increased risk of nonunion. Patients with screw fixation had the highest rate of nonunion at 50% (2/2) compared to pin and/or staple fixation at 6.8% (5/73), no fixation at 4% (3/75), and plate fixation at 0% (0/2). Both delayed union patients were treated with ultrasound bone stimulation, both patients were able to achieve complete union. Revision was attempted in 5/7 nonunions with all operative patients achieving union.

Conclusion:

Our study analyzed risk factors for developing non-union in patients undergoing calcaneal lengthening osteotomy for pediatric pes planus. We found age at time of surgery and graft fixation method to be significant risk factors for development of non-union. Our study highlighted that those patients who had non-union was on average >2yrs older at time of surgery. Overall, lateral column lengthening is a well-tolerated procedure with a complication rate, including non-and delayed union, of 10.8%. Surgeons should be aware, in the largest cohort of pediatric Evans/Mosca procedures to date, patient age and type of fixation were associated with nonunion.
Time and State Legislation Have Decreased Opioid Prescribing in Elective Foot and Ankle Surgery in the United States
Authors: Cunningham Daniel J. , Kwon Nicholas , Allen Nicholas B. , Hanselman Andrew , Adams Samuel B.
Published: January 2022

Category:

Other; Ankle; Ankle Arthritis; Arthroscopy; Bunion; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports

Introduction/Purpose:

The opioid epidemic has focused attention on opioid overprescribing. State legislation has been enacted to reduce acute opioid prescribing. However, the impact of this legislation on elective foot and ankle surgery is largely unknown. The purpose of this study was to evaluate the impact of opioid limiting legislation on opioid prescribing in elective foot and ankle surgery.

Methods:

90-day perioperative opioid prescription filling in oxycodone 5-mg equivalents was identified in all patients ages 18 and older undergoing non-trauma, non-arthroplasty foot and ankle surgery from 2010 - 2019 using a commercial database. States with and without legislation were identified and opioid prescription filling before and after legislation was tabulated. Unadjusted and adjusted analyses were performed to evaluate the impact of time and state legislation on perioperative opioid prescribing in this patient population.

Results:

Initial and cumulative opioid prescribing decreased significantly from 2010 to 2019 (39 vs 35.7 initial and 98.1 vs 55.7 cumulative oxycodone 5-mg equivalents, p<0.001). States with legislation had larger and more significant reductions in initial and cumulative opioid prescribing compared to states without legislation over similar timeframes (41.6 to 35.1 with legislation vs 40.6 to 39.1 without legislation initial oxycodone 5-mg equivalents prescription filling volume and 87.7 to 62.8 vs 88.6 to 74.1 cumulative oxycodone 5-mg equivalents prescription filling volume, p<0.001). The figure shows state-level changes in opioid prescription filling from pre-act to post-act.

Conclusion:

State legislation and time have been associated with large, clinically relevant reductions in 90-day perioperative cumulative opioid prescription filling although reductions in initial opioid prescription filing have remained low. These results encourage states without legislation to enact restraints to reduce the impact of the opioid epidemic.
Second-Look Arthroscopy after Surgery for Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis
Authors: Dahmen Jari , Vreeken Jelmer T. , Stornebrink Tobias , Emanuel Kaj , Stufkens Sjoerd A. , Kerkhoffs Gino
Published: January 2022

Category:

Ankle

Introduction/Purpose:

The primary aim was to assess and compare cartilage quality after different surgical interventions evaluated by second-look arthroscopy (SLA). Secondary aims were to report concomitant diagnoses found during SLA, and to correlate the cartilage quality with clinical- and radiological outcomes.

Methods:

A literature search was performed through PubMed, Embase (Ovid), and Cochrane Library. The primary outcome was the difference of cartilage quality as assessed with SLA between different surgical interventions. The Moderator analysis was used to calculate differences between treatment groups. Associated 95% confidence intervals (CI) were calculated with the Clopper- Pearson interval. Additionally, correlations between the cartilage quality and clinical- or radiological outcomes were calculated and percentages of concomitant diagnoses per treatment group were reported.

Results:

Nineteen studies comprising 447 ankles having undergone SLA 14 months after the initial surgery were included. The cartilage quality success rate for bone marrow stimulation (BMS) was 53% (95% CI 38-68%), for Retrograde Drilling (RD) 100% (95% CI 66-100%, for fixation (FIX) 92% (95% CI 70-89%), for Osteochondral Transplantation (OCT) 94% (95% CI 69-99%) and Chondrogenesis-Inducing Techniques (CT) this was 81% (95% CI 70-89%). The success rate of BMS was significantly lower than FIX, OCT and CIT. There were no significant differences in success rates between the other treatment options. The incidence of concomitant diagnoses found during second-look arthroscopy differed among different treatment strategies. For BMS, a positive correlation was found between the International Cartilage Repair Society score (ICRS) and AOFAS-scores (rc =.67, p <0.01). For OCT, no significant correlation was found between the MOCART score and the ICRS (rc =.36, p =.23).

Conclusion:

Bone marrow stimulation yields inferior cartilage quality as assessed with SLA in comparison to fixation, osteo(chondral) transplantation and cartilage implementation. The role of the quality of the subchondral bone and its repair must be highlighted concerning correlation with clinical outcomes and long-term success as well as prevention of development of osteo- arthritis.
Incidence of Deep Vein Thrombosis (DVT) in Patients Using A Knee Scooter
Authors: Davidson Stuart , Pogorzelski Nina , Dowd Thomas C. , Huh Jeannie
Published: January 2022

Category:

Ankle; Trauma

Introduction/Purpose:

Functional limitations after lower extremity injury often require the use of an assistive device such as a knee scooter. Many patients find these devices to be easier and more comfortable to use than crutches or walkers. There is concern regarding the possible correlation between scooter use and DVT. Prior literature demonstrated decreased venous flow with the knee flexed, and venous stasis is a known risk factor for DVT1-3. Further, healthy volunteers using a scooter demonstrated a significant decrease in volumetric blood flow rate at the popliteal fossa4. We report the incidence of DVTs after prescription of a scooter following lower extremity injury. We hypothesized that DVT rates would be higher in patients using a scooter compared to rates of DVT in the NSQIP database

Methods:

A retrospective record review of adult patients age 18-74 within the Military Health System (MHS) database between 2010-2020 was completed to identify the total number of patients who were prescribed a knee scooter and those who subsequently developed a DVT. Additional demographic and clinical data were collected on patients who had both a scooter and a DVT. This was compared with recorded 2015 NSQIP data on DVT incidence in major orthopaedic surgery procedures.

Results:

Between 2010 and 2020, 46,840 of patients within the MHS database were prescribed a rolling scooter after a lower extremity injury or surgery. Of those patients who were prescribed a scooter, 377 subsequently developed a DVT within 90 days of prescription. DVTs were diagnosed on average 26.5 days after scooter prescription. The incidence of DVT of in this population was 0.8%.

Conclusion:

In the Military Health System database, the use of a knee scooter following lower extremity injury or surgery is associated with a higher incidence of DVT compared to the 2015 NSQIPS incidence of DVT following major orthopedic surgery (0.80% vs 0.55%), and is most frequently diagnosed within 30 days of scooter prescription. Higher level study is needed to confirm these findings and identify risk factors of patients who experience DVTs associated with scooter use after lower extremity injury or surgery.
Flexor Digitorum Longus Transfer for Posterior Tibial Tendon Dysfunction is the Standard of Care: Does the Evidence Support It?
Authors: Dooley Sean W. , Evashwick-Rogler Thomas , Murawski Christopher D. , Guyton Gregory P. , Smyth Niall A.
Published: January 2022

Category:

Basic Sciences/Biologics; Hindfoot; Other

Introduction/Purpose:

Flexor digitorum longus (FDL) transfer, in conjunction with osseous procedures, is used routinely for the treatment of posterior tibial tendon dysfunction (PTTD). It is well established however that the relative power of the FDL tendon is significantly inferior than that of the native posterior tibial tendon. The purpose of this study is to systematically evaluate the evidence that supports or refutes the use of an FDL transfer in the surgical treatment of PTTD.

Methods:

A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta- Analysis. Using the terms 'flexor digitorum longus OR FDL AND posterior tibial tendon dysfunction OR PTTD OR adult acquired flatfoot OR AAFD' we searched the PubMed/Medline database. Both clinical and biomechanical studies were eligible for inclusion.

Results:

Forty-one studies met the inclusion criteria, including 31 clinical studies and 10 biomechanical in vitro studies. All 31 clinical studies consisted of Level IV evidence, and support the use of an FDL transfer. There was significant heterogeneity of the clinical evidence due to the variety of concomitant procedures. Of the 10 biomechanical in vitro studies, 2 support the use of an FDL transfer, although these did not assess the procedure in isolation. 8 biomechanical in vitro studies specifically assessing the effect on of an FDL transfer contradict its use for PTTD.

Conclusion:

There is poor quality clinical evidence to support the use of an FDL transfer for PTTD and the biomechanical literature refutes the use of the procedure. It remains unknown if the clinical improvement reported in the literature can be attributed to the FDL transfer or the concomitant osseous procedures. Additional studies are needed to assess the validity of the FDL transfer and whether alternatives are available to preserve the PTT muscle.
Contact Pressure Reduction in the Anterior Ankle During Placement of Short Leg Splints
Authors: Farrar Nicholas , Walley Kempland C. , Shams Kameron A. , Mell Kristopher , Walton David M. , Holmes James R. , Talusan Paul G.
Published: January 2022

Category:

Trauma; Ankle

Introduction/Purpose:

Lower extremity splints are commonly used in orthopaedic care throughout emergency departments, operating rooms, and outpatient clinics. Although the mainstay of ankle immobilization, they have been associated with ulcers due to high contact pressures over bony prominences and the anterior ankle. High contact pressures may occur in the anterior ankle when splint padding is applied while the ankle is in a plantarflexed position and subsequently dorsiflexed as the plaster or fiberglass hardens. The purpose of this study is to measure contact pressures in the anterior ankle when cast padding is applied in a plantarflexed position and subsequently dorsiflexed. We hypothesized, that the removal of padding over the anterior ankle following dorsiflexion would result in reduced anterior ankle contact pressures.

Methods:

Short leg posterior U-splints were applied to the right lower extremity in two healthy volunteers with an underlying pressure transducer [Tekscan I-Scan system (Tekscan Inc, South Boston, MA, USA)] on the skin surface centered over the tibialis anterior tendon. Anterior ankle surface pressures were measured when the padding was applied in maximum plantar flexion and dorsiflexed to neutral position as measured by a goniometer. This was then repeated in the same subjects but prior to dorsiflexion, a 3cm x 3cm square of padding was removed over the pressure transducer prior to dorsiflexion. Percent change from initial contact pressure centered on the tibialis anterior with either Webril (Covidien/Medtronic, Dublin, Ireland), or Specialist Cotton Blend Cast Padding (BSN Medical, Charlotte, NC, USA) was calculated.

Results:

There were 2 limbs analyzed for presentation of this pilot data. The percent change in anterior ankle contact pressure when padding was applied in plantar flexion and then placed in neutral was an average increase of 264% with just padding and 238% with padding and plaster. [TP1] Subsequently, the removal of padding from the anterior ankle resulted in an average decrease of 126% of[TP2] the increased pressure relative to baseline measurements (Figure 1). The reduction in contact force with the removal of Webril was greater than Specialist.

Conclusion:

In this pilot data, we report increases in anterior ankle contact pressures when splint padding is applied in plantar flexion and re-positioned into neutral. However, removal of anterior ankle padding reduces pressure over the anterior ankle and may reduce the risk of iatrogenic splint related ulcers in this area. Additionally, this technique may elicit varying reductions in anterior ankle pressure depending on the type of cast padding utilized. This data, though preliminary, underscores the importance of avoiding excess padding over the anterior ankle during splint application.
Two Year Patient Reported Outcomes of 334 Minimally Invasive Chevron Akin Osteotomies (MICA) in Hallux Valgus Surgery
Authors: Gordon David , Lewis Thomas L. , Ray Robbie
Published: January 2022

Category:

Bunion; Midfoot/Forefoot

Introduction/Purpose:

There are many different procedures described for the correction of hallux valgus deformity. Minimally invasive surgery has become increasingly popular, with clinical and radiological outcomes comparable to traditional open osteotomy approaches. There is increasing interest in hallux valgus deformity correction using third-generation minimally invasive chevron akin osteotomy (MICA) technique. Objective: To assess the radiographic correction and 2-year clinical outcomes of third-generation MICA using validated outcome measures.

Methods:

This is a prospective single-surgeon case series of 420 consecutive feet undergoing MICA surgery between July 2014 and Jan 2019. Primary clinical outcome measures included the Manchester-Oxford Foot Questionnaire (MOXFQ), EQ-5D, and the Visual Analogue Pain Scale. Secondary outcome measures included radiographic parameters, and complication rates.

Results:

Pre-operative and 2 year post-operative patient reported outcomes were collected for 334 feet (79.5%). At minimum 2 year follow-up, the MOXFQ scores (mean +- standard deviation (SD)) had improved for each domain: pain; pre-operative 43.9+- 21.0 reduced to 9.1+-15.6 post-operatively (p<0.001), walking and standing; pre-operative 38.2+-23.6 reduced to 6.5+-14.5 post- operatively (p<0.001) and social interaction; pre-operative 47.6+-22.1, reduced to 6.5+-13.5 post-operatively (p<0.001). At 2 year follow-up, the VAS Pain score (mean +- SD) improved from a pre-operative of 31.3+-22.4 to 8.3+-16.2 post-operatively (p<0.001). 1-2 intermetatarsal angle (mean +- SD) reduced from 15.4°+-3.5° to 5.8°+-3.1° (p<0.001) and hallux valgus angle reduced from 33.1°+-10.2° to 9.0°+-5.0° post-operatively (p<0.001).

Conclusion:

Third-generation MICA showed significant improvement in clinical outcomes at 2 year follow-up and can be successfully used for correction of a wide range of hallux valgus deformities.
Effect of Long and Short Term HgbA1c on Surgical Treatment Outcomes of Diabetic Patients with Emergent Foot and Ankle Surgery
Authors: Gotewal Sunny , Panchbhavi Vinod K. , Jupiter Daniel
Published: January 2022

Category:

Ankle; Diabetes; Midfoot/Forefoot

Introduction/Purpose:

Elevated HgbA1c are associated with higher postoperative complications. It is not as well understood whether the HgbA1c levels measured at the time of surgery, or those measured in the months prior to surgery, are more strongly associated with complications. We carried out a study of our EMR examining whether historic HgbA1c and burden of diabetes, are more or less impactful than more proximately measured HgbA1c.

Methods:

We identified patients using CPT codes for ankle, tibia, fibula, and femur fracture repair. Similarly, post-operative complications (infection, dehiscence, DVT, PE and SSI) were retrieved using ICD 9 and 10 codes. Variables recorded were comorbidities and complications, age, sex, race, ethnicity, marital status, and HgbA1c. HgbA1c was noted within a month before and a month after repair, and within 18 months and 6 months before repair. For each complication, the association with every other variable was assessed using t-test or chi-squared/Fisher's exact tests, for continuous and categorical variables, respectively.

Results:

20 patients had the data needed to carry out the analysis. While t-test revealed no significant differences between those with and without complications, either in terms of long or short term HgbA1c, the differences between HgbA1c at a year prior to surgery appear to be larger.

Conclusion:

Given that differences between historic HgbA1c in those with and without complications appear to be larger than the differences in more recent HgbA1c using our small sample size, we would like to explore whether these relationships are significant, using larger data sets.
Transglutaminase Modification of Tendon Collagen
Authors: Gross Christopher E. , Rex James C. , Scott Daniel J. , Bradshaw Amy
Published: January 2022

Category:

Ankle

Introduction/Purpose:

Achilles tendinopathy is one of the most common overuse conditions encountered in foot and ankle surgery. Various etiological risk factors for this disease have been explored: age, body-mass index, and patient specific biomechanics. However, the pathogenesis remains poorly understood. Healthy tendon is composed primarily of type III and I collagen, which undergo post-translationally modification by lysyl oxidase and transglutaminase (TG) enzymes. The expression and activity in the latter of these two is poorly characterized in Achilles tendon. This study aims to describe the function of a specific transglutaminase, TG2, within solubilized collagen and Achilles tenocyte cultures, and to demonstrate evidence of TG2 activity within pathologic human Achilles tendon tissue.

Methods:

Acellular Collagen: Type I collagen gels were aliquoted into a silicone well plate. Gels were then seeded with either 2.4 ng of TG2 or a control. Two sets of gels were prepared; one undergoing a 10% stretch at 2Hz for 24 hours and the other a static control. TG2 substrates were labelled, and the relative quantity of higher molecular weight collagens produced by TG2 activity was compared. Tenocytes: Human tenocytes were grown in 3D cultures as well as traditional cultures in a conditioned fibroblast growth media. Proteins expressed by tenocytes in both cultures were extracted and examined for TG modification. Pathologic Tendon: After receiving Institutional Review Board approval, tissue was collected from patients undergoing debridement of Achilles tendinopathy. Collagen was extracted in 0.1M acetic acid and Western blot analysis was used to identify TG2 crosslink epitopes.

Results:

In each of three experimental paradigms: acellular, cellular, and human tendon extracts, evidence for transglutaminase modification of collagen I was noted. Dynamic conditions increased TG2 modification of collagen in acellular cultures, as evidenced by higher molecular weight collagen forms. Western blot analysis of protein expression demonstrated that tenocytes cultured in 3-D produced higher levels of TG-modified proteins than those in 2-D. Similarly, western blot analysis demonstrated presence of TG2 modification epitopes in the harvested human Achilles tendon tissue. However, the enzyme itself did not appear to be strongly expressed and could not be detected from the samples.

Conclusion:

Transglutaminase 2 expression by tenocytes in 3D culture and evidence for transglutaminase-dependent modification of collagen I by TG2 under dynamic loading supports a key role for transglutaminase in tendon biology and in repair. Though evidence of TG2 modification was found in diseased human samples, the absence of detectable TG2 expression suggests that it may play a significant role in the healthy physiologic turnover of Achilles tendon collagen.
Effect of Pathology on Patient Reported Outcomes of MTP Arthrodesis
Authors: Halstrom Jared R. , Andrews Nicholas A. , Tran Sterling , Ray Jessyca , Harrelson Whitt , Pate James , Hughes Austin , Jacob Roshan , Shah Ashish
Published: January 2022

Category:

Ankle; Midfoot/Forefoot

Introduction/Purpose:

Metatarsophalangeal (MTP) joint arthrodesis of the hallux is a common and reliable procedure performed on patients with various pathologies including hallux rigidus and hallux valgus. While the effect of foot pathology on MTP arthrodesis union rates has been previously explored, there is a lack of literature comparing long term patient reported outcomes between pathology types. The purpose of this present study was to compare patient reported and clinical outcomes following MTP fusion between those with hallux valgus and hallux rigidus.

Methods:

Patients undergoing primary MTP arthrodesis from 2010-2020 were identified. Additionally, Radiographic follow-up of >12 weeks, no ongoing ipsilateral infection, and complete response to a postoperative patient report outcomes (PROMIS AND Foot Function Index (FFI)) survey were required. After these criteria, 112 patients remained and were grouped by hallux valgus (HV, 53) and hallux rigidus (HR, 59). Medical records were examined for patient characteristics, operative variables, and complications. Patients were grouped by indication and compared.

Results:

Nonunion rates and complications including wound dehiscence, infection, and reoperation were not different between indications. Patients completed the patient reported outcomes instruments a median of 1.9 years (IQR 2.6) postoperatively. All patient reported outcomes measures were not significantly different between pathology groups with PROMIS physical function ((median, IQR) HR 44.6, 9.9 vs. HV 44.1, 12.2), pain interference (HR 52.8, 9.9 vs. HV 52.4, 12.3), FFI pain scale (HR 33.3, 40.0 vs. HV 28.3, 37.0), FFI disability scale (HR 30.0, 41.0 vs. HV 28.9, 41.0), FFI activity limitation scale (HR 10.0, 27.0 vs. HV 10.0, 23.0), and FFI total (HR 25.8, 50 vs. HV 37.4, 37).

Conclusion:

Arthrodesis of the first MTP joint provides similar nonunion and complication rates between hallux valgus and rigidus groups. At intermediate follow-up, MTP arthrodesis provides comparable validated patient reported outcomes scores between these two groups. Surgeons should be aware of these results when prognosticating the effect of MTP arthrodesis.
Case Report: Tibiotalocalcaneal Arthrodesis Utilizing a Titanium Mesh Implant for Limb Salvage after Failed Charcot Reconstruction
Authors: Heidari Keemia S. , Lalli Trapper
Published: January 2022

Category:

Other; Ankle; Diabetes; Trauma

Introduction/Purpose:

Tibiotalocalcaneal (TTC) arthrodesis has been employed as a mean to achieve hindfoot fusion and limb salvage. A particular challenge in limb salvage is achieving successful fusion in the setting of massive bone deficit. Several augmentation strategies have been trialed in this setting, such as structural allografts, 3D printed implants, fibular strut grafts, to name a few.

Methods:

We present a case describing TTC fusion for limb salvage utilizing a titanium mesh implant, combined with bone graft in the setting of massive bone deficit in an individual with Charcot arthropathy from Diabetes Mellitus and HIV after Pilon fracture, performed as revision procedure after failed Charcot reconstruction with a ringed external fixator and femoral head allograft with subsequent nonunion.

Results:

At last follow-up (22 months postoperative) patient is weight bearing as tolerated in Charcot Restraint Orthotic Walker boot. CT imaging at 18 months postoperative demonstrates stable implant and arthrodesis.

Conclusion:

Use of a titanium mesh implant is a reasonable option combined with bone graft for augmentation of TTC fusion in the setting of massive bone deficit.
Efficacy of Bone Graft on Fusion Rates in Primary Open Ankle Arthrodesis: A Systematic Review
Authors: Heifner John , Monir Joseph G. , Reb Christopher W.
Published: January 2022

Category:

Ankle Arthritis; Basic Sciences/Biologics; Trauma

Introduction/Purpose:

Success in ankle arthrodesis has been reported between 74% and 100%. Despite many recent reports with success rates >95%, the modern literature details a precipitous increase in the use of biological adjuvants for primary ankle arthrodesis. These additions raise the cost of the procedure and potentially incur morbidity related to the donor site or adverse graft response. For these reasons the routine use of bone graft has come under scrutiny with no consensus regarding its use. The cost - both direct and indirect - of biological adjuvant should be weighed against its added value to clinical outcomes. This systematic review aimed to assess the efficacy of bone autograft versus no graft on achieving a clinically successful primary open ankle arthrodesis fixated using cannulated screws.

Methods:

Included studies were divided into 3 groups based on the use of bone graft: no bone graft (NBG), fibular onlay with local autograft (FOBG), and the use of autograft without fibular onlay (BG). Pooled data analysis was performed, and fusion rates were frequency weighted in order to appropriately judge the impact of each study. Cohen's d was used to evaluate effect size for the use of bone graft. Modified Coleman Methodology Score (MCMS) was calculated to analyze reporting quality.

Results:

These selected studies described outcomes for a total of 884 patients with mean follow up of 46 months. The reviewed literature was of moderate quality, with an MCMS of 60.6. The weighted mean rate of fusion for the 3 groups was 96% in the NBG group (n=182), 96% in the FOBG group (n = 257), and 95% in the BG group (n = 445), with no significant difference between the groups (p=0.98). Use of bone graft resulted in a Cohen's d effect size of 0.10 (95% confidence interval 0.07- 0.26). Time to fusion for the 3 groups was 13.60 weeks for the NBG group, 14.51 weeks for the FOBG group, and 15.10 weeks for the BG group, with no significant difference between the groups (p=0.87). Number needed to treat was 7 with the event of interest defined as a fusion rate less than 95%.

Conclusion:

Bone graft use in primary open ankle arthrodesis fixated with cannulated screws did not have a significant effect (p=0.98) on union rates and yielded a small effect size. Further data demonstrated that 7 ankle arthrodesis patients need to be treated with bone graft in order to prevent 1 clinically significant nonunion. The current findings are both clinically and economically relevant, as commercial bone graft carries additional cost and autologous graft harvest is not consistently a benign endeavor. With increased cost and potential for complication, bone graft use should demonstrably improve clinical outcomes in order to validate these additional burdens.
Are Preoperative PROMIS Scores Associated with Postoperative ED Visits?
Authors: Hughes Austin , Andrews Nicholas A. , Halstrom Jared R. , Dib Aseel G. , Patch David A. , Harrelson Whitt , Fellows Kenneth J. , Pate James , Naranje Sameer , Shah Ashish
Published: January 2022

Category:

Other

Introduction/Purpose:

Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores have been shown to be predictive of postoperative success in orthopedic foot and ankle patients. The purpose of this study was to determine if an association exists between pre-operative PROMIS scores and patients going to the emergency department (ED) in the first 60 days following their operation.

Methods:

PROMIS scores, including physical function (PF) and pain inference (PI), were collected from 290 patients prior to foot and ankle procedures. Patients with presence of ongoing infection were excluded. Electronic medical record (EMR) data was retrospectively gathered for each patient to determine if they visited the ED for any reason during the first 60 days following their operation. A Backward Stepwise Logistic Regression analysis was conducted for postoperative ED visits with p<0.1 in univariate analysis required for entry into the model.

Results:

The median age was 50.0 with an interquartile range (IQR) of 20.0, while the median BMI was 33.1 with an IQR of 11.6. In univariate analysis, Preoperative PROMIS PF and PI scores were significantly associated with ED visits within the first 60 days after surgery. Patients who visited the ED had lower preoperative PROMIS PF (median 34.9 (IQR 10.2)) and higher PROMIS PI (median 66.9 (IQR 9.1)) compared to patients who did not visit the ED, PROMIS PF (median 38.0 (IQR 10.2)) and PROMIS PI (63.6 (IQR 9.0)), respectively. In multivariate analysis, only PROMIS PF was associated with lower risk of ED visits OR 0.92 (95% CI.85-.99). Other factors independently associated with ED visits included non-traumatic surgical indication OR 3.7 (95% CI 1.1- 12.9), any pulmonary disease OR 4.2 (95% CI 1.4-12.8), ASA classification OR 4.4 (95% CI 1.3-14.9), and wound complications OR 10.2 (95% CI 2.6-39.9).

Conclusion:

Patients with lower PROMIS PF scores preoperatively were significantly more likely to visit the ED postoperatively. While all of the factors found to be associated with ED visits are not modifiable by the surgeon, preoperative PROMIS scores could quickly and easily be used to identify patients for potential interventions. This study demonstrates the potential of the PROMIS outcomes system outside of quantifying surgical outcomes. Further study is being conducted to investigate the optimal PROMIS PF cutoff for best identifying patients at risk for ED visits.
Weight Bearing CT Analysis of the Transverse Tarsal Joint During Eversion and Inversion
Authors: Jeng Clifford L. , Rowe Nicholas , Robertson Cassandra E. , Singh Stuti , Campbell John T.
Published: January 2022

Category:

Basic Sciences/Biologics; Hindfoot

Introduction/Purpose:

Current understanding of the kinematics of the transverse tarsal joint continues to evolve. Unfortunately, most prior studies have been in cadavers or under non-physiologic conditions. Weight bearing CT scans may provide more accurate in vivo information about the position of the transverse tarsal joint during eversion and inversion.

Methods:

Institutional Review Board approval was obtained. Five normal volunteers underwent bilateral weight bearing cone- beam PedCAT scans (CurveBeam LLC, Hatfield, PA) while standing on platforms that positioned both hindfeet in 20o of valgus and then 20o of varus. The CT scans had a field-of-view diameter of 350 mm and a field-of-view height of 200 mm. The scan exposure time was 9 seconds, with a total scan time of 54 seconds. The datasets were reconstructed using filtered back projection with 0.37mm isotropic voxels. The resulting volumes were then segmented, identifying the [x, y, z] coordinates that comprised each bone. Each bone of the hindfoot was segmented on the scan images and the motion between the talus and calcaneus was analyzed. A similar analysis was done for motion between the navicular and cuboid. Two-tailed paired Student's t- tests were used to compare the angle and distance measurements between valgus and varus positions.

Results:

In the coronal plane, the axis of the talus rotated by 17.0° relative to the axis of the calcaneus as the hindfoot moved from eversion to inversion (p=0.03). The distance between the centers of the talar head and the anterior calcaneus also moved closer to each other by 7.1 mm (p=0.00005). There was no significant change in angle or distance between the navicular and cuboid when moving from eversion to inversion. The angle between the navicular and cuboid axes changed 2.1° (p=0.7), while the distance changed 0.8 mm (p=0.7)

Conclusion:

Previous work proposed that the transverse tarsal joint locking mechanism occurs from the talonavicular and calcaneocuboid joint axes diverging (less parallel) as the hindfoot inverts. The current weight bearing CT data shows that not only do the talar and calcaneal axes rotate relative to each other during inversion, but the center of the talar head and anterior calcaneus translate to move closer together. Because the navicular and cuboid do not move, transverse tarsal joint locking may occur due to tightening of the joint capsules and ligaments. Further in vivo study is warranted, especially under dynamic weightbearing conditions.
Return to Sports and Clinical Outcomes in Suture-Tape Augmentation for Ankle Instability: A Systematic Review
Authors: Kanakamedala Ajay C. , Mercer Nathaniel P. , Samsonov Alan , Walls Raymond J. , Hurley Eoghan T. , Kennedy John G.
Published: January 2022

Category:

Ankle; Sports

Introduction/Purpose:

There is minimal literature on the use of suture-tape augmentation in the treatment of chronic lateral ankle instability (CLAI), prompting an investigation on its use and effect during surgery of the lateral ankle. The purpose of this systematic review is to evaluate the evidence for the use of suture-tape augmentation in the treatment of CLAI, and the outcomes following this technique.

Methods:

A literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they evaluated the use of suture-tape for CLAI. Quantitative and qualitative analysis was performed.

Results:

There were 11 studies (LOE II: 2, LOE III: 1, LOE IV: 8) with 334 patients and 334 ankles, and 66.7% were females. The mean age of patients was 27.3 years. The mean follow-up was 27.6 months (range: 11.5-38.5). Overall, 9 recurrent instability events (4.1%) were reported for suture-tape augmentation, with no significant difference between Modified Broström repair and suture-tape augmentation (MD;.81, 95% CI,.19, 3.50, I2 = 0%, p = 0.78). There was no significant difference in talar tilt angle (TTA) improvement between Modified Broström repair and suture-tape augmentation (MD; -0.07, 95% CI, -0.68, 60.54, I2 = 0%, p = 0.82). There was no significant difference in anterior talar translation (ATT) improvement between Modified Broström repair and suture-tape augmentation (MD; -0.06, 95% CI, -0.69, 0.56, I2 = 0%, p = 0.84).

Conclusion:

Suture-tape augmentation did not significantly improve clinical or radiological outcomes in the setting of Modified Broström repair for CLAI. Quicker return to play was the single most important advantage of the suture-tape augmentation procedure identified in the current study. This indicates that there is a role for suture-tape augmentation in ATFL repair for athletes and high-demand patients.
Is Arthroscopic Surgery Favorable for Freiberg’s Disease in Metatarsophalangeal Joint?
Authors: Kim Do Yeon , Lee Kwang-Bok , Park Gun Joo , Kim Jong Kil
Published: January 2022

Category:

Arthroscopy; Midfoot/Forefoot

Introduction/Purpose:

Freiberg's disease is osteochondrosis involving the metatarsal heads. It is a rare disease, mostly found in the second or third metatarsal. The surgical treatment regimens for this disease have not yet been completely defined. We report the outcomes of cases of Freiberg's disease treated with arthroscopic surgery. To assess the effectiveness of a minimally invasive procedure with arthroscopic surgery for the treatment of Freiberg's disease.

Methods:

From 2015 to 2019, 13 patients (15 feet) diagnosed with Freiberg's disease were enrolled for arthroscopic surgery. Patients were divided based on the Smillie's classification system; 2 stage I, 8 stage II, 3 stage III, 1 stage IV, and 1 stage V. Arthroscopic procedures included synovectomy, debridement, chondroplasty, microfracture, and loose body removal. For radiological evaluation, we obtained pre- and post-operative follow-up X-rays and MRIs. We evaluated clinical outcomes using the American Orthopaedic Foot & Ankle Society (AOFAS) lesser metatarsophalangeal (MTP)-interphalangeal score, and the Visual Analogue Scale (VAS) score. The MTP joint range of motion (ROM) was measured pre- and post-operatively.

Results:

Radiological study showed no evidence of osteonecrosis progression in the post-operative follow-up X-ray images in any of the 15 cases. Postoperative 12-month MRIs showed reduction of bone-marrow edema, irregularity of subchondral bone, and cartilage defects in all cases. There were significant improvements in AOFAS scores and VAS scores at post-operative 2 weeks and 3 and 12 months over the pre-operative scores (p < 0.05). The MTP joint ROM improved at the last follow-up (p < 0.05).

Conclusion:

Arthroscopic surgery applied to Freiberg's disease showed excellent results regardless of grades (Smillie's classification system) in radiological evaluation, clinical outcomes, and MTP joint ROM. We suggest it as a treatment of choice for surgeons when they encounter Freiberg's disease.
Comparison of the Distributions of Mechanoreceptors in the Three Parts of ATFL (Fibula Attach, Mid- Substance, Talar Attach)
Authors: Kim Woo Jong , Lee Young Koo , Hong Young Cheol
Published: January 2022

Category:

Basic Sciences/Biologics; Ankle

Introduction/Purpose:

To investigate the functional characteristics of the anterior talofibular ligament (ATFL) in the ankle, we divided the ligament into three parts and compare the distribution of mechanoreceptors in each part by type.

Methods:

The ATFL were obtained from 20 ankles of 10 fresh-frozen cadavers. The ligament was divided into three parts: fibula attach, mid-substance, and talar attach. Historically, mechanoreceptors were identified and classified as Ruffini (type I), Vater-Pacini (type II), Golgi-Mazzoni (type III) corpuscle, Free nerve ending (type IV). Difference in receptor density were compared.

Results:

The ATFL were obtained from 20 ankles of 10 fresh-frozen cadavers. The ligament was divided into three parts: fibula attach, mid-substance, and talar attach. Historically, mechanoreceptors were identified and classified as Ruffini (type I), Vater-Pacini (type II), Golgi-Mazzoni (type III) corpuscle, Free nerve ending (type IV). Difference in receptor density were compared.

Conclusion:

There were no significant differences in the densities of the four types of mechanoreceptors among the three parts of the ATFL.