bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Patient Outcomes for Treatment of Difficult Osteochondral Lesions of the Talus with Particulated Juvenile Allograft Cartilage Implantation with and without Calcaneal Autograft
Authors: Manzi Joseph , Manchanda Kshitij , Nasra Matthew , Sudah Suleiman , Coladonato Carlo , Quan Theodore , Wishman Mark , Moran Jay , Murray Daniel P. , Chapman Cary
Published: December 2023

Category:

Ankle; Other

Introduction/ Purpose:

Osteochondral lesions of the talus (OCLT) are common injuries that can be difficult to treat. To date, long-term patient reported outcome measures (PROMs) of patients with particulated juvenile allograft cartilage implantation with or without calcaneal autograft have not been compared.

Methods:

From 2010-2012, thirteen patients with difficult to treat OCLTs underwent arthroscopic-assisted implantation of particulated juvenile allograft cartilage (DeNovo NT®) with or without autogenous calcaneal bone grafting by a single surgeon. Calcaneal bone graft use was determined by lesion size >150 mm2 and/or deeper than 5 mm. Patients were evaluated using physical examination, patient interviews, and PROMs. Pre-operative and post-operative PROMs were compared with a Mann Whitney test.

Results:

When comparing patients in regards to calcaneal bone graft implantation, no difference in age, BMI, pre-operative PROMs, or follow-up was noted, however, calcaneal bone graft patients did have a significantly larger lesion size (188.5±50.9 vs. 118.7±29.4mm2 respectively; p-value=0.027). VAS and FAAM ADL scores during final follow-up improvement did not significantly differ between cohorts. The FAAM Sports score improved significantly more for the DeNovo alone group compared to the bone graft cohort (p-value=0.032). The AOFAS score improvement did not differ between cohorts (p-value=0.944), however, the SF-36 PCS improved significantly more for the DeNovo alone group compared to the bone graft cohort (p-value=0.038). No intraoperative/perioperative complications were observed with calcaneal bone grafting.

Conclusion:

While patients followed over the course of ~8 years after implantation of particulated juvenile allograft cartilage (DeNovo NT®) with/without autogenous calcaneal bone graft had positive post-operative PROMs, patients without calcaneal bone graft had significantly greater improvement in functional outcome scores. Whether these differences are due to graft incorporation or larger lesion size is unclear.
Predicting the Potential Complications of Lateral Column Lengthening: A Cadaveric Biomechanical Study
Authors: Zhu Mingjie , Maher Moustafa A. , Baldini Todd , Keeter Carson , Hunt Kenneth , Myerson Mark , Li Shuyuan
Published: December 2023

Category:

Hindfoot; Other

Introduction/ Purpose:

Lateral column lengthening calcaneus osteotomy is a common procedure used to treat flatfoot deformity. However, the incidence of subtalar joint impingement and sinus tarsi pain presents a concern related to this treatment. The hypothesis of this study was with opening of the osteotomy, the anterior fragment of the calcaneus anterior process moves anteriorly, while the posterior fragment simultaneously moves posteriorly which can compromise the outcome as well as cause subtalar joint impingement. The goal of this study was to observe movements of the anterior and posterior fragments with an osteotomy of different sizes.

Methods:

Eight fresh frozen cadaveric feet were used. A vertical calcaneus osteotomy was designed 1.5cm posterior to the calcaneocuboid joint. Optical markers were attached on each side of the osteotomy to measure movements of the anterior and posterior segments during the lengthening procedure. Three more markers were placed for reference purposes with one on the lateral process of the talus, one on the table, and one on the base of the 3rd metatarsal (Figure 1). Following the osteotomy 4mm, 6mm, 8mm, 10mm and 12mm of lengthening was obtained for each specimen using a lamina spreader. The exact lengthening achieved was measured with a micro-caliper. Movements of the anterior and posterior fragments were recorded using a Sentech model STC-MBCM401U3V camera and calculated with MaxTRAQ motion analysis software. Mixed linear regression analyses were performed using R Studio.

Results:

With the open osteotomy, the anterior fragment moved anteriorly, while the posterior fragment moved posteriorly (Table 1, 2). The anterior movement was larger than the posterior one. There was no difference in the amount of anterior movements during each attempted 2mm lengthening, however, the amount of the posterior movement peaked at 6mm-8 mm and went down at 8mm-10mm and 10mm-12mm, which was caused by subtalar joint impingement and limited the posterior excursion. Starting at 6mm lengthening there was a linear regression relationship between the anterior & posterior movement and the lengthening (anterior movement = -4.80 + 1.06 × Lengthening of the Lateral Column, posterior Movement = -1.26 + 0.22 × Lengthening of the Lateral Column) (Figure 2,3). 1mm lengthening induced 1.06mm anterior (p < 0.05), and 0.22mm posterior shift (p < 0.05).

Conclusion:

Lateral lengthening causes the calcaneus to move both anteriorly and posteriorly which not only compromises the power of the procedure, but also can cause subtalar impingement. The findings of this study provide our colleagues with more insight into the correlation between the size of the lengthening, results, and potential complications.
Recurrent Toe Walking in Pediatric Orthopedic Patients: Idiopathic vs Concomitant Sensory Processing Disorders
Authors: Zide Jacob R. , Riccio Anthony I. , Zak Taylor , Minopoli Anthony , Polk Jordan L. , Shivers Claire
Published: December 2023

Category:

Other

Introduction/Purpose:

The purpose of this study is to compare rates of recurrent toe-walking following operative intervention between idiopathic toe walkers and toe walkers with associated sensory processing/autism spectrum disorders.

Methods:

An IRB-approved retrospective review of patients at a single pediatric institution who underwent surgical treatment for toe-walking over a 12-year period was conducted. Children with peripheral or central neurologic disorders, muscle disorders, congenital foot/extremity deformities, prior ankle/foot surgery, and those not managed with an isolated triceps surae procedure were excluded. The remaining patients were divided into those with idiopathic toe-walking (ITW Group) and those with toe- walking associated with sensory processing/autism spectrum disorders (SPD Group). Recurrence of toe walking and need for additional surgery for recurrence were compared between cohorts. Recurrence rates and subsequent operations were assessed for each group. Multivariate regression and Fischer exact test were used to evaluate differences in group characteristics.

Results:

106 patients met inclusion criteria. 29 patients (27%) had an associated sensory processing disorder, the remaining 77 patients comprised the ITW group. There were no differences between groups in length of follow-up (p=0.08) or type of initial surgery performed (p=0.48). The SPD group contained a significantly greater percentage of males (75% vs 56%, p=0.01) and were younger at the age of index surgery (8.5 vs 10 years, p=0.03). At an average follow-up time of 1.2 years, 11 patients (10%) developed clinical recurrence, of whom, 4 underwent a subsequent intervention. The SPD group had significantly higher rates of recurrence than idiopathic toe walkers (24% vs 5%, p=0.009). Multivariate regression analysis demonstrated that an underlying sensory processing disorder was an independent predictor of recurrence (p=0.018, OR=7.5).

Conclusion:

Clinical recurrence following the surgical treatment of toe-walking is over seven times greater in children with autism spectrum and/or other sensory processing disorders than idiopathic counterparts.
Return to Alpine Sport and Physical Activity After First Metatarsophalangeal Joint Arthrodesis
Authors: Buckley Sara E. , Garcia Stefan , Jamieson Marissa , Hewitt Michael A. , Hanson Romney B. , Hunt Kenneth
Published: December 2023

Category:

Midfoot/Forefoot; Sports

Introduction/Purpose:

First metatarsophalangeal (MTP) arthrodesis is an effective procedure to alleviate pain and correct deformity. The unique location of our academic center allows us to study an extremely active patient population with high rates of participation in impact sports and particularly alpine specific sports, including Nordic and alpine skiing, snowboarding, hiking, trail running and biking. There is limited literature regarding these specific activities with regards to a 1st MTP arthrodesis. The goal of the study is to better define the ability to return to physical activity, with a focus on alpine and mountain sports. This will help physicians counsel patients appropriately when discussing surgical options.

Methods:

Patients over 18 years old who underwent MTP arthrodesis with minimum 1 year follow up were identified using CPT code 27850. Patients undergoing concomitant forefoot and hindfoot procedures were excluded. Demographic data and complications were recorded by retrospective chart review. A custom sports questionnaire, PROMIS Physical Function (PF), PROMIS Pain Interference (PI), and Foot and Ankle Ability Measure (FAAM) scores were administered to patients. Postoperative radiographs were analyzed for time to union and fusion position.

Results:

96 patients were eligible for analysis. Preliminarily, 34 have completed the follow-up survey. Most common activities were walking, hiking, alpine skiing, biking and running. Compared to preoperatively, patients rated 70.5% of activities as less difficult, 20.5% as the same, and 9.0% as more difficult. 74% of patients returned to their activities by 6 months and 62% of patients reached their maximum level of activity by 9 months postoperatively. Patients who participated in skiing/snowboarding were all able to ski the same level of terrain compared to before surgery, but nearly half (46%) of patients required boot modifications. 43% of patients were able to increase incline when hiking/trail running, and 48% of patients were able to increase their running/walking mileage. Average PROMIS PF was 51.9 (±6.20).

Conclusion:

Patients are able to participate in a variety of high impact and alpine related sports after 1st MTP arthrodesis. The majority of patients are able to function at similar or increased levels when returning to hiking, walking, skiing and snowboarding. Up to 25% of patients may not reach maximum level of activity until 1 year postoperatively. Additional investigation is required to identify potential risk factors for patients that may experience difficulty returning to activity. Continued survey participation is underway to strengthen these results. Patient counseling on activity participation following hallux MTP arthrodesis is important to optimize outcomes and patient satisfaction.
Rising Patient Out-of-Pocket Costs for Common Outpatient Orthopaedic Foot and Ankle Surgeries
Authors: Goldfarb Sarah I. , Xu Amy L. , Gupta Arjun , Mun Frederick , Durand Wesley M. , Gonzalez Tyler , Aiyer Amiethab A.
Published: December 2023

Category:

Other

Introduction/Purpose:

The purpose of this study is to characterize out-of-pocket (OOP) cost trends in both elective and trauma foot and ankle surgeries for commercially insured patients. Secondarily, we sought to compare the OOP costs of these surgeries between hospital-based outpatient departments (HOPDs) and ambulatory surgical centers (ASCs), as well as insurance plan types.

Methods:

Adult patients who underwent elective or trauma foot and/or ankle surgeries between 2010 and 2020 were identified using the MarketScan Database. Demographic, procedural, and financial data were recorded. The primary outcome was OOP costs, which were defined as the sum of the deductible, coinsurance, and copayment for each episode of care. Monetary data were adjusted to 2020 dollars. General linear regression, Kruskal-Wallis test, and Wilcoxon-Mann-Whitney test were used for analysis, as appropriate. Alpha was set at 0.05.

Results:

A total of 966,095 patients (806,707 elective and 159,388 trauma) underwent common outpatient foot and ankle surgeries between 2010 and 2020. Trauma surgeries generated significantly higher mean OOP costs than elective procedures ($1438.79 versus 1058.53, P< 0.001). OOP costs were significantly lower for procedures performed in ASCs compared to HOPDs ($1071.09 vs $1126.96, P< 0.001). This trend was driven by significantly higher coinsurance for HOPDs ($727.98) versus ASCs ($622.95) (P < 0.001). Of the insurance plans studied, high deductible health plans had the highest average OOP costs. Average OOP costs for common outpatient foot and ankle surgeries increased by 55.2% from $875.11 in 2010 to $1357.86 in 2020.

Conclusion:

OOP costs for foot and ankle surgeries have increased significantly since 2010. Average OOP costs from surgeries performed in ASCs were less than in HOPDs. Patients enrolled in HDHPs tended to incur the greatest average OOP costs. As direct costs for patients increase over time, it is critical to be aware of this financial burden and work towards improving access to necessary care.
The Use of a Sustained Dynamic Compression Intramedullary Nail for Subtalar Arthrodesis
Authors: Shaheen Philip J. , Priester Jacob , Giza Eric , Kreulen Christopher D.
Published: December 2023

Category:

Hindfoot; Other

Introduction/Purpose:

Subtalar arthrodesis has traditionally been performed using fixation made of titanium or stainless steel. While these devices can provide initial compression, the compressive loads can be lost soon after surgery as bone settling or resorption occurs at the joint spaces. The DynaNail® Mini is a subtalar arthrodesis intramedullary nail that allows for compression during surgery and has a stretched nitinol element that attempts to contract but is held by talus and calcaneus screws providing sustained dynamic compression across the joint. There is minimal clinical data evaluating the effects of sustained compression devices on isolated subtalar arthrodesis. The goal of this study was to prospectively follow patients undergoing subtalar arthrodesis with the DynaNail® Mini and evaluate its clinical efficacy via fusion rate and patient reported outcomes.

Methods:

We prospectively enrolled patients aged 18-85 who underwent subtalar arthrodesis with the DynaNail® Mini from one of two academic surgeons. Demographic data and patient reported outcomes were collected preoperatively and at follow-up visits including Visual Analog Pain Scale (VAS), Foot Function Index (FFI), Foot and Ankle Ability Measure (FAAM) Sports Subscale, and Veterans Rand 12 (VR-12) physical and mental subscores. Patients were followed at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. The primary outcome measure was fusion rate via CT scan at 4 months with secondary outcomes consisting of the patient reported outcome data and rate of revisions.

Results:

21 patients met inclusion criteria, 14 patients had a 4-month postoperative CT scan to assess for fusion with 78.6% of the CT scans (11 out of 14) demonstrating fusion at that time. 20 of the patients were followed through their 6 month visits, 16 patients through 1 year, and 16 patients were seen for their 2-year follow-up visit. All patient reported outcomes demonstrated improvement from preoperatively to final follow-up with VAS scores improving from 5.69 to 3.84, FFI improving from 56.43 to 37.88, FAAM-sports improving from 20.31 to 30.47, VR-12 Physical improving from 28.70 to 34.41, and VR-12 Mental improving from 43.64 to 49.81.

Conclusion:

This prospective study demonstrates that patients undergoing subtalar arthrodesis with the DynaNail® Mini demonstrate favorable clinical outcomes that are comparable to existing methods of subtalar arthrodesis with 78.6% of patients achieving fusion on a 4-month postoperative CT scan and with steady noted improvement in multiple validated patient-reported outcome measures.
Tolerability and Safety of Collagenase Clostridium Histolyticum Injection in Participants with Plantar Fibromatosis
Authors: Pollak Richard , Anderson C. James , Hernandez David , Xiang Qinfang , Vijayan Saji , Ortega Luis A. , Caporusso Joseph
Published: December 2023

Category:

Midfoot/Forefoot; Basic Sciences/Biologics

Introduction/Purpose:

Plantar fibromatosis (PFi) is a functionally disabling disorder characterized by fibrous collagen-containing nodules along the plantar fascia. Collagenase clostridium histolyticum (CCH) is a nonsurgical treatment approved for Dupuytren’s and Peyronie’s disease; both can coexist with PFi. Composed of two collagenases, CCH specifically hydrolyzes certain collagen types and may disrupt the nodule when injected directly. This proof-of-concept study evaluated pharmacokinetics, immunogenicity, and assessed tolerability and safety of CCH treatment of PFi.

Methods:

In this Phase 1, multicenter study, participants were randomly allocated (1:1:1) to receive 0.6, 1.2, or 2.25 mg/mL CCH. All participants underwent the initial treatment period (ITP) and received 1–2 intralesional injections per nodule on Day 1 with pharmacokinetic samples collected over 24hrs, followed by 5 follow-up visits. Post-ITP, participants with a remaining, palpable nodule could enter the retreatment period (RP) and receive additional CCH doses (at 2.25 mg/mL) with follow-up at specified intervals. Immunogenicity test sampling occurred at screening and at the end of ITP/RP. Adverse events (AEs) were monitored throughout.

Results:

Twenty-four participants enrolled into ITP, with 11 continuing into RP. Pharmacokinetic and immunogenicity findings were consistent with previous CCH studies in other therapeutic areas. CCH treatment was generally well tolerated, with no serious treatment emergent adverse events (TEAEs), drug discontinuations, or study withdrawals by study end. Over 70% of participants during ITP (19/24) and RP (8/11) reported at least 1 TEAE. Eighty-six TEAEs occurred during ITP and 35 in RP; most were mild in severity (73%, ITP; 83%, RP), and 67% of ITP and 49% of RP TEAEs were treatment related. TEAEs were reportedly injection site- related, with injection site bruising, pain, and swelling frequently recorded.

Conclusion:

CCH had an expected pharmacokinetics/immunogenicity profile and was safe and well tolerated in participants with PFi. CCH may be a potential nonsurgical intralesional option for PFi treatment.
Weight-Bearing Computed Tomography Evaluation of Acute SER4a Ankle Fractures
Authors: Michalski Max P. , Porter Giselle M. , Rockov Zachary A. , Little Milton , Moon Charles , Charlton Timothy
Published: December 2023

Category:

Ankle; Trauma

Introduction/Purpose:

Recent studies have reported cadaveric and early clinical data regarding Weber B supination-external- rotation (SER)4a ankle fractures. SER4a ankle fractures have discordance of the medial clear space (MCS) between weight-bearing (WB) and gravity stress (GS) radiographs, showing instability on the GS view which normalizes with WB. Unfortunately, evaluation of the medial clear space only provides a two-dimensional evaluation of a three-dimensional structure. Prior cadaveric research has shown significant decreases in the tibiotalar joint contact area with only 1 mm of displacement of the talus. The purpose of this study is to utilize weight-bearing computed tomography (WBCT) to evaluate differences in the tibiotalar joint contact area and rotational alignment in patients with acute SER4a ankle fractures compared to their contralateral uninjured ankle.

Methods:

Adult patients presenting within ten days of injury with an isolated Weber B fibula fracture and a normal MCS ( < 5 mm) on injury radiographs were evaluated with weight-bearing and gravity stress radiographs. Patients determined to have isolated Weber B SER4a ankle fractures (GS positive but WB negative radiographs) and no history of injury to the contralateral ankle were included. The ability to place equal weight on both extremities was confirmed by standing on side-by-side scales. WBCT scans were obtained of both the healthy and injured ankles. The images were evaluated using Disior Bonelogic (Paragon28, Helsinki, Finland) software to calculate the tibiotalar joint contact area, axial tibiotalar rotation, and talocrural angle. An a priori power analysis was performed with six patients needed.

Results:

Five out of ten patients have been enrolled in the study to date (3 females, 2 males, average age 52.4). Preliminary data show an average 4.3% (standard deviation (SD) 4.9) increase in tibiotalar joint contact area between the injured and uninjured extremity. The average difference in axial tibiotalar angle is 3.6 (SD 6.9) degrees of internal rotation of the injured ankle. The talocrural in the injured and uninjured extremity have an average difference of 0.062 (SD 1.8) degrees.

Conclusion:

This study provides the first in vivo evaluation of the joint contact area changes seen in SER4 ankle fractures. Although limited in sample size, the results demonstrate that SER4a ankle fractures do not have decreased tibiotalar joint contact area relative to the healthy, uninjured side. The trend towards increased surface area in the injured ankles is hypothesized to be a result of the increased reliance on joint congruency with injury to the fibula and deltoid.
A Comparative Retrospective Radiographic Analysis of the Outcomes of Double and Triple Arthrodesis in the Correction of Severe Flatfoot Deformity
Authors: Aravindan Shreyaas , Maher Moustafa A. , Zhu Mingjie , Huo Donglai , Guo Yi , Wipf Caleb , Lee Anna D. , Myerson Mark , Li Shuyuan
Published: December 2023

Category:

Hindfoot; Midfoot/Forefoot

Introduction/Purpose:

Choosing between a double arthrodesis or a triple arthrodesis in treating severe flatfoot deformities is often a matter of surgeon preference with proponents of each, and this study compared the radiographic outcomes of the two procedures.

Methods:

A retrospective chart review was performed for patients who underwent either a double or triple arthrodesis during a period of one year. Twenty-one double and 9 triple arthrodesis with at least one year of follow up were included in this study. Radiographic measurements on pre and postoperative anteroposterior and lateral weightbearing images were collected to reflect the correction of the hind and midfoot deformities, in particular, the relative height of the medial and lateral columns.

Results:

Both procedures significantly improved the talus-1st metatarsal angle (AP), talar declination angle, and the Meary’s angle. The double arthrodesis more significantly improved the talo-navicular coverage angle, while the triple arthrodesis significantly was far more effective in correcting the talar declination angle, the calcaneal pitch angle, and the cuneiform/cuboid height ratio. (Tables 1,2)

Conclusion:

Both double and triple arthrodesis have the ability to correct severe flatfoot deformities with improved radiographic outcomes. The triple arthrodesis has more power to improve the arch height as noted on the significant differences between the two groups in the calcaneal pitch angle and the medial cuneiform/cuboid height ratio.
A Retrospective Comparison of Single Screw vs Dual Screw Fixation for Treatment of Medial Malleolus Fractures
Authors: Mason Lyndon W. , Aamir Junaid , Caldwell Robyn , Long Sarah , Sreenivasan Sachith , Mavrotas Jason , Panesa Ayn , Lampridis Vasileios
Published: December 2023

Category:

Trauma; Ankle

Introduction/Purpose:

Medial Malleolus Fractures (MMF) are frequently managed by orthopaedic surgeons and are one of the most treated fractures of the ankle. Many approaches to fixation are described in the literature. Currently, there is a lack of consensus on the number of screws used in fixation when attempting lag-screw fixation of MMF.

Aim:

To compare the outcomes of MMF with patients between fractures which have either undergone single-screw (SS) or dual-screw (DS) fixation.

Methods:

Patients who had undergone surgical fixation of their MMF were identified from 2012 to 2022, using electronic patient records. Analysis of their pre-operative, intra-operative and post-operative radiographs was performed to determine the initial type of injury and then surgical outcomes relating to non-union, malunion and whether revision surgery was required.

Results:

A total of 653 patients were identified across a 10-year period. There were 271 patients (41.50%) in the SS group and 382 patients in the DS group (58.50%). When comparing the outcomes of SS compared to DS, a non-union rate of 19.19% (52/271) was found in the SS group as compared to 18.85% (72/382) in the DS group. There was a malunion rate of 11.07% (30/271) in the SS group as compared to 3.93% (15/382) in the DS group, which was statistically significant (p <.001). On multi regression analysis, the other factors which gained significance for development of non-union was non fixation of syndesmosis (p= .039), ankle dislocation on arrival (p <.001) and non-restoration of fibular length (p <.001).

Conclusion:

Use of a single screw rather than double screw showed a significant increase in non-anatomical reduction but did not increase non-union or reoperation rate. Syndesmosis fixation has clear impact on the stresses on the medial malleolus and should have a low index of suspicion of injury and fixation.
Anatomic Lateral Ligaments Repair Augmented with Suture-tape for Chronic Ankle Instability with Poor Quality of Remnant Ligamentous Tissue
Authors: Lee Yo-Han , Cho Byung-Ki , Choi Seung-Myung , Kim Sunghoo , Kim Seong-Hyeon
Published: December 2023

Category:

Sports; Ankle

Introduction/Purpose:

Because modified Broström procedure for chronic ankle instability provides a restoration of mechanical stability by reinforcing attenuated host tissue, poor quality of remnant ligamentous tissue can be considered as a prognostic factor for anatomic ligament repair surgery. The aim of this study was to evaluate the intermediate-term clinical outcomes after anatomic lateral ligaments repair augmented with suture-tape for chronic ankle instability with poor quality of ligament remnants.

Methods:

Thirty-six patients with the insufficient lateral ligament remnants confirmed by preoperative magnetic resonance image and intraoperative inspection were followed for more than 3 years after the augmented Broström repair. The clinical evaluation consisted of the Foot and Ankle Outcome Score(FAOS), Foot and Ankle Ability Measure(FAAM). Measurements on stress radiographs were performed to evaluate the changes of mechanical instability. To identify the changes of functional ankle instability, postural control ability was evaluated using single leg stance test with eyes closed.

Results:

FAOS and FAAM scores had significantly improved from preoperative average 56.3 and 51.8 points to 90.2 and 88.5 points at final follow-up, respectively (p < .001). Talar tilt angle and anterior talar translation had significantly improved from preoperative average 16.3° and 13.2 mm to 3.5° and 4.3 mm at final follow-up, respectively (p < .001). Balance retention time had significantly improved from preoperative average 3.8 seconds to 6.6 seconds at final follow-up (p < .001). Complications included two wound problems (one with superficial infection and one with marginal necrosis) and one superficial peroneal nerve injury with temporary paresthesia. Although 8 patients sustained an ankle sprain after operation, only 1 patient(2.8%) showed a recurrence of subjective and mechanical instability.

Conclusion:

Modified Broström procedure augmented with suture-tape appears to be an effective alternative for chronic ankle instability with poor quality of ligament remnants. Through the suture-tape augmentation and the direct repair of attenuated ligaments, this combined procedure can provide reliable stability and advantages of the anatomic ligament repair.
Anterolateral Ankle Impingement due to Bassett’s Ligament
Authors: Park Chul Hyun , Woo InHa
Published: December 2023

Category:

Arthroscopy; Ankle

Introduction/Purpose:

The Bassett’s ligament, an accessory band of the anterior inferior tibiofibular ligament (AITFL), is known to be a normal ligamentous structure present in 21-92% of cases. The Bassett’s ligament is also known as a structure that causes anterolateral impingement of the ankle joint after an ankle sprain. However, not much is known about the cause or prognosis of anterolateral impingement by Bassett's ligament. In this study, the symptoms, characteristics, and postoperative results of impingement by Bassett's ligament were reported.

Methods:

From November 2017 to August 2021, 12 patients who underwent surgical treatment for pain in the anterolateral aspect of the ankle joint, which did not improve with conservative treatment, were enrolled. There were 5 males and 7 females, and the average age was 34.4 years (21-76). The symptoms complained of by the patients and accompanying injuries were analyzed. And the arthroscopic findings and postoperative results were analyzed.

Results:

All patients had a history of ankle sprain before symptoms. All patients complained of pain and tenderness in the anterolateral aspect of the ankle joint, and the pain improved after injection of lidocaine. And 3 patients (25%) complained of snapping during ankle ROM. Ankle instability was present in 10 patients (83.3%), and OLT was present in 2 patients (16.7%). Arthroscopic findings showed that the Bassett’s ligament impinged with the anterolateral aspect of the talar dome during ROM in all cases. And synovitis was found around the Bassett ligament in all cases, fraying of the Bassett ligament in 5 cases (41.7%), and fraying of the cartilage of the dome of the talus in 4 cases (33.3%). Anterolateral ankle pain disappeared in all patients after surgery.

Conclusion:

Impingement between the talar dome and the Bassett’s ligament should be considered as one of the causes of anterolateral ankle pain, especially in patients with ankle sprains.
Ballooning Periprosthetic Osteolysis Related to Crystalline Arthropathies Following Total Ankle Arthroplasty: A Case Series
Authors: Umbel Benjamin D. , Anastasio Albert T. , Haghverdian Brandon A. , Ricci A. Gianni , Hanselman Andrew , Easley Mark , Nunley James A. , Schweitzer Karl M.
Published: December 2023

Category:

Ankle Arthritis; Basic Sciences/Biologics

Introduction/Purpose:

From 2009-2019, there has been a 120% increase in the incidence of total ankle arthroplasty (TAA) in the United States. With the rise in primary TAA, future increases in revision TAA cases is anticipated. Aseptic loosening with periprosthetic osteolysis continues to account for a significant number of revisions. While several factors may contribute to the pathophysiology of osteolysis, an underlying inflammatory response surrounding TAA implants may play a primary role. It is well known that monosodium urate (gout) and calcium-pyrophosphate (pseudo-gout) crystals evoke a highly inflammatory response and may involve the foot and ankle joints. However, the effect of these conditions following TAA has not yet been reported. We present a small case series of patients with ballooning osteolysis following TAA with confirmed crystalline arthropathy.

Methods:

This is a retrospective study from a single academic institution looking at patients who underwent TAA revision surgery for periprosthetic osteolysis and concern for aseptic loosening. Revision surgeries were performed by three orthopedic foot and ankle fellowship trained surgeons. Case characteristics, including pre-operative imaging, clinical presentations, intra-operative findings and surgical treatments performed were analyzed and presented in this small case series.

Results:

We report 5 patients whom underwent revision surgery for ballooning periprosthetic osteolysis following TAA. Intra- operative pathology samples from periprosthetic cysts returned positive for monosodium urate (MSU) or calcium pyrophosphate (CPP) crystalline deposition (1 MSU and 4 CPP) in all 5 patients. Final intra-operative cultures were all negative for infection. Upon gross intra-operative inspection, all polyethylene liners were considered to be normal without abnormal wear characteristics. Periprosthetic cysts were isolated to the tibial component in 2 patients and involved both the tibial and talar components in 3 patients. Staged TAA revision was performed in 2 patients. Bone cyst curettage, bone grafting and polyethylene liner exchange was performed in 3 patients.

Conclusion:

Periprosthetic osteolysis is a known complication following TAA and often leads to implant loosening, functional disability and subsequent revision surgery. An objective strategy for management of this condition has not been agreed upon amongst orthopedic foot and ankle surgeons, as uncertainty remains surrounding the pathophysiology of osteolysis in TAA. To our knowledge, we are the first to describe a small case series of patients with crystalline arthropathy as a potential cause for periprosthetic osteolysis following TAA. Future prospective studies are warranted to better elucidate this potential cause of TAA failure.
Biomechanical Analysis about Syndesmotic Stability for AITFL Augmentation with Fibular Plate
Authors: Takahashi Katsunori , Teramoto Atsushi , Murahashi Yasutaka , Watanabe Kota , Yamashita Toshihiko
Published: December 2023

Category:

Trauma; Sports

Introduction/Purpose:

Surgical technique to treatment syndesmosis injury is controversial. Additional suture-tape (ST) augmentation of anterior inferior tibiofibular ligament (AITFL) has been reported to improve syndesmotic stability compared with only suture-button (SB) fixation. ST fixation on the fibula is mainly performed with suture anchors, but suture holes with fibular plates can also be used. However, there is no biomechanical study about syndesmotic injury treated with ST augmentation using fibular plate. The aim of this study is to evaluate the stability of the syndesmosis injury model treated with ST augmentation using fibular plate. Our hypothesis is that ST augmentation using fibular plate can provide equivalent syndesmotic stability compared with ST augmentation using suture anchor.

Methods:

8 normal fresh-frozen cadaver legs (4 males and 4 females) were used. The mean age at the time of death was 84.3 (70- 101). The specimens were tested while applied traction and rotational forces to represent dorsiflexion and external rotation of ankle joint. The fibular rotational angle related to the tibia (FRA) and anterior tibiofibular diastasis(aTFD) were measured using the magnetic tracking system while each load was applied. Intact, injured, SB + ST augmentation using suture anchor (anchor model), SB + ST augmentation fixation using fibular plate (plate model) models made, and loaded forces and measured FRA and aTFD with each model. One-way ANOVA was used to evaluate the relationship of the angles or the diastasis among each model. Post-hoc analysis for differences among the models were checked using Dunnett’s test. P value of 0.05 was chosen as the level of significance.

Results:

With dorsiflexion forces, in the injured model, both FRA and aTFD were significantly increased compared with intact model. In the anchor and plate model, both FRA and aTFD were not significantly different compared with intact model. With external rotation forces, in the injured model, both FRA and aTFD were significantly increased compared with intact model. In the anchor and plate model, both FRA and aTFD were not significantly different compared with intact model.

Conclusion:

The result of this study presented that ST augmentation using fibular plate provide syndesmotic stability similarly with ST augmentation using suture anchor. This technique was considered to be useful in cases of syndesmosis injury with lateral malleolar fracture. Particularly, it is difficult to use suture anchor for ST fixation to the fibula when there is a comminuted fracture near the AITFL attachment of the fibula. Using plate allows for stable ST fixation to the fibula without worrying about it.
Black/African Americans Experience Disparate Outcomes after Lower Extremity Orthopaedic Injury Evaluation in U.S. Emergency Departments
Authors: Gupta Arjun , Singh Priya , Badin Daniel , Mo Kevin , Greenberg Marc , Musharbash Farah , Hughes Alice J. , Aiyer Amiethab A. , Ficke James
Published: December 2023

Category:

Trauma; Other

Introduction/Purpose:

Racial and ethnic disparities remain a major problem in orthopaedic surgery, driving inequitable resource distribution, disparate clinical outcomes, and increased healthcare costs. The objective of this study was to investigate potential racial/ethnic disparities in the incidence and injury patterns of orthopaedic lower extremity trauma (LET) in the U.S. over the last 10 years, as well as differences in final disposition outcomes.

Methods:

The National Electronic Injury Surveillance System (NEISS) database was queried for all orthopaedic LET presenting to U.S Emergency Departments (ED) from 2010–2020. Incidence rate ratios (IRR) were used to compare incidence rates between racial/ethnic groups at the population level. To compare outcomes specifically among patients with LET, adjusted odds ratios (aOR) were calculated for each racial/ethnic group using multivariate logistic regression.

Results:

Black/African Americans (Black/AAs) consistently experienced the highest incidence of LET over the ten-year period analyzed (709.108 per 100,000 person-years), followed by Whites (547.159 per 100,000 person-years) (Figure 1). Furthermore, Black/AAs had the highest incidence of polytrauma (114.19 per 100,000 person-years), over 1.7x greater than Whites (IRR: 1.73 [95% CI: 1.72–1.75]). Black/AAs had over 2-fold higher odds of death after LET compared to Whites (aOR 2.15 [95% CI: 1.78– 2.59]) (Figure 2). By 2019–2020, the incidence of deaths among Black/AAs reached more than triple that of Whites (IRR: 3.50 [95% CI: 2.74–4.46]). Black/AAs were also the most likely to be discharged AMA (aOR: 1.94 [95% CI: 1.92–1.96]), and the least likely to be admitted as inpatients (aOR: 0.683 [95% CI: 0.679–0.688]).

Conclusion:

Despite Black/AAs experiencing a disproportionately higher incidence of LET and over 2-fold greater odds of death compared to Whites, they were also the most likely to be discharged AMA and least likely to be admitted as inpatients. Improved patient education and more effective communication may help ensure that injuries in this patient population are not prematurely discharged, potentially improving clinical outcomes and reducing mortality.
Body Mass Index is a Predictor of Discharge to a Post-Acute Care Facility Following Total Ankle Arthroplasty
Authors: Bakaes Yianni , Gonzalez Tyler , Jackson J. Benjamin
Published: December 2023

Category:

Ankle

Introduction/Purpose:

The utilization of total ankle arthroplasty (TAA) continues to increase, and identifying preoperative factors that influence postoperative outcomes after TAA may be valuable. The use of post-acute care (PAC) facilities has also grown substantially, and discharge to a PAC facility can increase patient morbidity and postoperative costs. The purpose of this study is to define the effect of BMI on discharge to a PAC facility and hospital length of stay (LOS) following TAA.

Methods:

We performed a retrospective review to identify a large cohort of adult patients who underwent TAA between 2006 - 2020 from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Using overweight patients as the reference BMI group, we estimated a sex- and age- adjusted log-binomial regression model on BMI categories to estimate risk ratios to analyze the association between BMI and risk of being discharged to a PAC facility and/or hospital LOS.

Results:

Relative to overweight patients, obese patients had 1.47 times the risk (P=0.008), and morbidly obese patients had 2.26 times risk (P < 0.001) of being discharged to a PAC facility after TAA. Males had 0.47 times the risk of females (P < 0.001), and for each year older, patients had 1.07 times the risk (P < 0.001) of being discharged to a PAC facility. There was no difference in hospital LOS for underweight patients, but healthy weight patients stayed an additional 0.29 days (P=0.004), obese patients stayed an additional 0.18 days (P=0.010), and morbidly obese patients stayed an additional 0.34 days (P=0.006). Males stayed 0.30 fewer hospital days than females (P < 0.001), and for each year older, patients stayed 0.011 days longer (P < 0.001).

Conclusion:

This study found that women and patients who are obese and morbidly obese have a greater LOS and chance to be discharged to a PAC facility. Increasing age is also associated with an increase in LOS and discharge to a PAC. These may be important factors when discussing the postoperative plan with patients prior to TAA.
Casting is a Cost-Effective Management Option in Appropriate Cases of Charcot Neuroarthropathy
Authors: Shehaj Andrea , Dopke Kelly , Mansfield Kirsten N. , Saloky Kaitlin L. , Stauch Christopher , Ozdemir Erdi , Aynardi Michael
Published: December 2023

Category:

Diabetes; Midfoot/Forefoot

Introduction/Purpose:

Charcot Neuroarthropathy (CN) is a chronic and debilitating condition that impacts the nerves of the foot. The progression of CN may result in severe joint deformities, ulcers, and amputation in certain cases. Treatment options for CN include surgical interventions (e.g., arthrodesis, exostectomy, and amputation) and non-surgical interventions (e.g., casting). A cost analysis on the various treatment modalities can guide physicians to help their patients make informed decisions about their care. Here, we aim to characterize the total costs associated with the various treatments of CN, in addition to the physical therapy (PT) related costs.

Methods:

Following IRB approval, a sample of patients at a single institution diagnosed with CN of the lower extremity, who underwent exostectomy, arthrodesis, amputation, and/or casting were identified through patient records. Various demographics such as age, sex, and race were collected. Individuals were placed in their respective categories based on the first procedure they had performed. The groups were divided as follows: exostectomy, arthrodesis, major amputation, minor amputation, casting, and failed casting (the group that first received casting but later needed further intervention with other treatment modalities). Each procedure and PT appointment was counted toward the total cost. Descriptive statistics, t-tests, and one-way ANOVA were performed for statistical analysis.

Results:

Two-hundred and sixteen patients were identified; exostectomy (n = 81), arthrodesis (n = 47), major amputations (n = 10), minor amputations (n = 28), failed casting (n = 16), and casting (n = 34). The average age was 58 ± 12.1 years, and males accounted for 54% of the sample size with the various demographic information depicted in table 1. The effect of procedure type on total cost demonstrated a statistically significant difference between at least two groups (F-value = 18.53, p-value < 0.01), as demonstrated in figure 1. The total costs for casting were significantly lower than all other treatment modalities (p-value < 0.05). Furthermore, there was no statistical significance related to physical therapy costs among the groups (figure 2).

Conclusion:

Casting was demonstrated to be a more cost-effective management strategy for patients diagnosed with CN. However, it is important to note that this cost-related benefit is only apparent when CN patients are appropriately treated with casting, exemplified by the failed casting group. It is critical to utilize casting with appropriate patients in order to reduce the cost burden associated with these various management modalities. Early surgical intervention should still be strongly considered for patients who are not appropriate candidates for casting.
Characterization of Motor Performance in 200 Normal Ankles Through Isokinetic Evaluation
Authors: Maciel Eduard Souza , Fonseca Lucas , Mansur Nacime Salomao Barbachan , Netto Cesar de Cesar , Inojossa Thiago , Astur Diego
Published: December 2023

Category:

Ankle; Sports

Introduction/Purpose:

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

Methods:

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

Results:

The mean age was 38.5 years and BMI 25.8 in 69 men and 31 women. In 78 participants, the dominant ankle was the right one. The non-dominant side was consistently stronger in all movements (p < 0.001). The mean values obtained for force in each movement were 29.9N/m for eversion, 34.8N/m for inversion, 48.6N/m for dorsiflexion and 140.2 N/m for plantar flexion. Such parameters for men and women were also obtained (p < 0.001) and there was no correlation between age or BMI with the maximum torque through Spearman's Correlation. The ratio of eversors/inverters was 88.8% and that of dorsiflexors/plantar flexors was 36.1%. The Muscle Deficiency Index showed a balance between the sides for each movement, with an average global difference of less than 10% between them.

Conclusion:

As far as we know, this is the largest isokinetic assessment of normal ankles ever performed. The sample, although not stratified, was considered homogeneous (coefficient of variation < 50%), which allows to propose several normative values for a non-athlete population in the isokinetic evaluation. It would be interesting to compare these data in the future with the functional results in patients after the treatment of certain injuries.