bluuebunny/crossref_metadata_2025 huggingface dataset:
Favorable Outcomes Following Extra-Corporeal Shockwave Therapy for Chronic Non-Insertional Achilles Tendinopathy Compared to Chronic Insertional Achilles Tendinopathy: A Retrospective Review
Authors: Butler James J. , DeClouette Brittany , Walls Raymond J. , Jejelava George , Zheng Danny , Azam Mohammad T. , Kennedy John G.
Published: December 2023

Category:

Ankle; Basic Sciences/Biologics

Introduction/Purpose:

Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment modality that is utilized in the treatment of chronic Achilles tendinopathy (AT). The purpose of this study was to retrospectively assess outcomes following ESWT for both NAT and IAT at greater than 1-year follow-up, and to identify potential predictors of outcomes.

Methods:

Chart review was conducted to identify patients who underwent ESWT for AT with a minimum of 1-year follow-up. Data collected and assessed included: patient demographics, pathological characteristics, treatment characteristics, Victorian Institute of Sports Assessment-Achilles (VISA-A) and visual analog scale (VAS) scores and failures. Linear regression was performed to identify potential predictors of outcomes. Survival analysis was conducted using Kaplan Meier curves. Fifty-two cases of IAT and 34 cases of NAT were included. The mean follow-up in the NAT cohort was 22.3±10.2 months and the mean follow-up time in the IAT cohort was 26.8±15.8 months.

Results:

Improvements in VISA-A and VAS scores were observed in the NAT cohort at 6 months follow-up and at final follow-up (p < 0.01). Improvements in VISA-A scores and VAS scores were recorded in the IAT cohort at 6 months follow-up which subsequently deteriorated at final follow-up. In the NAT cohort, the failure rate at 6 months follow-up was 11.8% which increased to 29.4% at final follow-up. In the IAT cohort, the failure rate at 6 months follow-up was 32.7% which increased to 59.6% at final follow-up. Predictors of poor outcomes in the NAT cohort included pre-ESWT subjective clinical score, male, presence of cardiovascular risk factor, and increasing MRI severity. Predictors of poor outcomes in the IAT cohort included pre-ESWT subjective clinical score and increasing MRI severity.

Conclusion:

This study found that superior subjective clinical outcomes together with a lower failure rate maintained over 1 year in the NAT cohort compared to the IAT cohort. This may implicate ESWT as a temporising treatment in IAT and a longer term solution in patients with NAT.
Heat Generation and Risk of Thermal Necrosis during Minimally Invasive Hallux Valgus Correction Utilizing a Shannon Burr: A Cadaveric Study
Authors: Hall SarahRose , Encinas Rodrigo , Cantrell Anthony C. , Jackson J. Benjamin , Gonzalez Tyler
Published: December 2023

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

Minimally invasive (MIS) bunion correction is growing in popularity as a treatment option of hallux valgus deformities. This technique has been shown to help with post-operative pain and improve functional outcomes. Despite these benefits there are concerns that the Shannon burr may lead to excess heat generation, thermal necrosis of bone and potentially increase the risk of nonunion. The purpose of our study was to assess the heat generation while using a Shannon burr during MIS first metatarsal osteotomies.

Methods:

Four below knee cadavers were utilized and osteotomies of the distal and proximal aspects of each of the first metatarsal were performed utilizing a 2mm x 20mm Shannon burr under fluoroscopic guidance. 3 K-type thermocouples were placed in each metatarsal, one distal, one in between and one proximal to the osteotomy sites. Temperatures were evaluated during the entire burring process and after to assess heat dissipation and total heat generated. Three different techniques of burring were utilized, 1. Continuous without irrigation, 2. Continuous with irrigation and 3. Pulse burring technique with irrigation (20 seconds on, 10 seconds off).

Results:

The pulse burring technique with irrigation showed the overall lowest max temperature and change in temperature compared to the other techniques. Average burr time, maximum heat generation and overall change in heat was 86.2 seconds, 102.4 °F and 78.9 °F for all trials.

Conclusion:

The pulse burr technique with irrigation generated less heat than both continuous burring with and without irrigation. There was an overall trend toward higher heat generation with longer burr times regardless of irrigation and burring technique. Utilizing a Shannon burr with pulse burring and irrigation can minimize heat generation and potentially decrease the risk of thermal necrosis of bone.
K-Wire Fixation vs Implant Device Fixation for Hammertoe Deformity: A Systematic Review and Meta-Analysis
Authors: Butler James J. , Konar Kishore , Azam Mohammad T. , Kennedy John G.
Published: December 2023

Category:

Lesser Toes; Other

Introduction/Purpose:

The purpose of this systematic review was to compare the clinical and radiological outcomes between K- Wire fixation and implant device fixation for the management of hammertoe deformity.

Methods:

During November 2022, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following either K-Wire fixation and implant device fixation for the treatment of hammertoe deformity at a minimum of 1-year follow-up. Data regarding surgical characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. 19 studies were included for quantitative analysis, of which 4 studies were included for qualitative analysis.

Results:

In total, 1343 patients (3468 feet) underwent K-Wire fixation and 456 patients (664 feet) underwent implant device fixation for the management of hammertoe deformity.The osseous union rate in the K-wire cohort was 71.3% versus 74.8% in the implant device cohort. The complication rate in the K-wire cohort was 9.7% versus 29.3% in the implant device cohort. The failure rate in the K-wire cohort was 8.6% versus 6.5% in the implant cohort. The secondary surgical procedure rate in the K-wire cohort was 8.3% versus 3.6% in the device cohort. Qualitative analysis found no difference in osseous union rates (RR=0.5832; 0.0830-4.0985; p=0.3562), complication rates (RR=1.12; 0.11-11.34; p=0.8571), failure rates (RR=0.87; 0.04-21.86; p=0.8746) nor secondary surgical procedure rates (RR=1.05; 0.06-18.32; p=0.9487) between the K-wire cohort and device cohort.

Conclusion:

This systematic review and meta-analysis demonstrated improvement in clinical and radiographic outcomes following both K-wire fixation and implant device fixation for hammertoe deformity. Qualitative analysis found no significant difference in osseous union rates, complication rates, failure rates nor secondary surgical procedure rates between the 2 cohorts. However, the marked heterogeneity between the included studies and few high level comparative studies limits the generation of any robust conclusions. Further research is warranted to determine the optimal role of both K-wire fixation and implant device fixation in the management of hammertoe deformity.
Long-Term Outcomes of Infinity Total Ankle Arthroplasty Compared to Ankle Arthrodesis
Authors: Willegger Madeleine , Veljkovic Andrea , Younger Alastair , Wing Kevin , Penner Murray
Published: December 2023

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

End-stage ankle arthritis causes severe pain and disability. The most common treatment has been ankle arthrodesis (AA) with proven long-term results. However, total ankle arthroplasty (TAA) has become a viable option to preserve ankle joint motion, relieve pain and shield adjacent joints. And with the evolution of TAA prostheses over the past 2 decades, the use of TAA has been steadily increasing. Nevertheless, long term outcome data on the latest generation of TAA prostheses is scarce. The primary purpose of this study is to evaluate long-term PROMs after Infinity™ TAA and to compare the outcome to a patient cohort of ankle arthrodesis (AA) performed during the same time period.

Methods:

Patients with end-stage ankle arthritis who received surgical treatment with a primary Infinity TAA or AA performed between 2013-2015 were included in this study. All surgeries were performed by four fellowship trained foot and ankle surgeons. Patient reported outcomes (PROMs) comprising the AOS and SF-36 PCS score were prospectively collected for patients who were willing to enroll into the Canadian Orthopaedic Foot and Ankle Society (COFAS) database. PROM data was compared between the TAA and AA patient cohorts. Implant survivorship as well as revision and reoperation rates were also analyzed.

Results:

33 patients/ankles underwent primary Infinity™ TAA and 59 patients/ankles underwent AA. Of these, 25 TAA and 46 AA were enrolled in the prospective database, 20 and 46 had PROMs available for follow-up, respectively. Mean TAA PROM follow- up was 6.8 years (3-9) and for AA 6.4 years (2-9). Mean TAA age at surgery was 67 years (54-85) and 58 years for AA (27-84). TAA total AOS score pre-operatively was 52.9, which improved significantly to 23.9. SF-36 PCS scores improved from 33.1 to 43.3. Pre- and post-operative PROMs were similar to the AA cohort. At clinical follow up of 8-10 years, TAA implant survival was 97% with one metal component exchange. Two TAA patients had two reoperations each. In the AA cohort, the reoperation rate was 10.8%.

Conclusion:

This is the first report on patient reported outcomes and implant survival at 8 or more years after primary Infinity™ TAA. PROMs remain significantly improved at long term follow-up and are comparable to a cohort of long-term AA patients. Revision rates were low with a single component revision in 33 patients resulting in an implant survivorship of 97%. Long-term outcome of the Infinity™ total ankle arthroplasty is promising.
Midterm Outcomes Talocalcaneal Coalition Arthroscopic Resection in Adults
Authors: Guo Qinwei
Published: December 2023

Category:

Arthroscopy; Hindfoot

Introduction/Purpose:

Arthroscopic resection3-term outcomes. However, the midterm outcomes of this approach remain uncertain.

Methods:

We performed a retrospective study of patients who underwent arthroscopic resection for symptomatic TCC. The patients were divided into 2 groups (group P, patients with isolated posterior facet coalition; and group MP, patients with both middle and posterior facet coalition). The preoperative and postoperative visual analog scale (VAS) scores for pain and American Orthopaedic Foot & Ankle Society (AOFAS) scale scores were calculated. The postoperative AOFAS and VAS scores between the 2 groups were analyzed. Patient satisfaction was also assessed.

Results:

Thirty-two patients were included in this study. The mean age at the time of surgery was 26.0 8.5 years, and the mean follow-up period was 56.9 18.0 months. Postoperative VAS and AOFAS scores improved more significantly than preoperative scores. At the final follow-up, excellent and good subjective outcomes were attained in 26 patients (81%), fair and poor outcomes in 6 patients (19%). There were no statistical differences in the postoperative AOFAS (91.0 7.0 vs 85.8 10.8, P = .532) and VAS score (2.1 1.7 vs 4.0 2.6, P = .537) between patients with the ratio of coalition/posterior facet more than or less than 50%.

Conclusion:

We found that TCC arthroscopic resection was generally associated with reasonable outcomes at midterm follow-up.
Midterm Survivorship and Complications of the Cadence Total Ankle Arthroplasty
Authors: Kim C. James , Tsai Justin , Pedowitz David I.
Published: December 2023

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

The Cadence total ankle arthroplasty (TAA) system first entered clinical use in 2016. Short-term outcomes with a minimum of two-year follow-up time have demonstrated survivorship between 93.7% and 100% with improvements in patient-reported outcomes measures, coronal alignment, and range of motion1–4. The purpose of this study is to report the midterm survivorship and complications of Cadence TAA patients with a minimum of 4.5-year radiographic follow-up.

Methods:

A retrospective chart review was conducted to identify a total of 22 TAA patients with the Cadence implant and a minimum follow-up time of 4.5-years. Patient age, sex, body mass index, diabetes mellitus status, rheumatoid arthritis status, smoking status, laterality, and diagnosis for TAA were collected from patient chart reviews. Preoperative FAAM-ADL subscore, FAAM-Sport subscore, and VAS pain scores and the postoperative scores at the last follow-up visit was also collected. 13 out of 22 patients had preoperative FAAM-VAS scores available while 10 out of 22 patients had postoperative FAAM-VAS scores available. Postoperative complications in the form of wound-related issues and those requiring reoperation or revision were noted, with revision defined as removal or exchange of metal component. 5-view radiographs obtained preoperatively and at the last follow-up visit were used to measure coronal alignment, range of motion, evidence of subsidence or loosening, and osteolysis as previously described1.

Results:

3 out of 22 patients required a revision surgery, 1 for loosening of tibial component and 2 for infection. 4 out of 22 patients underwent a reoperation, 2 for gutter debridement due to impingement or heterotopic ossification, 1 for periprosthetic medial malleolar fracture, and 1 for removal of painful medial malleolar screws. The average FAAM-ADL, FAAM-Sport, and VAS pain scores improved from 50.6, 26.5, and 59.9 to 69.5, 35.5, and 23.6, respectively. The coronal alignment angle decreased from 5.96 degrees from neutral to 2.31 degrees. The average dorsiflexion and plantarflexion angles were 14.74 and 17.18 degrees, respectively, for an average range of motion of 31.9 degrees. 3 out of 22 patients had evidence of osteolysis while no patients had evidence of loosening or subsidence.

Conclusion:

The midterm survivorship of Cadence TAA system in 22 patients was 86.4%. Excluding the two cases of infection which are typically not attributed to implant performance, the survivorship was 95.4%. The reasons for reoperation included impingement, heterotopic ossification, periprosthetic fracture, and removal of painful hardware. The average FAAM-ADL, FAAM- Sport, VAS pain scores and coronal alignment improved. Analysis of longer follow-up time in greater patient cohorts is necessary for clearer understanding of this fixed-bearing implant’s performance.
Obesity Significantly Impacts Patient Reported Outcomes after Total Ankle Arthroplasty: Results from 615 Controls and 478 Patients with Obesity
Authors: Kim Billy I. , Anastasio Albert T. , Wixted Colleen M. , DeOrio James K. , Nunley James A. , Easley Mark , Adams Samuel
Published: December 2023

Category:

Ankle Arthritis

Introduction/Purpose:

There is limited data evaluating the effect of obesity on outcomes following total ankle arthroplasty (TAA), especially in adequate sample sizes to detect impacts on patient reported outcomes (PROs). The purpose of this study was to assess the effect of obesity on complication rates and PROs.

Methods:

This was a single-institution, retrospective study of 1,093 primary TAA performed between 2001 and 2020. Minimum follow-up was 2 years. Patients were stratified by body mass index (BMI) into Control (BMI=18.5-29.9; n=615), Obesity Class I (BMI=30.0-34.9; n=285), and Obesity Class II (BMI>35.0; n=193) groups. Patient information, intraoperative variables, postoperative complications, PRO measures were compared between groups using univariable statistics. Multivariable Cox regression was performed to assess risk for implant failure. Mean follow-up was 5.6 years (sd:3.1).

Results:

Compared to Control and Class I, Class II patients had the lowest mean age (p=0.001), highest mean ASA score (p < 0.001), and greatest proportion of female sex (p < 0.001) and Black/African American race (p=0.005). There were no statistically significant differences in postoperative complications (infection, implant failure, or impingement) across the BMI classes (p>0.05). Preoperatively, Class II had lower (worse) mean scores for FAOS Pain and ADL subscales than Controls (posthoc pairwise p< 0.001 for both). At final follow-up, both Class II and Class I had lower (worse) mean SMFA (posthoc pairwise p< 0.001 and p=0.030, respectively) and SF36 scores (posthoc pairwise p< 0.001 and p=0.005, respectively) than Controls.

Conclusion:

At midterm follow-up, obesity was not associated with increased rates of complications after TAA. Patients with obesity reported worse musculoskeletal function and overall quality of life after TAA but there was no differential improvement in PROs across BMI classes. To our knowledge, this is the largest single institution study to date examining the effect of obesity on outcomes after primary TAA.
Outcomes and Complications of Tibiotalocalcaneal Arthrodesis
Authors: Fayed Aly M. , Mansur Nacime Salomao Barbachan , Glass Natalie , Phisitkul Phinit , Femino John
Published: December 2023

Category:

Ankle Arthritis; Hindfoot

Introduction/Purpose:

Tibio-talo-calcaneal (TTC) arthrodesis is usually a salvage procedure to address several hindfoot and ankle conditions. Non-union rate after TTC fusion is variably reported 3.4% - 48%. The aims of this study were to describe the outcomes and complications of this procedure and to determine potential risk factors associated with non-union.

Methods:

In this IRB-approved retrospective cohort study, we used the following codes (28705,28725 and 27870) to search the medical records for all patients who underwent TTC fusion between 2006-2022. All relevant demographic data, surgical indications, surgery details (type of the graft, type of the implant, and surgical approach, associated procedures), post-operative course (complications and union rate) and follow-up duration were extracted. Descriptive statistics were performed, and continuous variables were described using median (interquartile range) and categorical variables were described using frequency (%) and mean (standard deviation, SD). Patients and surgery characteristics were compared between united and non-united cases using Wilcoxon Rank Sum Tests for continuous variables and Chi-squared or exact tests, as appropriate, for categorical variables. Analyses were performed using SAS statistical software version 9.4 (SAS Institute Inc., Cary, NC).

Results:

Fifty-one patients (53 feet) were included in the study. Long hindfoot fusion nails were used in 51 cases.Ten cases were routinely dynamized 8-10 weeks after surgery. In 24 (45.3%) patients, morselized allograft was combined with infuseTM and reamer irrigation aspiration autograft (RIA). In 20 (37.7%) patients, morselized allograft was combined with infuseTM only. There were 6 non-union cases (11.3%). When comparing patients and surgery characteristics between non-union versus union group, smoking (P = 0.0150) and routine dynamization (P= 0.0297) were higher in the non-union group. No difference in union rates between different types of graft. Frequency of other complications is listed in (Figure 1). Follow up duration was 27.2 months (range 4-108 months).

Conclusion:

TTC fusion achieves good union rate (88.68%), however it carries a relatively high risk of complications. Routine dynamization of the TTC nail at 8-10 weeks could be a risk factor for non-union. Smoking was also associated with a high non- union rate.
Outcomes following Open vs Minimally Invasive Chevron Osteotomy for the Management of Hallux Valgus Deformity: A Systematic Review and Meta-Analysis
Authors: Butler James J. , Rajivan Ragul , Konar Kishore , Randall Grace W. , Azam Mohammad T. , Kennedy John G.
Published: December 2023

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

The purpose of this systematic review and meta-analysis is to compare outcomes between patients who underwent open chevron osteotomy (OCO) and minimally invasive Chevron osteotomy (MICA) for the management of hallux valgus deformity.

Methods:

During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies comparing outcomes between patients who underwent open chevron osteotomy (OCO) and minimally invasive Chevron osteotomy (MICO) for the management of hallux valgus deformity. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, failure rates and complications were extracted and analysed. In total, 6 comparative studies were included in this review.

Results:

In total, 183 patients (208 feet) underwent OCO and 209 patients (244 feet) MICA for the management of hallux valgus deformity. Meta-analysis demonstrated no difference in post-operative MOFXQ scores (SMD: 0.0849, [-0.2584, 0.4282], p = 0.6277), hallux valgus angle (SMD: -0.1245, [-0.4204, 0.1715], p = 0.4099), intermetatarsal angle (SMD:-0.2565, [-0.5539, 0.0408], p = 0.909) and failures (RR: 1.0765, [0.0993, 11.6760], p = 0.9278) between the OCO cohort and the MICO cohort. There was a lower complication rate in the OCO cohort compared to the MICO cohort (RR: 0.2614, [0.1453, 0.4704], p < 0.0001).

Conclusion:

This systematic review found comparable improvements in subjective clinical outcomes, functional outcomes and radiographic outcomes following both OCO and MICO at short-term follow-up. However, a lower RR with respect to complications was found in the OCO cohort compared to the MICO cohort. Despite the significant heterogeneity across the included studies, the similar outcomes between the 2 cohorts reinforces that further research is warranted to determine the optimal role of OCO and MICO in the management of hallux valgus deformity.
Patterns of Anterior Inferior Tibiofibular Ligament Avulsion Fracture Accompanied by Ankle Fracture
Authors: Kim Dae-Yoo , Seo Won-Seok
Published: December 2023

Category:

Ankle; Trauma

Introduction/Purpose:

The anterior inferior tibiofibular ligament (AITFL) avulsion fracture accompanying an ankle fracture cause compromising ankle stability, and requires accurate evaluation and clarifies pathophysiology. The aim of this study was to investigate the correlation between AITFL avulsion fracture and Lauge–Hansen, Wagstaffe classification.

Methods:

128 patients (70 males and 58 females) operated at the present institution between January 2013 and July 2017 were included. AITFL avulsion fractures occurred in 68 patients. Fracture was diagnosed based on the preoperative simple radiographs obtained of the ankle joint in the anteroposterior, lateral and mortise views. In cases wherein diagnosis was difficult using radiographs alone, CT was additionally used. AITFL avulsion fractures were classified based on the fracture site according to the Wagstaffe classification system. The anteroposterior and horizontal lengths as well as the height of the avulsed bone fragment were measured using CT scans in the coronal, sagittal and axial views. Thereafter, the relationship between the Lauge-Hansen classification of ankle fractures and the characteristics of AITFL fracture was statistically analysed using the Fisher exact test.

Results:

Type II of the modified Wagstaffe classification system was 39 examples, followed by type III (9 examples) and type IV (8 examples). Out of 7 pronation-abduction fractures, 3 were those of AITFL avulsion fracture, while out of the 21 pronation- external rotation fracture examples, 9 were those of AITFL avulsion fracture. Out of the 95 examples of supination-external rotation fracture, there were 56 examples (59%) of AITFL avulsion fracture. Of the pronation fractures, 0% was a fibular avulsion fracture and 43% were a tibial avulsion fracture. Of the supination fractures, 44% were a fibular avulsion fracture and 16% were a tibial avulsion fracture. The difference in the ratio of fibular and tibial avulsion fractures between the pronation and supination fractures was significant. (p < 0.0001)

Conclusion:

Some of the AITFL avulsion fractures examined in this study may have been caused by collisions with the talus rather than the traction of the AITFL. Although Wagstaffe fractures accompanied by a supination–external rotation-type fracture results from the traction of the AITFL, a tibial avulsion fracture in a patient with a modified Wagstaffe type 4 fracture and a supination fracture appears to result from a continuous external rotation and repeated collisions of the talus with the anterolateral corner of the distal tibia.
Retrospective Review of 200 Consecutive, Single Surgeon, Fibula Nails with Proximal and Distal Fixation
Authors: Rodriguez-Materon Solangel , Lopez Kyra E. , Trynz Samantha , Chapman Cary , Fleites Jorge , Hodgkins Christopher , Hodgkins Christopher
Published: December 2023

Category:

Trauma; Ankle

Introduction/Purpose:

Ankle fractures are one of the most common injuries presenting to orthopedic surgeons. Unstable ankle fractures require surgical intervention and the most common fixation method is the use of a plate and screw construct. However, this requires an extensive open incision, which potentially increases the risk of post-operative wound complications and the possibility of hardware irritation. The purpose of this abstract is to evaluate the clinical outcomes of the treatment of unstable lateral malleolar fractures using a fibula nail with both proximal and distal locking capabilities from our original cohort, and in our increased cohort of 200 consecutive single surgeon fibula nails using a mini open incision to anatomically reduce.

Methods:

We retrospectively reviewed 200 consecutive FibuLock Fibula Nail® fixation constructs (Arthrex, Naples, FL, USA) of a single surgeon in a private practice community hospital. Demographic, operative, clinical, and radiographic outcome data were analyzed.

Results:

The average follow-up time of the patients was 18.5 months. The demographics of the patients can be found in table 1. There were no cases of infection, loss of reduction, delayed union, or nonunion. All fractures healed. There were two cases of focal superficial epidermal lysis treated with local wound care, that did not require antibiotics. One patient required removal of the nail as a result of it being proud, which was an iatrogenic error. In our previously reported first 110 nails, we had to convert two fractures to plate fixation intraoperatively due to excessive comminution, which made the implantation more difficult. There were no further episodes of this in our next 90 cases due to adoption of plate assisted nail technique.

Conclusion:

The use of an intramedullary nail with a mini-open technique allows for anatomic fracture reduction and no-profile fixation, thus reducing the risk of wound complications and providing stable fixation. Our technique results in anatomic healing in nearly all patients. Also, there were no incidents of delayed or malunion and no postoperative loss of reduction. Our results demonstrated a very low complication rate compared to traditional plate fixation with good patient reported outcomes.
Risks of Increased Operative Time and Longer Hospital Stays Based on Age in Total Ankle Arthroplasty
Authors: Peairs Emily M. , Anastasio Albert T. , Kim Billy I. , Walley Kempland , Adams Samuel
Published: December 2023

Category:

Ankle Arthritis

Introduction/Purpose:

Total joint arthroplasty is increasingly being performed in younger individuals across the United States. While age-specific outcomes have been evaluated in total hip and knee replacements, the data are not as clear for total ankle arthroplasty (TAA). The purpose of this study was to analyze TAA outcomes and complications by age to improve shared decision-making when considering ankle replacements.

Methods:

A total of 1,619 primary and revision TAAs from 2012-2020 were collected and included from the National Surgical Quality Improvement Program. Patients were stratified by age into groups less than 55, between 55-70, and greater than 70 years of age. Demographics, medical comorbidities, ASA class, operative time, 30-day complications, and comorbid conditions were compared by univariable analysis. Multivariable analysis was used to analyze readmission rates, reoperation rates, operative time, and hospital length of stay.

Results:

By univariable analysis, patients greater than 70 have significantly more comorbidities when compared to patients younger than 55. Younger patients have a significantly longer hospital stay, with an average of 1.64 days for those younger than 55 compared to patients 55-70 (1.50 days) and patients older than 70 (1.38 days, p< 0.001). Younger patients also have a significantly longer operative time and a higher risk of still being in the hospital after 30 days (p < 0.001, p=0.034). By multivariable analysis, patients 55-70 have a statistically lower risk of readmission compared to the other two cohorts (p = 0.043).

Conclusion:

As the incidence of total ankle arthroplasty increases across all ages, it is important to understand specific risks for each age group. Patients younger than 55 experience higher operative times and longer lengths of stay. Patients between 55-70 have a significantly lower risk of reoperation but longer hospital stays. Patients older than 70 tend to have lower reoperation rates, lower readmission rates, and shorter operative times.
Semi-Automatic 3D Assessment of Zadek Osteotomy Effects
Authors: Nunes Gustavo Araujo , Carvalho Kepler A.M. , Mansur Nacime Salomao Barbachan , Kim Ki Chun , Chrea Bopha , Mann Tania Szejnfeld , Godoy-Santos Alexandre Leme , de Cesar Netto Cesar
Published: December 2023

Category:

Hindfoot; Sports

Introduction/Purpose:

Zadek's procedure is a surgical option to treat insertional Achilles tendinopathy(IAT). This procedure consists of a closing wedge osteotomy of the calcaneus with biomechanical consequences. Great modifications in the hindfoot alignment can result in poor functional outcomes for athletes. Additionally, some authors stated that Zadek osteotomy is a good choice for patients with IAT associated with cavovarus foot. This study aims to analyze the hindfoot alignment and the parameters related to Haglund's syndrome after Zadek's osteotomy using a virtual surgical simulation by specific software. The authors hypothesize that the Zadek is an effective technique to decompress the Achilles tendon against the Haglund deformity without major modifications in the alignment.

Methods:

A total of 20 WBCT scans of patients with IAT were included. The WBCT images were run through the Foot & Ankle module of Disior's BonelogicTM software, creating a 3D virtual model. With this 3D model built into this software, 20 virtual Zadeck osteotomies standardized with a 10 mm resection wedge were performed using the virtual osteotomy module of Bonelogic®. The Calcaneal Inclination angle (sagittal view)7; Talocalcaneal angle (sagittal view)8; Talocalcaneal angle (axial view)8; Saltzman angle (45 degrees view)9; Saltzman angle (20 degrees view)9; Hindfoot moment arm angle;10 Hindfoot angle10; Fowler Philips angle11 and the calcaneal length7 were measured before and after the virtual osteotomy. These results were compared and statistically analyzed.

Results:

A virtual Zadek osteotomy was realized in 20 WBCT from patients with an insertional Achilles tendinopathy. Most of the patients were female, and the mean age was 55 years. There were significant statistical differences in the average of the calcaneal length (79 mm to 73 mm), Fowler Philips angle (57º to 43º), calcaneal pitch ( 24º to 20º ), sagittal talocalcaneal angle (55º to 47º ), and the hindfoot moment arm angle (20 º to 21,8º). The axial talocalcaneal angle, Saltzman view 45 º and 20 º, and Hindfoot moment arm showed subtle modifications.

Conclusion:

The virtual analysis of Zadek's osteotomy decreased the Fowler Philips angle, shortened the calcaneus, and modified the alignment in the sagittal view. It suggests that Zadek's procedure reduces the bone impingement with Achilles and the Achilles push. The effect of this osteotomy in Hindfoot Alignment was subtle, modifying only the sagittal plane.
Sex Differences in Muscle Hypertrophy Response to Training of the Peroneus Longus and Peroneus Brevis Muscles
Authors: Tamura Yuki , Urabe Yukio , Maeda Noriaki , Komiya Makoto , Arima Satoshi , Oda Sakura
Published: December 2023

Category:

Ankle; Trauma

Introduction/Purpose:

It has been reported that there are no significant sex differences in muscle hypertrophy response after strength training for the quadriceps muscles (Roth et al., 2002). After an ankle sprain, the peroneus longus (PL) and peroneus brevis (PB) muscles develop morphological changes and dysfunction, which requires training for the PL and PB (Arima et al., 2022). However, to our knowledge, sex differences in muscle hypertrophic response to the PL and PB training have not been studied. This study aimed to compare the changes in muscle cross-sectional area (CSA) after the PL and PB training between men and women, and to examine the possible influence of sex on the muscle hypertrophy response to training for the PL and PB.

Methods:

Eighteen healthy adults (9 men and 9 women) were participated. All participants performed two types of ankle eversion training on the right leg with Thera-Band on separate days. PL training in which the Thera-Band was placed on the ball of foot and pushed out from the contact point, and PB training in which the Thera-Band was pushed out from the base of the fifth metatarsal. An ultrasound imaging device was used to measure the CSA of the peroneal muscles at the proximal 25% and distal 75% of the line connecting the fibular head and the lateral malleolus. The measurements were taken before (pre), immediately after (post), 10, 20, and 30 minutes after each training, and the amount of change over time relative to pre was calculated. Unpaired t-tests were used to compare the change in CSA between men and women at each time. Statistical significance was set at 5%.

Results:

After the PL training, the amount of change in CSA of the PL was significantly greater by 29.7 mm² in women than in men only at post (p < 0.05), but there were no significant differences at other times (10 minutes: p = 0.06, 20 minutes: p = 0.19, 30 minutes: p = 0.11). After the PB training, the amount of change in CSA of the PB was significantly greater by 16.0 mm² at post (p < 0.05) and 3.1 mm² at 30 minutes (p < 0.01) in women than in men. However, there were no significant differences at 10 and 20 minutes (10 minutes: p = 0.27, 20 minutes: p = 0.55).

Conclusion:

The results indicate that sex differences may influence the immediate muscle hypertrophic response to training for the PL and PB. The immediate muscle hypertrophy response after training is due to edema resulting from muscle damage, reflecting an immediate effect of training (Damas et al., 2016), which suggests that women are more likely to achieve effects of the PL and PB training than men in similar loads. Furthermore, the results also show that the effect of the PB training may be maintained longer in women, thus it is necessary to investigate the long-term effects of the training in the future.
Superior Rates of Return to Sport following Anterior Talofibular Ligament Repair Augmented with Suture-Tape compared to Anterior Talofibular Ligament Repair Alone: A Retrospective Comparative Study
Authors: Randall Grace W. , Butler James J. , Azam Mohammad T. , Rettig Samantha , Kennedy John G.
Published: December 2023

Category:

Ankle; Sports

Introduction/Purpose:

Chronic ankle instability occurs in 15-20% of patients with ankle sprains who do not recover following conservative management and typically requires surgical intervention. There is recent interest in Anterior Talofibular Ligament (ATFL) Repair techniques that may improve outcomes and expedite recovery. Evidence for the use of suture-tape as an internal in ATFL Repair is limited in the literature. The purpose of this study was to retrospectively assess outcomes and return to sport following ATFL Repair with and without suture-tape (ST) augmentation at greater than 1-year follow-up.

Methods:

Chart review was conducted to identify patients who underwent Anterior Talofibular Ligament (ATFL) Repair with a minimum of 1-year follow-up. Data collected and assessed included: patient demographics, pathological characteristics, treatment characteristics, Foot and Ankle Outcome Score (FAOS), visual analog scale (VAS) scores, return to sport (RTS), complications, and failures. Linear regression was performed to identify potential predictors of outcomes.

Results:

Eighteen cases of ATFL repair augmented with suture-tape (ST) and 20 cases of ATFL repair alone were included. The mean follow-up in the ST cohort was 20.8 ± 7.9 months and the mean follow-up time in the ATFL repair alone cohort was 25.3 ± 13.2 months. Improvements in FAOS and VAS scores were observed in both cohorts at final follow-up (p < 0.01). No statistically significant difference in FAOS and VAS scores at final follow up was found between the 2 cohorts. The mean time to RTS was 8.6 ± 3.3 weeks in the ST cohort and 13.3 ± 2.7 weeks in the ATFL repair alone cohort (p < 0.01). No statistically significant difference in complication rates nor failure rates was observed between the 2 cohorts.

Conclusion:

This retrospective study found that ATFL Repair with and without suture-tape augmentation produced comparable subjective clinical outcomes, complication rates and failure rates at short-term follow-up. A superior mean time to RTS was found in the ST cohort. The early results of this surgical technique are promising, but further studies with larger patient cohorts and longer follow-up times are needed to determine the optimal role of suture-tape augmentation of ATFL repair.
The Arterial Risk Posed by the Posterolateral Approach to the Ankle: An Anatomical Cadaveric Observational Study
Authors: Mason Lyndon W. , Heeran Niamh L. , Bond Alistair P. , Gomaa Abdul-Rahman
Published: December 2023

Category:

Ankle; Trauma

Introduction/Purpose:

The most commonly used approach for posterior malleolar access is the posterolateral approach. This approach gives good access to the fibula and lateral aspect of the posterior tibia, however; there is little known on the vascular risks with this approach.

Methods:

The aim of this study was to assess and describe the anatomy of the peroneal artery and its branches at the ankle region.

Methodology:

Eleven cadaveric foot and ankle specimens were dissected in layers, preserving the peroneal artery, anterior tibial artery (ATA) and posterior tibial artery (PTA).

Results:

The peroneal artery was consistently found between the peroneal compartment and deep muscular compartment of the posterior leg. A wide range of anatomical variation was found in the peroneal artery, in its location, muscular branches, anastomosis and anterior perforating branch. The peroneal artery was the largest diameter artery in one specimen. There was great variation in number and location of muscular branches. The mean proximal distance between the medial malleolus and the posterior communicating branch of the peroneal artery was 37.93mm (range: 19.03- 85.43mm). The mean proximal distance from the medial malleolus to the anterior peroneal perforating artery was 44.23mm (range:35.44-62.32mm). Distal to the anterior perforating branch of the peroneal artery, the peroneal artery was immobile.

Conclusion:

Understanding the common variations within the ankle’s arterial anatomy can help surgeons protect these vessels from damage during the surgical approach. The posterolateral surgical approach, specifically puts the peroneal artery at risk and knowledge of its anatomy and variability is important when undertaking this approach.
The Efficacy of Hyaluronic Acid Injections in Soft Tissue Foot and Ankle Pathology: A Systematic Review
Authors: Butler James J. , Wingo Taylor , Joshi Shravani , Konar Kishore , Kennedy John G.
Published: December 2023

Category:

Ankle; Basic Sciences/Biologics

Introduction/Purpose:

The purpose of this systematic review was to evaluate the clinical outcomes, complication rates and failure rates at short-term follow-up following hyaluronic acid (HA) injection for the management of various soft tissue foot and ankle pathologies.

Methods:

During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following HA injection for the management of various soft tissue foot and ankle pathologies. Data regarding study characteristics, patient demographics, pathological characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. In addition, the level of evidence and quality of evidence for each individual study was also assessed.

Results:

Studies examining outcomes following HA injection included the following pathologies: Achilles tendinopathy (AT) (6 studies, 126 patients, weighted mean follow-up of 2.9 months), plantar fasciitis (PF) (2 studies, 54 patients, 4.3), lateral ankle sprains (LAS) (2 studies, 119 patients, follow-up of 11.4 months) and Morton's neuroma (MN) (1 study, 83 patients, follow-up of 12 months). Seven different HA formulations were utilised across 10 studies. Weighted mean pain and functional scores improved significantly in all 4 cohorts. The complication rates for the AT cohort, PF cohort, LAS cohort and MN include: 3.2%, 1.9%, 2.5% and 20.5%, respectively. The failure rates for the AT cohort, PF cohort, LAS cohort and MN include: 1.6%, 0%, 0% and 0%, respectively.

Conclusion:

This systematic review demonstrated improvements in subjective clinical outcomes together with low complication and failure rates following HA injections for various soft tissue foot and ankle pathologies at short term follow-up. However, the heterogeneity between the studies, low number of high quality studies and short-term follow-up limits the generation of any robust conclusions. Further research is warranted to assess the optimal role of HA in the management of foot and ankle soft tissue pathologies.
The Evaluation of Muller Weiss Diseased and Normal Feet on a Three-Dimensional Foot Model
Authors: Gu Wanjun , Zhu Mingjie , Sun Chengyi , Zhang Mingzhu , Myerson Mark , Li Shuyuan
Published: December 2023

Category:

Hindfoot; Midfoot/Forefoot

Introduction/Purpose:

The deformities associated with Müller Weis Disease (MWD) have not been well understood which inevitably impacts clinical and surgical decision making. Despite most previous studies characterizing MWD as a paradoxical flatfoot deformity, ie, a flat arch and a varus heel, some studies have treated MWD as a flatfoot deformity by performing a medializing calcaneus osteotomy, and others as an arthritic disorder treated with hind foot arthrodesis but without correcting the deformity. This study used an automatic 3D segmentation program to create an average 3D foot model for both normal controls and a large group of MWD feet, to demonstrate the deformity pattern, and to provide surgeons with a foundation for detailed alignment evaluation and surgical planning.

Methods:

Weight bearing Scans of 55 health feet without deformities, trauma and surgical histories, and 69 MWD feet were included in this study. The Bonelogic program (Disior, Paragon 28,) was used to automatically segment the bones and 3D information of each foot in the same group was pooled to create an average foot model for both the controls and the MWD feet. Videos were created using all feet in both groups to demonstrate the deformity patterns ranging from normal feet transitioning to MWD feet. Since current axial and angular metrics for alignment evaluation using traditional 2D imaging cannot be extrapolated to 3D this study was kept as a descriptive paper, and no traditional metrics were analyzed and reported.

Results:

Compared to the average normal foot, the MWD foot model demonstrated the following features: narrowing on the lateral pole and dorsal side of the navicular, lateral rotation and slight dorsal lifting of the talar head and medial rotation of the navicular, a varus heel with more opening in the sinus tarsi, proximal shift of the calcaneal tuberosity, a flat medial arch with subsidence at the talonavicular joint, decreased adduction of the forefoot, medial translation of the cuboid at the calcaneocuboid articulation, and a shortened 1st metatarsal. All of the above changes were consistently demonstrated in video one (a comparison between the two foot models), and video two (a comparison of the peritalar joint alignment between the two groups).

Conclusion:

The foot models were built up with pixels, with each pixel carrying its own 3D information in space allowing exploration of real 3D alignment evaluation tools. The MWD foot model clearly demonstrated and validated the deformity patterns originally described by Maceira, and subsequently by other authors using both radiographs and WBCT scans. This model facilitates evaluation of alignment from the hindfoot to the forefoot, as well as advanced 3D analysis to assess the morphology of the bones and joints and can be the foundation for surgical planning and predication of outcomes.
The Variation Between Unilateral and Bilateral Weight Bearing in Hindfoot Alignment Evaluation. Part I: A Prospective In Vivo Radiographic Study
Authors: Zhu Mingjie , Far Munib D. , Pham Kenneth , Read Jake , Constantine Evangelia , Tyler Benjamin , Wittels Stephen , Myerson Mark , Li Shuyuan
Published: December 2023

Category:

Hindfoot; Midfoot/Forefoot

Introduction/Purpose:

When weight bearing radiographs are taken, the patient is frequently asked to stand on the foot being examined with the other foot lifted off the floor. We have found however that alignments of the hind and midfoot change when bearing weight switches from bilateral to unilateral standing. This study investigated the possible differences in hindfoot alignments between unilateral and bilateral weight bearing using radiographical evaluation.

Methods:

Eight flexible feet without symptoms symptoms, nor significant trauma & surgical history in their lower limbs were recruited for this study. A portable fluoroscopy machine (Smart C, Turner Imaging, Salt Lake City, USA) was used to take weightbearing lateral views. The patient first stood on both feet with the non-examined foot standing outside of the collimator but bearing weight evenly (Figure 1), and then lifted the non-examined foot off the floor when the lateral XR image was taken for the examined foot. Hindfoot alignment in both positions was reflected by measuring the angle between the long axes of the proximal and distal portions of the Achilles tendon on the skin using the subtalar joint line as the intersection. On lateral XRs, various parameters were measured to reflect the subtalar joint alignment, the position of the calcaneus with inversion and eversion of the hindfoot, and the lateral and medial arch heights.

Results:

From bearing weight on two feet (bilaterally) to one foot (unilaterally), the Hindfoot Alignment Angle (Achilles) increased (6.23 to 11.21 degrees), the Calcaneal Pitch Angle decreased (22.06 to 19.22 degrees), the Middle vs Posterior Facets Angle decreased (166.46 to 160.74 degrees), and the 5th metatarsal/cuboid height decreased (0.73 to 0.67) all significant changes (p < 0.05). All of these represented a pronation movement in the mid and hindfoot, ie, valgus tilt/eversion of the calcaneus, decreased sinus tarsi opening, and reduced lateral arch height. In this small cohort, these differences were more obvious in the feet that were either slightly flat or cavus shaped (Figure 1, Table 1, and 2) than in feet with a more neutral alignment.

Conclusion:

The hindfoot and midfoot are more pronated in unilateral weightbearing than in bilateral weightbearing which may mask the severity of the deformity in a flexible cavovarus foot, but increase that in a flexible flatfoot. Modification of the traditionally used unilateral weightbearing position in obtaining clinical radiographs should be considered. Bilateral WBCT scans may be a better alternative, taking advantage of allowing both feet to stand in the most natural position without one foot blocking the other during the radiographic imaging.