bluuebunny/crossref_metadata_2025 huggingface dataset:
Tarsal Tunnel Syndrome Following Medializing Calcaneal Osteotomy
Authors: Cafruni Virginia M. , Bilbao Facundo , Galich Facundo , Cardone Guillermo , Carrasco Nelly M.
Published: January 2022

Category:

Hindfoot

Introduction/Purpose:

The tarsal tunnel syndrome is a compressive neuropathy that affects either the posterior tibial nerve, within the tarsal tunnel, or one of its terminal branches. It can be caused by extrinsic or intrinsic factors. Even though the tarsal tunnel syndrome has been reported as a complication of lateralizing calcaneal osteotomy, we have not identified in the literature reports of this syndrome associated to medializing calcaneal osteotomy. We report the case of a 60-year-old female who developed a tarsal tunnel syndrome, on the third postoperative week, following a medializing calcaneal osteotomy for flatfoot correction with stage IIB posterior tibial tendon dysfunction.

Methods:

We reviewed and obtained the information from the medical records of this patient: clinical examination, radiographs, computed tomography, magnetic resonance imaging, and outcome. Pain was assessed with visual analog scale (VAS).

Results:

The patient is a 60-year-old female with left stage II posterior tibial tendon dysfunction who failed to respond to conservative treatment. Medializing and lengthening (Evans) osteotomies of the calcaneus were performed, together with posterior tibial tendon repair and spring ligament reconstruction. In the postoperative, after a cast replacement into a more plantigrade position, the patient developed symptoms that suggested a compressive neuropathy of posterior tibial nerve within the tarsal tunnel associated to calcaneal medializing osteotomy. Initial conservative treatment failed and the posterior tibial nerve was explored under loupe magnification and the tarsal tunnel was released. Figure 1. An immediate improvement in pain was observed postoperatively and almost full recovery occurred within 6 months.

Conclusion:

In our case report, the tarsal tunnel syndrome was a consequence of the osteotomy fragment displacement that generated a reduction of the tarsal tunnel volume. It has been described that the tarsal tunnel syndrome symptoms become more evident with ankle dorsiflexion and eversion, in our patient this can be associated with the symptom exacerbation presented when the cast was placed into plantigrade position. We conclude that even though in the literature the tarsal tunnel syndrome has been mainly associated to lateralizing osteotomies, it is important to take this complication into account when performing a medializing osteotomy.
Factors Associated with Surgical Success of End Stage Ankle Arthritis with Minimum 4-Year Follow-Up
Authors: Chawla Sagar , Shofer Jane , Norvell Daniel , Ledoux William R. , Sangeorzan Bruce J.
Published: January 2022

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Both total ankle arthroplasty (TAA) and ankle arthrodesis (AA) are effective treatments for ankle arthritis. This study sought to use a statistical modeling approach to determine factors associated with success following either surgery. While a number of studies have explored risk factors associated with complications, our aim was to guide management based on factors which may be predictive of success.

Methods:

We retrospectively analyzed data from a prospective multicenter cohort study conducted between May 2012 and May 2015. We compared outcomes in 448 patients who had follow-up of at least 4 years and were treated for ankle arthritis with either TAA or AA. We collected baseline factors including demographics, pre- and post-operative outcome scores including the Foot and Ankle Ability Measure (FAAM), Short Form-36 (SF-36) Physical and Mental Component Summary scores, pain, ankle related adverse events, and radiographs (coronal tilt and sagittal subluxation). We defined fully Successful as an increase in the FAAM ADL score by the minimum clinically important difference (MCID) and the absence of post-operative complications. We performed a multivariate logistic regression model adjusted for age, sex, BMI, and surgery type to identify associations with success.

Results:

Of the 517 patients who consented, had surgery and completed post-operative surveys, 414 (80.0%) underwent TAA and 103 (19.9%) underwent AA. Of the 517 patients, 448 patients (86.7%) had a minimum of 4-year follow-up. Of the 448 patients, 331 (73.9%) were successful) outcome and 117 (26.1%) were not fully successful. Out multivariable logistic model found female sex (0.83 +- 0.03, p=0.002), treatment with TAA (0.80 +- 0.020, p=0.001), and no previous surgery (0.82 +- 0.03, p=0.030) as variable significantly associated with success. Notably, mental health factors and pre-operative radiographic measurements, including coronal tilt and sagittal subluxation, were not significantly associated with success.

Conclusion:

Surgeons treating patients with ankle arthritis have two viable surgical alternatives. Recognizing the factors associated with mid-term success may be as valuable as knowing risk factors associated with failure. In addition, we also find variables thought to affect outcomes, mental health and pre-operative radiographic measurements such as coronal plane misalignment, were not found to significantly affect outcomes.
Anterior Capsule Reconstruction in the Setting of PVNS
Authors: Chopra Aman , Lukosius Eric Z. , Parekh Selene G.
Published: January 2022

Category:

Ankle; Other

Introduction/Purpose:

Pigmented villonodular synovitis (PVNS) is a rare benign proliferative disease affecting tendon sheaths and synovial tissue. Most cases of PVNS arise in the hip and knee joints, while < 5% of total cases occur in the foot and ankle. PVNS of the ankle has a high rate of recurrence and can be destructive to the affected joints if incompletely removed. This case series analyzes functional outcomes after PVNS surgical resection and anterior ankle capsular reconstruction, using a novel technique.

Methods:

This case series included three patients who underwent surgery between 2010 and 2020 for their ankle pain and swelling caused by PVNS. The surgical technique involved a posterior, midline approach for PVNS resection of the affected ankle joint, followed by a standard anterior approach for capsular excision. Subsequent anterior capsular reconstruction was performed with a regenerative tissue matrix and a bioresorbable anchoring system. Preoperative and postoperative range of motion testing for the ankle and subtalar joints were assessed along with appropriate radiographs and MRI imaging.

Results:

All three surgical procedures for PVNS of the ankle resulted in successful recovery and promising clinical outcomes. The mean cohort age was 43.7 (R:36-58) years and follow-up period was 52.3 (R:4-123) months. Preoperative ankle dorsiflexion and plantarflexion along with subtalar inversion and eversion range of motion were all normal. Postoperative ankle motion and subtalar motion were recorded at final follow up and found to be unchanged. No complications or recurrence of PVNS occurred.

Conclusion:

This case series demonstrates that PVNS surgical resection and anterior ankle capsular reconstruction is a safe and effective treatment modality that allows for maintenance of pre-operative motion. Further investigation is warranted to better understand the clinical outcomes of this surgical technique on PVNS recurrence.
Comparing Open vs Minimally Invasive Techniques for the Correction of Hallux Valgus: Clinical and Patient Reported Outcomes
Authors: Chrea Bopha , Day Jonathan , Dean Daniel M. , Cortina Rose E. , Reilly Megan , Caolo Kristin C. , Cerrato Rebecca A. , Johnson A.
Published: January 2022

Category:

Bunion

Introduction/Purpose:

Multiple operative techniques have been developed for hallux valgus with varying success. While correction has been traditionally achieved through open surgical approaches, there has been a growing interest in minimally invasive surgical (MIS) techniques. The purpose of this study was to compare clinical and patient-reported outcomes for patients undergoing hallux valgus correction with Lapidus, Scarf and MIS. Our hypothesis was that while a superior clinical correction would be achieved with open techniques there would be similar patient-reported outcomes among open and MIS techniques.

Methods:

A total of 257 patients who underwent Lapidus (n=82), Scarf (n=82) or MIS (n=93) hallux valgus correction between January 2017- January 2020 at one of two academic institutions by 1 of 9 foot and ankle-fellowship trained orthopedic surgeons were included in this study. Only 3 of 9 performed MIS correction. The average age at the time of surgery 55.4 (range 14-79). Patients were required to have a minimum baseline and 1-year postoperative Patient-Reported Outcomes Measurement Information Scores (PROMIS) and minimum 3-month clinical follow-up. Retrospective chart review was performed to assess the incidence of postoperative complications and reoperations, with an average clinical follow-up of 8 months.

Results:

All groups had statistically significant differences between pre- and post-operative measurements of HVA, IMA, DMAA, and tibial sesamoid position (<0.05). In addition, the Lapidus group demonstrated change in all parameters measured including Meary's angle, sagittal IMA and Seiberg index. All groups had statistically significant improvement in the PROMIS physical function, pain interference, and global health physical at 1 year (p<0.05). The Lapidus group had significant improvement in all 6 PROMIS domains measured. There were no significant differences in PROMIS score changes from pre to post-op for any PROMIS domain when comparing MIS vs Scarf vs Lapidus. Complications: Minor Complications were classified as infection, symptomatic hardware, delayed union, nerve irritation, transfer metatarsalgia (Lapidus n=14 (17.1%), Scarf n=2 (2.4%), MIS n=15 (16.1%)). Major complications were classified as nonunion, recurrence, hallux varus, recurrence (HVA >20) (Lapidus n=7 (8.5%), Scarf n=9 (11.0%), MIS n=9 (9.7%)).

Conclusion:

In the last decade, there has been a growing interest in the use of minimally invasive surgical MIS techniques for the treatment of hallux valgus. When compared with traditional open techniques using Lapidus and Scarf osteotomies MIS presents a safe and effective approach to treating hallux valgus.
Low Tibial Valgization Osteotomy for Varus Ankle Arthritis: Does Age Effect the Outcome?
Authors: Chun Kyung Ah , Choi Jun Young , Suh Jin Soo
Published: January 2022

Category:

Ankle; Ankle Arthritis

Introduction/Purpose:

Evidence-based literature identifying the age limit for low tibial valgization osteotomy (LTO) is lacking to date. We addressed the following research questions: (1) is LTO effective for ankle arthritis in patients over 65 years?; (2) does patients' age alter the effectiveness of LTO?; and (3) does preoperative Takakura stage affect the degree of correction in patients over 65 years?

Methods:

We retrospectively reviewed the radiographic and clinical findings of 49 cases which underwent LTO. Patients were divided into two groups according to age at operation (19 cases in group 1 aged >=65 years and 30 cases in group 2 aged <65). Patients in a single group were regrouped into two subgroups according to preoperative Takakura stage (stage II+IIIA versus IIIB) to determine if the degree of correction varied in Takakura stage IIIB.

Results:

Significant changes in radiographic parameters were observed with no significant differences in the amounts of correction between groups 1 and 2. Comparison of Takakura stage II+IIIA in group 1 to that in group 2 and stage IIIB in group 1 to that in group 2 revealed no significant differences in the amounts of correction.

Conclusion:

LTO could be indicated for patients over 65 years if patient selection was appropriate. LTO in patients over 65 years showed similar radiographic improvements to those in younger patients, and the correction was successfully maintained during the follow-up period. The correctional power of all radiographic parameters did not vary by preoperative Takakura stage.
Limited Evidence for Biological Adjuvants in Hindfoot Arthrodesis: A Systematic Review and Meta- Analysis of Clinical Comparative Studies
Authors: Dankert John , Seow Dexter , Yasui Youichi , Miyamoto Wataru , Calder James D. , Kennedy John G.
Published: January 2022

Category:

Hindfoot; Ankle; Ankle Arthritis; Basic Sciences/Biologics; Trauma

Introduction/Purpose:

The purpose of this study was to evaluate the efficacy of biological adjuvants in hindfoot arthrodesis.

Methods:

A systematic review of the PubMed and Embase databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using specific search terms and eligibility criteria. Assessment of evidence was three-fold: level of evidence by criteria published by The Journal of Bone & Joint Surgery, quality of evidence by the Newcastle-Ottawa scale and conflicts of interest. Meta-analysis was performed by fixed-effects models for studies of low heterogeneity (I2 <25%) and random-effects models for studies of moderate to high heterogeneity (I2 >=25%).

Results:

Hindfeet totaled 1579 patients as protocol and 1503 patients per protocol. Final reported mean follow-up ranged from 2.8 months to 43 months. Twelve of the 17 included studies were comprised of patients with comorbidities associated with reduced healing capacity. Based on the random-effects model for non-union rates for autograft versus allograft, the risk ratio was 0.82 (95% CI, 0.13 to 5.21; I2 = 56%; p = 0.83) in favour of lower non-union rates for autograft and for autograft versus rhPDGF/ß-TCP, the risk ratio was 0.90 (95% CI, 0.74 to 1.10; I2 = 59%; p = 0.30) in favour of lower non-union rates for rhPDGF/ß-TCP.

Conclusion:

There is a lack of data to support the meaningful use of biological adjuvants compared to autograft/allograft for hindfoot arthrodesis. The meta-analysis favoured the use of autograft when compared to allograft, but favoured rhPDGF/ß-TCP instead when compared to autograft in the short-term follow-up.
Sural Nerve Injury in the Achilles Tendon Repair with Dresden Instruments: Anatomical Study
Authors: David Anderson E. , Gamba Cesar E. , Reyes Claudia , Feijo Diego F. , Borrero Juan P. , Gil Gustavo A.
Published: January 2022

Category:

Trauma; Hindfoot

Introduction/Purpose:

The surgical reconstruction of the Achilles tendon has evolved in favor of the use of percutaneous techniques over the traditional approach with wide approaches to reduce the complications inherent to this procedure. These percutaneous techniques can present lesions of the sural nerve. The objective of this study is to evaluate the distance of this structure with respect to the instruments used in the Dresden technique.

Methods:

Dissections were made in 16 anatomical pieces (ankles) to which a reproduction of the complete Achilles lesion was previously made and reconstructed using the technique to be studied. After this, the distance of the instrument position with respect to the sural nerve was measured, as well as other relevant measures, and the presence or absence of nerve injury was evaluated.

Results:

None of the pieces there was lesion of the sural nerve neither by direct injury nor by entrapment, in addition, an approximate distance of 10mm of the nerve was found with respect to the entry site of the percutaneous needles as described by the technique. The location of the nerve was always external to the Crural Fascia. We demonstrate a safety area in which the instruments can be used without lesions of the sural nerve.

Conclusion:

The technique described by Amlang with the use of Dresden instruments has a low rate of cutaneous complications and infection compared to the traditional approach for this injury, we find that if the risk of presenting injury is performed properly of the sural nerve is low and its reproduction, for the repair of Achilles injuries, should be considered as the first option over traditional open management.
Recovery Position vs Prone Position in the Surgical Treatment of Trimalleolar Ankle Fractures Using Posterolateral and Medial Approach
Authors: Drago Sebastian R. , Alvarado Patricio Alfonso Zagal , Contreras Martin , Concha Marcelo F. , Bergeret Juan Pedro , Bastias Gonzalo F.
Published: January 2022

Category:

Trauma

Introduction/Purpose:

Posterolateral (PL) and medial approaches have been increasingly used for open reduction and internal fixation (ORIF) of trimalleolar ankle fractures. Traditionally this procedure is performed on the prone position. Nevertheless, this position itself has been related to general complications as brachial plexus injury and postoperative visual loss. Moreover, the prone position can provide difficult access for medial malleolar reduction. Recovery position was recently described as an alternative but its results have not been evaluated yet. This study aimed to compare the results using recovery position (RP) versus prone position in the surgical treatment of trimalleolar fractures.

Methods:

A retrospective analytic study was conducted in a Level 1 trauma center, analyzing patients who underwent ORIF for trimalleolar ankle fractures using posterolateral and medial approaches over 3 years. 58 ankles were divided according to the position used in the surgical fixation: Group 1 positioned in RP (27 ankles), and group 2 positioned in prone (31 ankles). Demographics, surgical time, hospital stay, quality of reduction, surgical site complications and re- interventions were compared between both groups. Statistical analysis was performed with Shapiro-Wilks test to assess normality in distribution, Chi-square test, and t-student test for group differences in parametric variables as Fisher's exact test and Mann-Whitney U test in non- parametric variables with a p-value set at 0.05.

Results:

Median age was 47 years old (IQR 40-58). Both groups were similar regarding age (p=0.794), gender (p=0.902), and posterior malleolus Haraguchi (p=0.064) and Bartonicek-Rammelt (p=0.055) classifications. Surgical median time was 115 (IQR 100-130) and 100 (IQR 75-129) minutes for RP and prone groups respectively (p=0,085), Both groups showed similar rates of lateral, posterior and medial malleolus insufficient reduction (Table attached). Median hospital stay was 4 (IQR 2-9 and 2-7 for RP and prone respectively) days for both (p=0,86) (Table attached). Surgical site complications and re-interventions were similar between both groups (p=0.349 and p=1.0 respectively).

Conclusion:

The RP showed similar results than the prone position while providing an accessible simultaneous approach to the posterolateral and medial regions of the ankle.
Effectiveness of a Superelastic Nitinol Device for Fixation of Syndesmosis in Ankle Fracture
Authors: Ellington J. Kent , Hunt Kenneth J.
Published: January 2022

Category:

Ankle; Trauma

Introduction/Purpose:

Syndesmosis injuries are increasingly common. Available fixation options are not yet optimal. The PUMA System (Panther Orthopedics, Sunnyvale, CA) is an FDA-cleared superelastic, nitinol-based fixation device for the ankle syndesmosis which provides stabilization without over-compression or loosening during cyclical loading. The spring-like design of the PUMA System allows physiological micro-motion while maintaining continuous compression and resisting syndesmosis widening, without material creep. The objective of this prospective study is to assess the effectiveness and complication rate of the PUMA device for treatment of fracture-associated syndesmosis injuries.

Methods:

We prospectively collected radiographic and clinical data on 32 consecutive patients treated for fracture-associated syndesmotic disruption with the PUMA SystemTM at 8 centers. Primary outcome measures included adverse event rates, radiographic evaluations for syndesmosis integrity and implant failure, and rates of revision surgery.

Results:

All 32 patients had successful repair of their ankle syndesmosis (Figure 1). The mean age of patients at time of operation was 42 years (range 16- 68). There were 13 females (13/32, 40.6%) and 19 (19/32, 59.4%) males. Postoperative radiographic evaluations confirmed satisfactory syndesmosis healing with maintained reduction in the ankle mortise in 33/33 (100%) ankles. There was no evidence of lysis, device migration or syndesmotic or medial clear space widening. There were no infections or soft tissue complications. All fractures healed. No devices required removal and there were no revision surgeries.

Conclusion:

The PUMA SystemTM provides physiologic stabilization of the syndesmosis due to the design features that allow for continuous compression without creep. We found no device-related complications nor construct failures in our series. The superelastic implant design allows physiologic motion at the syndesmosis but does not creep or stretch following displacement. This flexibility obviates the need for routine removal. The implant's low-profile buttons without suture and knot tying requirements eliminate the concern for subcutaneous knot irritation and slippage. Additional biomechanical and clinical outcomes study of this device may further optimize rehabilitation protocols for patients treated for syndesmotic injury.
National Survey of COVID-19 Infections Among Head Surgical Specialists Regarding Orthopedic Foot and Ankle Surgeons in Mexico
Authors: Garza Fernando Alfredo F. , Garza Jaime I. Ortiz , Espinosa-Uribe Abraham , Carranza-Cantú Eduardo R. , Gutierrez Jorge A.
Published: January 2022

Category:

Other

Introduction/Purpose:

The health contingency due to COVID19 has represented an unprecedented state of health contingency with implications for the economy and public health. There is a concern in the medical community regarding the risk of contagion of COVID19. Recently, the occupational risk of contagion by COVID19 has been described in surgical specialties that involve proximity to the face and airway of the patient Ophthalmology and Otorhinolaryngology and head and neck surgery (ENT). A possibility has been raised that Foot and Ankle joint surgeons have some occupational protection due to the distance greater than 1m with respect to the patient's airway during surgical activities. The objective of this study is to compare COVID-19 infections referred by different surgical specialties and subspecialties.

Methods:

An observational, cross-sectional, and descriptive study will be carried out in which a survey will be applied to 134 surgical specialists divided into 3 groups (ophthalmology, ENT, and orthopedic surgeons performing foot and ankle surgery) during the months of August to September 2020.Percentage prevalences of each variable to be evaluated will be obtained, likewise, a Chi- square test will be applied to determine statistical differences between the proportions of referred positivity in the 3 groups. This research study was reviewed by our institution and hospital research ethics committee. All participants gave their informed consent at the time of conducting the survey, as well as allowing the use of their responses for the purposes of this project.

Results:

A total of 134 surveys pertaining to 30, 69, and 35 Mexican ophthalmology, ENT, and orthopedic surgeons who perform foot and ankle surgery respectively were evaluated. The geographical distribution of the surveys is identified in figure 1. After the statistical analysis, non-significant statistical differences (p> 0.32) were documented in the proportion of infections between ophthalmologists or ENTs, with respect to the proportion of infections referred by COVID-19 in the group of Orthopedic foot and ankle surgeons surveyed.

Conclusion:

When analyzing the results of this survey-type study, it is possible to establish that the statistically non-significant differences between the proportions of infections of the groups of specialists evaluated could suggest that the working distance with respect to the patient's airway is not a protective factor for contagion. by COVID-19. Preventive strategies, as well as the vaccination of health personnel involved in patient care, are essential.
The Relationship of the Sural Nerve and Anatomic Landmarks Relevant to the Extensile Lateral and Sinus Tarsi Approaches: A 3T MRI Study
Authors: Ghetti Claudio B. , Mitchell Brendon , Shah Vrajesh J. , Huang Brady K. , Kent William , Foran Ian M.
Published: January 2022

Category:

Hindfoot; Trauma

Introduction/Purpose:

The extensile lateral and sinus tarsi approaches are commonly used during foot and ankle surgery, and pose a risk of iatrogenic injury to the sural nerve, a cutaneous nerve that innervates the ankle and lateral foot. Our understanding of the SN's location is based primarily on anatomic cadaver studies with small sample sizes. Our research analyzes a large cohort of high-field 3 Tesla (3T) magnetic resonance images (MRI) of the ankle to obtain a more generalizable, in-vivo sample of the distal course of the SN. A better understanding of the course and variability of the sural nerve will allow surgeons to minimize the risk of iatrogenic injury to the SN.

Methods:

High-field 3T MRI studies of the ankle performed at our institution between January 2015 and December 2020 were analyzed. The vertical distance of the SN to the distal tip of the lateral malleolus (DTLM), horizontal distance of the SN to the DTLM, and the lateral border of the Achilles tendon (LBA) at the level of the DTLM were measured by 3 blinded reviewers. Also measured was the horizontal distance of the SN to the LBA at the level of superior Achilles insertion (SAI) onto the calcaneus, as well as 5 cm above the SAI. We then analyzed upper and lower quartile ranges to compare the outer anatomic distribution frequencies of the SN to the locations of common approach incision lines. This outer limit analysis may serve to quantify the variability of the SN.

Results:

A total of 204 3T MRIs of the ankle were included. 1st and 4th quartile ranges for vertical distance from the SN to the DTLM were 0.9-1.9 cm and 2.5-3.6 cm respectively. 1st and 4th quartile ranges for horizontal distance of the SN to the DTLM at the level of DTLM were 0.8-1.5 cm and 2.0-3.0 cm respectively. 1st and 4th quartile ranges for horizontal distance of SN to the LBA at the level of DTLM were 1.0-1.6 cm and 2.1-2.9 cm respectively. 1st and 4th quartile ranges for horizontal distance of SN to the LBA at the level of the SAI were 1.4-2.3 cm and 2.8-3.7 cm respectively. 1st and 4th quartile ranges for horizontal distance of SN to the LBA, 5 cm above SAI were 0.4-0.8 cm and 1.0-1.8 cm, respectively.

Conclusion:

The vertical distance from SN to DTLM was greater than the previously reported maximum of 2.6cm in 25% of cases. This highlights the risk of injury to the sural nerve with the extensile lateral approach. Our first quartile range for vertical distance of SN to DTLM of 0.9-1.9cm indicates that even at the lowest range of values, the SN remains clear of the incision line used in the sinus tarsi approach, which extends from the DTLM to the base of the fourth metatarsal. The sural nerve is still at risk during posterior extension or retraction of the sinus tarsi incision.
Gender May Affect Mid-Term Outcomes Following Bone Marrow Stimulation for Osteochondral Lesions of the Talus
Authors: Gianakos Arianna L. , Williamson Emilie , Kennedy John G.
Published: January 2022

Category:

Ankle

Introduction/Purpose:

Bone marrow stimulation (BMS) is typically indicated as a surgical intervention for patients who have symptomatic osteochondral lesions of the talus (OLT). Despite differences in ankle biomechanics and cartilage morphology between male and female patients, there is scant evidence examining whether these differences affect outcomes following BMS. The purpose of this study was to compare the outcomes in female and male patients following BMS in the treatment of OLTs.

Methods:

A retrospective analysis comparing female and male patients treated with BMS for OLT between 2007 and 2015 was performed. Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS) and Short-Form 12 (SF-12). Magnetic resonance imaging (MRI) at final follow-up was evaluated with the modified magnetic resonance observation of cartilage repair tissue (MOCART) score.

Results:

Thirty-one females and 38 males were included in this study. The mean patient age was 39.6+-16.9 for females and 36.5+-14.5 years for males. There was no significant difference in age, lesion size, follow-up time, and a number of concomitant procedures. Lateral lesions occurred more frequently in male patients (p=0.034). In female patients, the mean FAOS pain score improved from 60.2 +- 15.5 preoperatively to 84.0 +- 8.9 at 1-2 year follow-up (p<0.001), and then decreased to 80.0 +- 13.1 at final follow-up at 3-4 years, which was not statistically significant (p=0.191). In male patients, the mean FAOS pain score improved from 64.7 +- 17.0 preoperatively to 83.1 +- 9.2 at 1-2 year follow-up (p<0.001), and then decreased to 76.0 +- 14.6 at final follow- up at 3-4 years (p=0.023). The mean MOCART scores were 59.3 +- 24.0 in female patients and 67.3 +- 23.6 in male patients (p=0.278).

Conclusion:

Lateral lesions were more common in male patients possibly indicating an acute traumatic etiology. Medial lesions were more common in female patients indicating potentially a chronic pathology. This may have implications in reducing the incidence of OLT in female patients. The outcomes following BMS in both female and male patients were good with no significant differences in FAOS pain score and MOCART score at short-term follow-up. FAOS scores in male patients were more likely to decrease after 1-2 years post-surgery, implying a possibly faster decline than in female patients.
Treatment of Chronic Ankle Instability in the Military Population
Authors: Goodrich Ezra , Herda Ashley A.
Published: January 2022

Category:

Ankle; Sports

Introduction/Purpose:

The high incidence of ankle sprain within the military sets the stage for prevalent chronic ankle instability. The purpose of this review was to compare and evaluate chronic ankle instability treatment strategies in the military population.

Methods:

Electronic databases were systematically searched for English-language, human studies with a military patient population that had been diagnosed with and treated for chronic ankle instability. Exclusion criteria were animal, cadaver, and review studies and case reports.

Results:

Eight studies met inclusion criteria and represented 695 military service members-625 males (89.9%) and 70 females (10.1%). The four treatment strategies included were Broström-related procedures, modified Watson-Jones procedure, Colville's technique, and anatomic lateral ligament reconstruction using semitendinosus tendon allograft. The percentage of subjective satisfactory outcomes ranged from 80 to 94.7%, and the percentage of objective satisfactory outcomes ranged from 72 to 100%. The range for Broström-related procedures was 73.2% (objective) to 94.7% (subjective). The modified Watson-Jones procedure had a subjective satisfactory outcome of 80% and objective satisfactory outcome of 72%. Colville's technique had an objective satisfactory outcome of 100%. No satisfaction outcome was available for the study utilizing the anatomic lateral ligament reconstruction with semitendinosus tendon allograft. Mean American Orthopaedic Foot & Ankle Society (AOFAS) scores, anterior drawer displacement, talar tilt, and visual analogue scale (VAS) scores were also reported.

Conclusion:

This review demonstrates that the Bröstrom procedure has consistently satisfactory outcomes within the military population, and Colville's technique is another promising option for this patient population, but would require future studies to fully support this claim.
Analysis of Change in Patient Reported Outcome Measures Following Minimally Invasive Chevron Akin Osteotomies (MICA) in Hallux Valgus Surgery
Authors: Gordon David , Lewis Thomas L. , Ray Robbie
Published: January 2022

Category:

Bunion

Introduction/Purpose:

There is a need to understand the rate of improvement following minimally invasive chevron akin osteotomies (MICA) for correction of hallux valgus deformity using validated patient reported outcome measures (PROMs) and whether this change is clinically meaningful in order to help counsel patients as to their progress.

Methods:

Between July 2014 and November 2018, data was prospectively collected from consecutive patients pre-operatively and at 6, 12, and 24 months following MICA. The primary outcome measure was the change in Manchester Oxford Foot and Ankle Questionnaire (MOXFQ) score at each timepoint following MICA. Secondary outcomes include radiographic deformity correction, and exploration of cases where PROMs did not improve following MICA.

Results:

190 feet with complete PROM data at each time point, were identified from a cohort of 334 feet undergoing third generation MICA. There was a statistically significant improvement in MOXFQ score for each MOXFQ domain at each time point following MICA although the majority of the improvement was within the first 6 months. 17 feet had worse MOXFQ Index scores at the six month timepoint compared to pre-operatively. Of these feet, 82.4% (n=14) improved over time such that by two years their score had improved compared to their pre-operative score.

Conclusion:

There is a statistically significant improvement in MOXFQ score at every time point following MICA for hallux valgus. The majority of patients who scores are worse at 6 months following will go on to have improved function compared to their pre-operative state.
Bilateral vs Unilateral Minimally Invasive Hallux Valgus Surgery: A Propensity Matched Case-Control Study with 2 Year Clinical Patient Reported Outcomes
Authors: Gordon David , Crooks Sophie A. , Lewis Thomas L. , Ray Robbie
Published: January 2022

Category:

Bunion; Midfoot/Forefoot

Introduction/Purpose:

Hallux valgus deformity correction using a third-generation Minimally Invasive Chevron Akin osteotomy technique (MICA) is becoming increasingly popular. There is limited patient reported outcome measure (PROM) outcomes for patients undergoing bilateral hallux valgus corrective MICA surgery during a single operative case.

Methods:

Between July 2014 and May 2018, 59 consecutive patients comprising 118 feet underwent bilateral MICA in a single operative case. 1:1 propensity score matching based on preoperative PROM assessment, age, and radiographic deformity data was carried out to match each foot in the bilateral cohort with 118 feet who had undergone unilateral MICA. The primary outcome measure was the Manchester-Oxford Foot Questionnaire (MOXFQ) which was prospectively measured pre-operatively, six months and two years post-operatively. Secondary outcomes included complication rates and radiographic deformity correction with regards to the hallux valgus angle (HVA) and inter-metatarsal angle (IMA).

Results:

At minimum 2 year follow up, the MOXFQ post-operative scores had significantly improved for every domain (p <0.001) in both unilateral and bilateral cohorts compared to pre-operative assessment. For all domains of the MOXFQ, there was no statistically significant difference in 6 month or two year outcomes between patients undergoing bilateral and unilateral MICA surgery (p >0.05 for all outcome measures). There was no statistically significant difference between the two cohorts in complication rate (p=>0.05) or post-operative IMA or HVA (p >0.05).

Conclusion:

This study demonstrates that there is no significant difference in patient reported outcome measured at two year follow-up between patients who underwent bilateral versus unilateral MICA. This study should reassure surgeons who perform bilateral hallux valgus surgery in a single case that, in the medium-term, there is no difference in clinical or radiographic PROMs compared to unilateral surgery. There are potentially positive health economic benefits of performing bilateral surgery in a single sitting if clinically indicated.
Outcomes Following Intramedullary Nail vs Plate Fixation for Tibiotalocalcaneal Arthrodesis: A Systematic Review
Authors: Hegeman Erik , Dowd Thomas C. , Huh Jeannie
Published: January 2022

Category:

Ankle Arthritis; Hindfoot; Trauma

Introduction/Purpose:

Tibiotalocalcaneal arthrodesis (TTCA) is indicated to treat pain and dysfunction that may result from a variety of ankle and hindfoot pathologies by achieving fusion of the tibiotalar and subtalar joints. Two common fixation methods exist to achieve TTCA: retrograde intramedullary nail (IMN) fixation and plate fixation using a lateral trans-fibular or posterior Achilles-tendon splinting approach. The purpose of this study is to review the literature and compare the outcomes of TTCA using IMN fixation with those of plate fixation using a lateral trans-fibular approach.

Methods:

A comprehensive search of the PubMed, Cochrane, and EMBASE databases was performed on 01 February 2021 for studies of all levels of evidence pertaining to TTCA using IMN and plate fixation. Reasons for exclusion included: no formal joint preparation, non-English language, concomitant methods of fixation (e.g., IMN with additional plate fixation) and follow-up less than 12 months.

Results:

Fourteen studies (11 level III and 3 level IV) met criteria and were included. A total of 386 fusions were documented in 356 patients [259 (67%) IMN and 127 (33%) plate fixation]. In the IMN group, union rates at the tibiotalar joint (TTJ) were 84% (219/259) and subtalar joint (STJ) were 90% (229/259) with an overall complication rate of 20% (53/259). Average initial AOFAS scores were 34.3+-7.9, increasing to 72.4+-9 postoperatively. In the plate fixation group, union rates at the TTJ were 82% (103/127) and STJ were 86% (108/127) with an overall complication rate of 30% (39/127). Average initial AOFAS scores were 37.0+-6.9, increasing to 74.4+-12.5 postoperatively. No statistical differences were noted between the TTCA IMN and plate cohorts when comparing rates of TTJ or STJ union (p= 0.6, and p=0.2, respectively) and postoperative AOFAS scores (p=0.59). However, the plating group had a statistically higher overall complication rate (p=0.02).

Conclusion:

A systematic review of the available literature suggests that there is no statistical difference in union rates or functional outcomes between TTCA using intramedullary nail or lateral trans-fibular plate fixation. However, the lateral trans- fibular plate has a statistically higher complication rate when compared to intramedullary nails. Further comparative prospective cohort studies and randomized controlled trials are needed to further elicit differences between these groups and confirm the findings of this systematic review.
Assessing the Influence of Pain and Resiliency Scores on Post-Operative Outcomes
Authors: Hoch Caroline P. , Pire Jonathan R. , Pire Jonathan R. , Scott Daniel J. , Gross Christopher E.
Published: January 2022

Category:

Other; Ankle; Hindfoot; Midfoot/Forefoot

Introduction/Purpose:

Resilience is defined as the ability to recover after stressful events and has been shown to correlate with surgical outcomes across multiple fields. To date, there has been minimal research on the impact of patient resiliency on outcomes of foot and ankle surgery. Thus, this study aimed to look for an association between resilience, as measured by the Brief Resilience Scale (BRS); pain, as measured by the Pain Disability Index (PDI) and Pain Catastrophizing Scale (PCS); and post-operative outcomes after foot and ankle surgery.

Methods:

At a single academic medical center, a retrospective review of prospectively collected data was conducted on orthopaedic foot and ankle (n=201) and podiatric (n=7) patients who completed a pre-operative BRS and underwent surgery between 2019 and 2020 (N=208). The cohort consisted of 46 post-operative opioid users and 162 non-users. Data collected included demographics, comorbidities, diagnoses, procedure (i.e., removal of implant=22, Brostrom=15, tenolysis of flexor or extensor tendons=11, 1st MTP fusion=11, cheilectomy=10, etc.), PDI and PCS scores, complications, outcome markers, and pre- and post-operative opioid and benzodiazepine use. Data was analyzed with one-way ANOVA and linear and multivariate regressions formulated by SPSS software.

Results:

The PDI score significantly correlated with post-operative benzodiazepine (p=.011) and opioid use (p=.006), the BRS score significantly correlated with post-operative benzodiazepine use (p=.007), and the PCS score significantly correlated with longer length of follow-up (p=.011). Pre-operative opioid use was associated with an increased rate of 30-day readmission (users=6.52%, non-users=2.47%; p<.001). The multiple regression analysis indicated that the BRS score remained significantly correlated to post-operative benzodiazepine use (p=.004). Results of the multiple regression analysis also indicated that higher PCS scores were significantly correlated with increased rates of 30-day readmission (p=.047) and longer length of follow-up (p=.005). No outcome measure was significantly correlated with PDI score, according to the multiple regression analysis.

Conclusion:

In conclusion, the PCS was not shown to be an effective tool for measuring post-operative outcomes in orthopaedic foot and ankle patients, despite evidence of the contrary in other fields of orthopaedics. Additionally, the BRS and PDI were only valuable in their association with post-operative narcotic usage. Pre-operative opioid use was shown to correlate with worse higher rates of readmission and limited follow up, as corroborated by numerous previous studies. This study did not find the BRS, PDI, or PCS as useful indicators of surgical outcomes in foot and ankle patients.
Effect of Postoperative Ketorolac Administration on the Union Rate Following First Metatarsophalangeal Joint Arthrodesis
Authors: Kachooei Amir R. , Hester William , Gaston Tara , Corr Daniel O. , Daniel Joseph N.
Published: January 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

To decrease postoperative opioid consumption, nonsteroid anti-inflammatory drugs (NSAIDs), including ketorolac, is considered a proper substitute with few side effects. This study aimed to assess the nonunion rate after the first metatarsophalangeal (MTP) joint arthrodesis and five-day ketorolac administration. We secondarily aimed to compare the observed rate of nonunion in our study with the reported rate of 5.4% in a systematic review.

Methods:

In a retrospective cohort study, we included 181 primary MTP arthrodeses from 2016 to 2020 in a single surgeon practice. The surgical technique was identical using a dorsal locking plate after preparing the joint with the cup-and-cone technique. Ketorolac was administered every 6 hours for five consecutive days postoperative. Patients were placed in a heel weight-bearing CAM boot for a minimum of 6 weeks. Union was determined radiographically at three months and the final follow- up. Nonunion was categorized as symptomatic versus asymptomatic.

Results:

At three months postoperative, patient characteristics did not show any statistically significant difference between union and nonunion groups. However, at the final follow-up, hallux rigidus was significantly associated with a higher rate of the union in comparison to the preexisting hallux valgus deformity (odds=3.7; P=0.04). of 181 feet, 15 (8.3%) at three months and 12 (6.6%) at the final follow-up revealed nonunion. Of 15, 7 (45%) were asymptomatic, and 8 (55%) were symptomatic. Six (75%) of the 'symptomatic' nonunion underwent an unplanned secondary surgery. Almost 50% of the asymptomatic nonunions at three months healed by the final follow-up; however, none of the symptomatic nonunions healed. Comparing the observed proportion of nonunions at three months (8.3%) and the final follow-up (6.6%) in our study to the mean nonunion rate of 5.4% found in the literature revealed no significant difference between our results and the literature (P=0.067 and 0.27, respectively).

Conclusion:

A short course of oral ketorolac does not seem to affect the union rate after MTP arthrodesis. Ketorolac can be used safely and effectively to decrease postoperative opioid consumption.
Apoptosis Occurs in Anterior Talofibular Ligament of Chronic Lateral Ankle Instability: Biochemical Evidence from Bench to Bed
Authors: Kim Yoon-Chung , Cho Sung Hyun
Published: January 2022

Category:

Ankle; Basic Sciences/Biologics; Sports

Introduction/Purpose:

Chronic lateral ankle instability (CLAI) is a common entity that can result in degenerative arthritis if left untreated. CLAI is treated operatively, while acute ligament injury, so-called 'ankle sprain' is primarily treated nonoperatively with good clinical outcomes. This widely accepted opinion has been proved by clinical scoring system, physical examination, stress radiographs, ultrasonography, or magnetic resonance imaging. However, some surgeons often rush to perform the operative repair for acute ankle ligament injury. Apoptosis has been demonstrated as a considerable cause of ligament degeneration. Up to date, there are few reports of biomolecular and histochemical evidence focused on the 'apoptosis' that occurred in the torn anterior talofibular ligament (ATFL). The aim of this study is to elucidate the apoptosis that occurs within the ATFL of CLAI.

Methods:

Ligamentous tissues were collected from 15 patients undergoing modified Broström operation (group C) and 10 patients undergoing distal fibular fracture surgery as controls (group A). We allocated distal fibular fracture patients as an alternative to acute lateral ankle ligament injury to harvest acutely injured ATFL tissue. In both groups, the tissue samples were harvested at ATFL. Apoptotic cells were determined by TUNEL (terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling) assay. Caspase 3/7, 8, 9, and cytochrome c activities were measured to determine the intracellular apoptosis pathway using Western blot. Immunohistochemistry staining was also performed to detect the expression of caspases and cytochrome c.

Results:

The TUNEL assay revealed a large number of positive staining cells in group C that included ATFL of CLAI. The apoptotic activities of ligaments from group C were significantly higher than those of group A (P < 0.05). Immunohistochemistry also revealed an increase in expression of caspase 3/7, 8, 9, and cytochrome c more in group C than in group A.

Conclusion:

This study demonstrates that the degenerated ATFL following CLAI showed higher apoptotic activity than acutely sprained ligament. Based on our biochemical findings, we could remind previous understanding about surgical indication and timing of lateral ankle ligament injury. We suggest that a clinical relevance between our laboratory research and previous knowledge Further study should be conducted to focus on biological augmentation to reverse or prevent further apoptosis within the lateral ankle ligament complex including ATFL.