bluuebunny/crossref_metadata_2025 huggingface dataset:
Natural Killer Cells and Telomerase in the Endometrium of Patients with Endometriosis
Authors: Petta Carlos A. , Peloggia Alessandra , Salamonsen Lois , De Angelo Andrade Liliana , Zhang Jin , Bahamondes Luis
Published: September 2018

Background

Although endometriosis is a common cause of pelvic pain and infertility, the pathogenesis of the disease remains poorly understood. Several theories have been proposed to explain the mechanisms involved in the development of this disease, including the role of the immunological system.

Objectives

To evaluate the percentage of endometrial natural killer (eNK) cells and telomerase expression in the endometrium of patients with and without endometriosis.

Materials and methods

Endometrium samples were obtained during the mid-secretory phase from two groups of women: 12 women with endometriosis diagnosed by laparoscopy and confirmed by histological evaluation of the lesion, and 13 fertile women (control group) who underwent tubal sterilization at the same institution and in whom no signs of endometriosis were detected at surgery. Specific antibodies were used for the immunohistochemical assessment of eNK and telomerase. Results: eNK cells were significantly higher in the group of women without endometriosis (p<0. 0001); however, telomerase expression in the endometrium was similar in the two study groups. Conclusions: Significantly fewer eNK cells were observed in the endometrium of women with endometriosis; however, there was no difference in telomerase expression. The finding of fewer eNK cells supports the hypothesis of a deficiency in the immune system facilitating the implantation of endometriotic tissue or interfering with implantation after fertilization.
Deep Infiltrating Endometriosis is Frequent in All Stages of Endometriosis and the Depth of Infiltration Influences Surgical Parameters Proportionally
Authors: Hackethal Andreas , Luck Catharina , Konrad Lutz , Muenstedt Karsten , Tinneberg Hans-Rudolf , Oehmke Frank
Published: September 2018

Background

Deep infiltrating endometriosis (DIE) in contrast to superficial endometriosis is known to cause intense pain-related symptoms depending on the anatomic region and depth of infiltration. Despite the known impact of DIE, clinical comparison to superficial endometriosis is difficult to accomplish because no DIE classification is used regularly and the rASRM score does not consider DIE adequately.

Methods

We regularly use the ENZIAN classification to group DIE additionally to the rASRM score. The surgical treatment of patients without prior known endometriosis from January 2006 to December 2008 was evaluated in relation to the classification systems used.

Results

The study population included 100 patients and all were scored according to the rASRM score. Forty-two percent (42/100) presented with DIE and were additionally classified to the ENZIAN score. In all rASRM stages of endometriosis, a high rate of over 33% DIE was found with a maximum of 80% in stage 4 patients. Patient characteristics did not differ between patients with superficial EM and DIE. Laparoscopy was the main surgical approach regardless of the type of endometriosis. The presence of intra-abdominal adhesions, duration of excisional surgery and hospital stay correlated with the depth of infiltration according to the ENZIAN.

Conclusions

This is the first study to reveal that the presence of DIE is an unexpectedly frequent finding in all rASRM stages. Though patient characteristics do not differ between DIE and superficial EM, the surgical parameters for adequate excisional surgery are significantly different and proportionally influenced by the depth of infiltration.
Autism Spectrum Disorder and Neonatal Serum Magnesium Levels in Preterm Infants
Authors: Bakian Amanda V. , Bilder Deborah A. , Korgenski E. Kent , Bonkowsky Joshua L.
Published: September 2018

Premature birth is associated with increased risk of autism spectrum disorder. Antenatal maternal magnesium administration is known to reduce subsequent risk of cerebral palsy including among premature infants, suggesting a potentially broader neuroprotective role for magnesium. Our objective was to determine whether magnesium could be protective against autism spectrum disorders in premature infants. A cohort of 4855 preterm children was identified, magnesium levels from 24 to 48 hours of life recorded, and subsequent autism spectrum disorder status determined. Adjusted relative risk of autism spectrum disorder with each 1 mg/dL increase in neonatal magnesium level was 1.15 (95% confidence interval: 0.86-1.53). Analysis of variance indicated that magnesium levels varied by gestational age and maternal antenatal magnesium supplementation, but not autism spectrum disorder status ( F1,4824 = 1.43, P = .23). We found that neonatal magnesium levels were not associated with decreased autism spectrum disorder risk. Future research into autism spectrum disorder risks and treatments in premature infants is needed.
“We Were All Just the Black Kids”: Black Mixed-Race Men and the Importance of Adolescent Peer Groups for Identity Development
Authors: Sims Jennifer Patrice , Joseph-Salisbury Remi
Published: September 2018

While critical Mixed-Race studies (CMRS) has paid attention to the intersections of race, gender, and sexuality in sampling and analysis, most studies disproportionately focus on women. This means that generalizability of findings and theories to men should not become axiomatic. Regarding black Mixed-Race people, for example, the theory that rejection from black people is influential for many black Mixed-Race individuals’ identity development is derived from interviews with mainly women. Explicitly noting that these processes are not as applicable for men, yet offering no accompanying theorizing as to the influence of gendered interactions on men’s racial identity development, appears to have become the standard. Therefore, bringing together data from two studies that explored black mixedness in the United States and the United Kingdom, this article joins a nascent literature on the gendered experiences of Mixed-Race men. Our analysis shows that, unlike black Mixed-Race women, black Mixed-Race men’s mixedness is often constructed as compatible with the heteronormative gender identities that are constituted in racialized peer groups. As such, black Mixed-Race men are able to cultivate a sense of strategic sameness with same gender black peers. This and other findings are discussed in light of their implications for CMRS’s intersectional theories of identity development.
Takedown of Ankle Fusions and Conversion to Total Ankle Replacements
Authors: Coetzee J. Chris , Nilsson Larry , Fritz Jacquelyn
Published: September 2018

Category:

Ankle

Introduction/Purpose:

With ankle replacements gaining credibility there is a small subset of patients that might benefit from a conversion of an ankle fusion to a replacement. There is not much in the literature about conversions and we began this study without having any specific data regarding success and expectations we could provide to the patients. Our hypothesis was that for the correct indication a conversion of an ankle fusion to a total ankle replacement might do as well as a primary total ankle replacement.

Methods:

Twenty five patients presented to the senior author with either ongoing ankle pain after a fusion, or increasing pain after a period of relative comfort after an ankle fusion. All patients came specifically with the desire to discuss a conversion to an ankle replacement. Exclusion criteria included a history of Diabetes, peripheral neuropathy, excision of either malleoli at the time of fusion, pantalar fusion and neurovascular compromise. This study was conducted in compliance and approved with a local IRB. Outcomes were evaluated pre-operatively and post-operatively with the Veterans Rand Health Survey (VR-12), Ankle Osteoarthritis Scale (AOS), Visual Analog Scale (VAS) Pain scale and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score forms. A patient satisfaction survey was distributed to all patients and results were tabulated. Average follow up for outcome scores 23.77 months (range 4 – 74.78 months).

Results:

All ankle fusion conversions done at our center were included; no patients were lost to follow-up. Twenty-five patients(19 females) with the mean age of 63.7 months(36.55-75.83) were followed with a mean follow-up of 22.19 months(4–74.78 months). The mean AOFAS improved pre-operatively 26.25(8.0-56.0) to the latest follow-up of 78(77-100). VR-12 Mental improved from 52.24(34.81-72.46) to 56.13(28.4–72.31), and Physical 21.88(13.34-35.79) to 36.49(19.82-50.39) pre-operatively to post-operatively, respectively. The AOS Pain improved: 533.33(243-898) to the latest follow-up 215.86(15 -641); AOS Disability: 628.67(306-900) to the latest follow-up 221.64(2-612). Given patients have minimal to no dorsiflexion(DF) and plantarflexion(PF) with an ankle fusion, the range of motion increased with the affected ankle. Patients have a DF of 9.47degrees(2-15) and PF of 21.53degrees(12-35). Overall patients were satisfied with their results: 76.81/100.

Conclusion:

This is a small study with reasonable short follow-up, but the evidence show very satisfactory functional outcomes after a conversion of an ankle fusion to a total ankle replacement. Patient selection is extremely important. Long-term follow-up will show whether the longevity of these replacements compare to primary replacements.
Z-cut Osteotomy for Correction of Adult Acquired Pes Planovalgus Deformity
Authors: Ebaugh Michael , Larson David , Reb Christopher , Hyer Christopher , Berlet Gregory
Published: September 2018

Category:

Ankle

Introduction/Purpose:

Medial displacement calcaneus tuberosity osteotomy and anterior process lengthening calcaneus osteotomy are traditional single-plane osteotomy techniques used in adult acquired flatfoot deformity reconstruction. More recently, three plane step-cut osteotomies were described for each of these and offer improved rotational stability via the horizontal limb. However, a major technical challenge is achieving a sufficiently long horizontal limb to correct deformity through lengthening without losing bony apposition. Combining the anterior process and tuberosity step-cuts using an elongated horizontal limb (“Z-cut”, Figure 1) alleviates this technical challenge, creates a very large surface area for bony healing, and utilizes a single incision. We hypothesized that the Z-cut osteotomy achieves clinical and radiographic flatfoot deformity correction with a high union rate.

Methods:

This was an IRB-approved retrospective study of 17 patients who underwent Z-cut osteotomy for treatment of moderate to severe symptomatic adult acquired flatfoot deformity, Stage IIB. Mean follow up was 8.3 months. Radiographic correction was assessed via weight bearing radiographs taken pre-operatively and at a mean of 26 +/- 2 weeks post operatively. Measurements included Meary’s angle (talo-1st metatarsal angle), talonavicular joint (TN) uncoverage percentage, TN incongruency angle, medial cuneiform to fifth metatarsal height, and calcaneal pitch. Union rates, calcaneocuboid joint arthritic changes and clinical outcomes via Foot Function Index (FFI) score were assessed preoperatively and at a mean of 29 months following surgery. Paired t-test was used to compare both clinical and radiographic outcomes with statistical significance set at p<0.05.

Results:

Nine patients returned an FFI questionnaire with a mean improvement of 52.1 to 10.3 (p = .002). Calcaneal pitch improved from 13.2 to 15.3 (p = .004), medial cuneiform/5th metatarsal distance improved from 13.3 to 18.5 (p = .004), TN coverage angle improved from 22.4 to 9.7 (p < .001), TN uncoverage % improved from 34.3 to 21.2 (p <.001), TN incongruency angle improved from 39 to 20.1 (p < .001). Deformity correction was well maintained in 14 of 17 patients at final follow up. Union rate of the osteotomy was 100%. Three patients had symptomatic hardware initially, one patient required removal of hardware. One patient developed a superficial infection that cleared. Another patient developed peroneal tendonitis, which resolved with corticosteroid injection.

Conclusion:

The Z-cut osteotomy is a novel, technically simplified, single incision, single osteotomy alternative to previously described double calcaneus osteotomy techniques for reconstructing flexible moderate to severe adult acquired flatfoot deformity which offers comparable short term clinical and radiographic outcomes with acceptably low complications.
New Persistent Opioid Use Following Common Forefoot Procedures for Treatment of Hallux Valgus
Authors: Finney Fred , Gossett Timothy , Walton David , Talusan Paul , Holmes James
Published: September 2018

Category:

Bunion

Introduction/Purpose:

Chronic opioid use and abuse is one of the greatest public health challenges in the United States and continues to worsen. Orthopaedic surgeons stand at #4 on the list of top prescribers of opioid analgesics by specialty and are squarely positioned to have an impact on the problem. A recent study revealed an 8% prevalence of new persistent opioid usage following abdominal surgery. At present, the incidence of persistent opioid use after foot and ankle surgery is largely unknown. Operative bunion correction is one of the most commonly performed elective foot and ankle surgeries in this country. We sought to determine the incidence of new persistent opioid use following surgical treatment of hallux valgus and to identify patient factors associated with persistent opioid use.

Methods:

A nationwide insurance claims data set from January 2010 to June 2015 was used to identify opioid naive patients (defined as patients with no prior opioid use 12 months prior to injury) who underwent surgical treatment of hallux valgus with either a proximal or distal first metatarsal osteotomy. The incidence of new persistent opioid use, defined by opioid prescription fulfillment between 90 and 180 days after surgery was then calculated. Data were assessed for patient factors which may be predictors of new persistent opioid use including surgery type, health insurance type, age, gender, household income, and comorbidities.

Results:

A total of 38,312 patients underwent surgical treatment of hallux valgus with either a distal or proximal first metatarsal osteotomy and filled a perioperative opioid prescription. The rate of new persistent opioid use among all patients was 5.6%. The majority of patients (90%) underwent treatment with a distal metatarsal osteotomy. Patients who underwent treatment with a proximal metatarsal osteotomy were more likely to have new persistent opioid use (aOR: 1.16; p=0.04). Logistic regression analysis demonstrated that patient factors independently associated with new persistent opioid use included depression, anxiety, alcohol and substance abuse disorders, and certain preoperative pain disorders. Age, gender, and income were not associated with new persistent opioid use.

Conclusion:

Despite rising national attention, opioid abuse continues to be a growing epidemic. In order for foot and ankle surgeons to help solve this problem, it must first be better defined. New persistent opioid use following surgical treatment of hallux valgus affects a substantial, growing number of patients. Fifty percent of patients using opioids for 3 months will be using them at 5 years. Understanding patient factors associated with persistent opioid use can help clinicians identify and counsel at-risk patients and ultimately focus strategies and interventions aimed at mitigating and eliminating this massive public health problem.
Periprosthetic Ankle Fractures
Authors: Lazarides Alexander , Vovos Tyler , DeOrio James , Easley Mark , Nunley James , Adams Samuel
Published: September 2018

Category:

Ankle

Introduction/Purpose:

Total ankle replacements (TAR) are an increasingly popular option for the management of tibiotalar arthritis. Periprosthetic fracture is an uncommon but challenging complication of patients undergoing arthroplasty. Evidence on the management of and outcomes from periprosthetic fractures about a TAR are limited. The purpose of this study was to evaluate patients with postoperative periprosthetic fractures about a TAR and determine clinical outcomes of these patients following operative fixation. Additionally, we propose an algorithm for the management of these patients.

Methods:

We retrospectively analyzed 400 patients who underwent TAR from 2007 through 2017. Charts were reviewed and patients with postoperative fractures were selected for inclusion. Patients with a fracture >4 weeks from index surgery were considered candidates for inclusion. Patients with intraoperative fractures were excluded. Univariate analyses were used to identify differences in outcomes.

Results:

32 patients were identified with a postoperative periprosthetic fracture about a TAR. Average age was 65.3 years. Average time to fracture was 39.5 months while average follow up from fracture was 26 months. Fractures were primarily located about the medial malleolus (60.6%). 76.8% of fractures were deemed to be stable (Table 1); 75% of these fractures were managed with ORIF or IMN, while 21% of these fractures were treated with immobilization. 80% of patients with stable fractures treated with immobilization ultimately required surgical intervention. 24.2% of fractures were deemed to be unstable. Fractures about the talus were always unstable and always required revision TAR surgery (100%, p= 0.0002).

Conclusion:

This retrospective review demonstrates that the majority of periprosthetic fractures about a TAR involve the medial malleolus. Additionally, the majority of stable fractures about a TAR required operative fixation. Despite attempts at nonoperative management, management with immobilization is fraught with a high rate of subsequent surgical intervention. Fractures about the talus should be treated with revision TAR surgery or arthrodesis. Based on these findings, we propose an algorithm for the management of patients with a periprosthetic fracture about a TAR.
Outcome of Autologous Bone Grafting with Preservation of Articular Cartilage to Treat Osteochondral Lesions of the Talus with Large Subchondral Cysts
Authors: Sawa Mikiya , Nakasa Tomoyuki , Yoshikawa Masahiro , Tsuyuguchi Yusuke , Kanemitsu Munekazu , Ota Yuki , Adachi Nobuo
Published: September 2018

Category:

Ankle

Introduction/Purpose:

Treatment options for osteochondral lesion of the talus (OLT) have substantially increased over the last decade. There are a wide variety of surgical treatments for OLT, and good clinical results have been reported. However, treatment for OLT with large subchondral bone cysts remains under discussion. The combination of autologous bone grafting for subchondral bone cyst with fixation of articular cartilage would be the desirable procedure for the repair of the large subchondral cyst preserving the original cartilage with native structure and geometry. The purpose of this study is to evaluate the clinical outcome of autologous cancellous bone graft and fixation of cartilage fragment for OLT with large subchondral cysts.

Methods:

Patients comprised seven men and five women, aged 14–70 (mean 35.9) years. All OLTs included full-thickness articular cartilage, extended through subchondral bone and were associated with subchondral cysts. The mean size of the cysts was 9 ×8.6 ×12.3 mm on preoperative CT. Medial lesions were exposed through an oblique medial malleolar osteotomy; lateral lesions through expansion of an anterolateral arthroscopic portal. After refreshed the subchondral cyst, it was grafted with autologous cancellous bone from the distal tibial metaphysis, then cartilage fragments were fixed with nylon suture to surrounding cartilage. Postoperative MRI and CT scans were acquired for all patients at one year after surgery. Seven patients requested screw removal although none had symptoms. The screws were removed and simultaneous arthroscopic examination was performed at 1.5–2 years after surgery with the patients’ permission. The cartilage repair was assessed according to the criteria of the International Cartilage Repair Society (ICRS).

Results:

Functional outcome was evaluated at 25.3 (15–50) months after surgery. Mean American Orthopedic Foot and Ankle Society ankle-hindfoot outcome score improved from 65.7 to 92 (90–100) postoperatively, with 100% patient satisfaction. All follow-up CT scans showed that the grafts were well consolidated with the surrounding subchondral bone. On MRI one year after surgery, no scans showed any signs of osteochondral graft instability. The mean ICRS arthroscopic score from follow-up arthroscopy was 11.1 (8–12) points, and represented nearly normal cartilage.

Conclusion:

Our study demonstrated good results of autologous bone grafting in preserving articular cartilage in cases of symptomatic OLT with subchondral cysts. In seven cases, we performed follow-up arthroscopy at 1.5–2 years after primary operation and the chondral fragment showed a smooth surface and good stability. The technique of autologous bone grafting with chondral fragment fixation could be a promising option for treatment of OLT with subchondral cysts.
Subtalar Joint Arthritis After Total Ankle Replacement
Authors: Sokolowski Marc , Zwicky Lukas , Schweizer Christine , Hintermann Beat
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

It has been shown that total ankle replacement (TAR) is effective in reducing pain and maintaining function in posttraumatic ankle osteoarthritis (OA). Compared to ankle fusion, TAR restores hindfoot kinematics more physiological. However, the assumption that the maintenance of ankle motion has a protective effect on the subtalar joint is still a matter of debate. Only a scarce number of long-term studies exist to support this statement.The purpose of this study was (1) to evaluate to which extent the integrity of the subtalar joint can be preserved by treating patients with a TAR, (2) to determine the rate of subtalar fusion following TAR, and (3) to determine whether the need of subsequent subtalar fusion was predictable at time of TAR.

Methods:

A consecutive series of 1140 primary TAR (508 female, 632 male, median age 63.5 years), performed between May 2000 and December 2015, were prospectively documented. The indication for TAR was posttraumatic OA in 78%, primary and systemic OA in 10% each, and other secondary OA in 3% of the cases. 199 subtalar joints were either fused before (n=73) or during TAR surgery (n=126), leaving 941 subtalar joints available for analysis. Radiographs before implantation and at latest follow-up were classified using the Kellgren and Lawrence Grading Score (KLS). In case of a subtalar fusion, the radiograph prior to the fusion was classified.

Results:

After a median radiographic follow-up of 6.1 years, the KLS remained unchanged in 66% of all cases. While it was increased by one stage in 30%, it was increased by two stages in 3%; whereas, signs of OA decreased by one stage in 1%. Cases with an increase of two stages on the KLS had a longer follow-up compared to cases without increase (p=0.047).37 cases (3.9%) underwent a subtalar joint fusion, of which the indication was progressive OA in 19 cases (51%), instability in 10 cases (27%) and others in 8 cases (22%). Subtalar joints that required a fusion after TAR did not show higher preoperative KLS than the group which did not need a subtalar joint fusion.

Conclusion:

Apparently, TAR protects the subtalar joint from secondary degeneration, as found in 67% with no increase in KLS. Although 33% showed an increase in the KLS, only 2% required a subtalar fusion due to progressive OA. Overall, the rate of subtalar joint fusion after TAR was low and comparable to the rates reported in the literature. Subtalar joints requiring fusion after TAR did not show higher preoperative rates of OA. Therefore, the KLS classification of subtalar OA on conventional radiographs provides only limited information about the need for postoperative subtalar fusion, and thus need to be interpreted with caution.
The Role of 3D Reconstruction True Volume Analysis in Osteochondral Lesions of the Talus
Authors: Walley Kempland , Gonzalez Tyler , Roush Evan , Saloky Kaitlin , Callahan Ryan , Ludwick Leanne , Juliano Paul , Lewis Gregory , Aynardi Michael
Published: September 2018

Category:

Other

Introduction/Purpose:

Evaluation and management of osteochondral lesions of the talus (OLTs) often warrant advanced imaging studies such as CT and/or MRI. While MRI has its advantages in determining the degree of cartilage damage, stability of the fragment and edema, CT imaging is better delineates the osseous anatomy and extent of the lesion. The latter imaging modality offers increasing acuity and resolution in characterizing the complex osteochondral landscape via three-dimensional (3D) reconstructions. It is possible that orthopedic surgeons may overestimate the size and misinterpret the morphology of OLT from conventional MRI and CT thereby influencing treatment strategies. The purpose of this study is to determine the utility of a novel means to estimate the true-volume of OLTs using 3D reconstructed images and volume analysis.

Methods:

After IRB approval, an institutional radiology database was queried for patients with OLTs and compatible CT scans between 2011 and 2016. Fourteen patients were found to have OLT compatible with the software used to approximate true-volumes of 3D reconstructed images. 3D reconstructions were created using Mimics software (Materialise, Belgium). From the 14 reconstructed OLTs, 5 were randomly selected for evaluation. 10 orthopedic surgeons independently estimated the volume of these 5 OLTs via standard CT scans. Then 3D reconstructions were made and true-volume (TV) analysis measurements of each OLT were generated. The percent change in volumes from CT were compared to TVs determined from 3D reconstructive analysis.

Results:

On average the volume calculated by conventional CT scanner grossly overestimated the actual size of the OLTs. The volume calculated on conventional CT scanner overestimated the size of OLTs compared to the 3D TV reconstructed analysis by 285-864%.

Conclusion:

Our results show that conventional measurements of OLTS with CT grossly overestimates the size of the lesion by up to 8-times the actual lesion size. This overestimation of volumes of the lesion can drastically change surgical planning and may lead to unnecessary costs associated with specific surgical treatments. With the use of our newly defined model for volume measurement in OLTs, we can more accurately predict the exact size of the OLT. This can better guide surgeons to choices both the correct cartilage restoring procedure as well as the need for bone grafting.
Patient Satisfaction versus Patient Reported Outcomes
Authors: Angthong Chayanin
Published: September 2018

Category:

Other

Introduction/Purpose:

Several researches focused on patient reported outcomes (PROs), however, little is known about the actual correlation between the patient satisfaction and PROs. The present study is to determine the correlation between patient satisfaction and PROs.

Methods:

A total of 35 patients with foot and ankle disability participated in this study to complete the data in terms of the patient satisfaction score and PROs. All of them were treated by a single foot and ankle surgeon. The Thai patient satisfaction score or Foot and Ankle Satisfaction Score [FASS] (0 [worst] -100 [best]) consisted of 4 items regarding patient’s perspectives as 1) symptoms, 2) function, 3) other complaints, and 4) recommendation of his/her treatment for other patients. PROs measures consisted of validated Thai visual analogue scale foot and ankle (VASFA) (0 [worst] -100 [best]) and Thai Short Form-36 (SF-36) (0 [worst] -100 [best]).

Results:

Mean total FASS was 92.0 ± 11.8, 87.7 ± 17.0, 98.6 ± 6.0, 98.6 ± 8.5 and for the items: symptoms, function, other complaints, and recommendation of his/her treatment for other patients, respectively. Mean total FASS was 94.2 ± 6.8. Mean VASFA was 67.7 ± 18.3. Mean SF-36 was 82.7 ± 10.7.There were no significant correlations between mean total FASS and PROs (VASFA [p-value < 0.05], SF-36 [p-value <0.05]). There were no significant correlations between mean FASS in all items and PROs (VASFA, SF-36) with all p-values < 0.05. The significant correlation was found between VASFA and SF-36 (Pearson correlation coefficient = 0.734; p-value<0.01).

Conclusion:

One of the successful treatment results is the improvement of patient satisfaction. Even if several researches focused on the assessment of PROs to achieve the successful outcome, this kind of measures was no significant correlation with patient satisfaction. PROs were not able to reflect the patient satisfaction following treatments. Patient satisfaction may be related to other parameters, in addition to the PROs, such as the patient expectation, the post-treatment level of physician-patient relationship, the patient’s confidence in his/her physician capability, etc. Further study is needed to clarify these factors.
All-arthroscopic AMIC® (AT-AMIC) for the treatment of talar osteochondral defects
Authors: Baumfeld Daniel , Baumfeld Tiago , Prado Marcelo , Nery Caio
Published: September 2018

Category:

Arthroscopy

Introduction/Purpose:

Various operative procedures have been used to treat osteochondral lesions of the talus. Among the new alternatives to treat these lesions, Autologous Matrix-Induced Chondrogenesis (AMIC®) has proven to provide satisfactory results through medium-term follow-up. The aim of this study is to report early post-operative clinical results of patients submitted to the AT-AMIC® technique and autologous bone graft, when necessary, for OLT’s at a six-month minimum follow-up.

Methods:

This is case series of 17 consecutive patients that were submitted to AT-AMIC®, between january of 2016 and april of 2017. 9 men and 8 women, between 15 and 67 years were diagnosed with OLTs with the typical history of deep ankle pain and corresponding magnetic resonance imaging injury. Surgery was proposed only after failure of conservative treatment of at least 3 months. Surgeries were performed by three different surgeons, with high arthroscopic experience. Patients answered the AOFAS score preoperatively and at the last follow-up, ranging from 6 to 18 months

Results:

Average size of OLTs were 1,12 cm2, with Raikin 4 location being the most common (70,5%). Calcaneal osteotomy was the most common associated procedure, with 17,6%. Average follow-up was 10,76 months. Average AOFAS before surgery was 46,35, increasing to 89,53 at the last follow-up. This difference was statistically significant with a p-value of <0,001. No complications were observed and no changes in the post-operative protocol were needed.

Conclusion:

AT-AMIC® is a reliable and reproducible method of treatment for OLTs, reaching high clinical postoperative scores, with a very low rate of complications. Further comparative study is needed to prove its efficacy.
Quality of Modern Total Ankle Arthroplasty Research
Authors: Bohl Daniel , Vafek Emily , Lee Simon , Lin Johnny , Holmes George , Hamid Kamran
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

Total ankle arthroplasty (TAA) is gaining popularity as an alternative to ankle arthrodesis in the setting of end-stage ankle arthritis. However, compared to hip and knee arthroplasty, there is a relative dearth of evidence to support its use. This study assesses the quality of literature surrounding modern TAA designs.

Methods:

A search of all peer-reviewed, English-language journals was conducted to identify publications involving TAA. The initial search identified 444 articles published during 2006-2016. Of these, 182 were excluded because they were not clinical outcomes studies, 46 because the TAA implant was no longer available, and 15 because the primary outcome of the study was not related to TAA, leaving 201 articles for analysis.

Results:

No Level I studies were identified. Seventeen (8%) studies were Level II, 48 (24%) Level III, 128 (64%) Level IV, and 8 (4%) Level V. One hundred forty-three studies (71%) were retrospective in nature. Stratification by study design revealed 128 (64%) case series, 33 (16%) experimental cohort studies, 19 (10%) case-control studies, 13 (6%) observational cohort studies, and 8 (4%) case reports. The number of studies published each year steadily increased from 2006 to 2016. A total of 51% of TAA research was published in only two journals: Foot and Ankle International and the Journal of Bone and Joint Surgery. Publications from the United States accounted for 36% of total publications. The most published implant was the Scandinavian Total Ankle Replacement (Figure 1).

Conclusion:

While the number of TAA studies published each year has steadily increased since 2006, the quality of this research as measured by level of evidence remains suboptimal. This analysis highlights the need for continued improvement in methodology and development of robust prospective registries to advance our knowledge of TAA as a treatment for end-stage ankle arthritis.
Intramedullary Screw Fixation and Relevant Diameter of the Proximal Phalanges of the Foot
Authors: Brandao Roberto , Van Dyke Bryan , Watson Benjamin , Weber Jeffrey , Larson David , McGann Maria , Hyer Christopher
Published: September 2018

Category:

Midfoot/Forefoot

Introduction/Purpose:

The average intramedullary diameter of the proximal phalanges of the foot has not been well documented in the literature. This dimension has important implications for surgical fixation devices, such as intramedullary screws. By design, intramedullary fixation devices rely on endosteal fit to provide stability. The precise intramedullary diameter is not readily identifiable on plain radiographs. A better understanding of the average diameter of the proximal phalanges of the foot can assist surgeons in surgical planning and appropriate screw diameter selection to provide more satisfactory patient outcomes.

Methods:

Twenty below-knee cadaveric specimens were dissected to expose each proximal phalanx. A sagittal saw was used to transect the diaphysis at its narrowest portion. The dorsal to plantar and medial to lateral diameters were measured using a digital manometer.

Results:

The average diameter dorsal to plantar for each digit was 6.25 ± 2.24 mm, 3.61 ± 1.25 mm, 2.94 ± 0.70 mm, 2.72 ± 0.77 mm, and 2.48 ± 0.80 mm, respectively. The average diameter medial to lateral for each digit was 7.83 ± 2.13 mm, 3.08 ± 0.93 mm, 2.47 ± 0.74 mm, 2.33 ± 0.73 mm, and 2.62 ± 0.69 mm, respectively. The overall average diameter for toes one through five was 7.04 ± 1.95 mm, 3.35 ± 1.04 mm, 2.71 ± 0.66 mm, 2.52 ± 0.71 mm, and 2.55 ± 0.63 mm, respectively.

Conclusion:

Understanding the intramedullary diameters of the proximal phalanges of the foot is a valuable tool when utilizing intramedullary surgical stabilization. The hallux proximal phalanx demonstrated the largest, and most variable, diameter, which could make selection intramedullary fixation difficult. In addition, the hallux proximal phalanx may lend itself better to 2 smaller fixation devices rather than one larger one. The lesser phalanges demonstrated smaller diameters more consistently, which is more amenable to a single smaller (2.5 mm) intramedullary device. This data can provide surgeons with an expected intramedullary diameter during surgical planning.
Subsequent Injury is Common after Foot and Ankle Surgery in Patients Receiving Workers’ Compensation
Authors: Bui Gabrielle , Phisitkul Phinit , Glass Natalie , Cychosz Chris , Boarini Sean
Published: September 2018

Category:

Ankle

Introduction/Purpose:

Workers’ compensation (WC) has been associated with poor outcomes following a variety of injuries and surgeries. Previous studies have investigated surgical outcomes via satisfaction surveys, but rates of subsequent injury following surgery have not been specifically studied. The purpose of this study was to investigate the rates, locations and risk factors for subsequent injuries in WC patients and non-WC patients who underwent the same surgeries.

Methods:

With IRB approval, we identified the records of patients with a foot or ankle surgery performed by a single surgeon from 2009-2015. We included only surgeries with one of the most common current procedural terminology (CPT) codes from the WC population. A retrospective chart review was performed on all WC and non-WC patients with at least one of these CPT codes. A subsequent injury was defined as a new injury at a different anatomical location that occurred from 2 months to 2 years after the index surgery. Chi-square and two-tailed t-tests were used to compare WC and non-WC patient populations, and to determine factors associated with subsequent injuries.

Results:

Overall, the WC population had higher rates of subsequent injury than the non-WC population 23.21% versus 7.27%, p=.0011. Within the WC patient population, patients with subsequent injuries were older than patients without subsequent injuries 48.78±7.30 versus 41.58±12.40, p=.0137. In a blinded review of the charts and Iowa Courts Online, legal representation was found to be more common in WC patients with subsequent injuries than WC patients without subsequent injuries (76.92% versus 37.21%, p=.0240). In the non-WC population, there were more males in the group without subsequent injuries than in the group with subsequent injuries 42.48% versus 8.33%, p=.0287. There were no significant differences in locations of subsequent injury. Hip, knee and contralateral foot and ankle were common areas of subsequent injury in both groups.

Conclusion:

Overall, WC patients had higher rates of subsequent injury than non-WC patients. Within the WC group, legal representation further raised the risk of subsequent injury. Gender may mediate variable reporting of subsequent injuries in non-WC populations. While the reason for this increased risk of subsequent injury is not known, the differences are enough that they should be considered when counseling WC patients considering these surgeries. Additionally, if further study supported these findings, knowledge of the areas at risk for subsequent injury might lead to preventative strategies that could decrease the risk of subsequent injury.
Isolated Gastrocnemius Recession for Plantar Fasciitis
Authors: Cheney Nicholas , Law Timothy , Zehnder David , Large Bryan , Rockwell Kyle , Whitehead Brent , Vazquez Mckinly
Published: September 2018

Category:

Hindfoot

Introduction/Purpose:

Plantar fasciitis is a debilitating problem that can cause long-term pain. Multiple different studies with various modalities have been suggested to treat the inflammation of the plantar fascia. None of them have provided a cause for the inflammation. A few recent studies have shown gastrocnemius equinus to be a driving factor in foot pain, which includes plantar fasciitis. Our belief is that the inflammation is due to a stretch placed on the plantar fascia due to a gastrocnemius equinus contracture and the beginning of an arch collapse per the Grand Rapids arch collapse model. As such, we wanted to review our results with an isolated gastrocnemius recession for the treatment of plantar fasciitis.

Methods:

We retrospectively reviewed patient data collected by isolating ICD-9 and ICD-10 codes for plantar fasciitis. These patients presented to the senior author’s office with a complaint of plantar heel pain, were diagnosed with a gastrocnemius equinus contracture and plantar fasciitis, failed conservative treatment, and opted for an isolated gastrocnemius recession as a definitive treatment of the fasciitis. From the timeframe of 1/1/2015 to 6/12/17, there were 68 out of 97 patients who qualified for the study based on the necessary criteria: an initial consultation pain score, initial post-operative pain score at two weeks, and second post-operative pain score at eight weeks. These patients did not have coexisting surgeries at the time of the gastrocnemius recession or prior surgery to the area in discussion.

Results:

For the 68 patients (five of which underwent bilateral procedures at a minimum of six weeks apart), who elected to have a gastrocnemius recession for plantar fasciitis, the average initial presenting pain was a 7.4 on a scale of 0 to 10. The average initial post-operative pain score was 2.8 and the average second post-operative pain score was 3.3. The average number of days from initial to second post-operative appointment was 136 days. Of the 68 patients, 21 returned after their eight-week post-operative visit for evaluation. Only 3 returned with recurrent plantar heel pain, 4 more presented with new onset tarsal tunnel syndrome, three more with heel pain different from their pre operative pain and the remaining patients had new onset unrelated pain.

Conclusion:

We have demonstrated that an isolated gastrocnemius recession can decrease the pain score in patients with recalcitrant plantar fasciitis. Follow up care beyond eight weeks post operation is not routinely performed due to the limited nature of the procedure. The improvement demonstrated in the VAS scores of the patients included in this study show a definite improvement and as such, we believe that an isolated gastrocnemius recession should be considered as a definitive treatment of plantar fasciitis. Future prospective randomized studies will need to be completed to further evaluate the effectiveness of this procedure.
AOFAS Position Statement on the Future Use of AOFAS Clinical Rating Scale
Authors: Davis Sophia , Baumhauer Judith , Karnyski Steven , Lawson Michelle
Published: September 2018

Category:

Other

Introduction/Purpose:

Measuring patient outcomes is a critical piece toward advancing medical care. A previous study reviewing the commonly obtained outcomes measures used in orthopaedic foot and ankle surgery (Hunt 2013) demonstrated the AOFAS clinical rating scale was the most commonly reported measure over the past 10 years (2002-2011). Since that time, the American Orthopaedic Foot and Ankle Society published a position statement recommending against the continued use of this rating scale. The purpose of this study is to determine the impact of this position statement on the continued use of this invalidated instrument.

Methods:

We systematically reviewed all foot and ankle articles published in six major orthopaedic journals between 2012 and 2017. Any clinical study utilizing outcome measures was included. All outcome measures, level of evidence, type of study, study date and topic were recorded. The current utilization of the AOFAS was compared to the prior published percentages (outcome measure/total number of clinical articles) to determine the impact of use over time.

Results:

A total of 660 foot and ankle articles using clinical outcome measures were identified from a total of 14,164 articles published from the six journals between 2012-2017. Of the 108 outcome measures used, the 6 most common were the AOFAS (57.42%), Pain VAS (38.33%), SF-36 (18.18%), FAOS (8.79%), SF-12 (6.67%) and FFI (6.67%). Compared with Hunt et al. 2013, there is a consistently high usage of the AOFAS clinical rating scale during the past 5 years. A unique finding was more clinical studies were using two or more measures (59.09%) than a single outcome measure (40.91%). The majority of the studies represented level IV evidence (55.91%) with only 7% Level I (Hunt et al. 70% and 9.4% respectively).

Conclusion:

There continues to be a wide variety of outcome measures used in foot and ankle clinical studies. There are more higher evidence (Level II and III) studies completed in the past 6 years than prior years. The purpose of the AOFAS position statement was to discourage the use of the AOFAS clinical rating scales. Although this did not occur, there was a shift from the isolated use of one to multiple different outcome measures. As researchers become more comfortable with other validated outcome measures, hopefully the use of the AOFAS clinical rating scale will decline.
Ankle Fusion Percutaneous Home Run Screw Fixation
Authors: de Cesar Netto Cesar , Roberts Lauren , Staggers Jackson , Smith Walter , Lee Sung , Dos Santos Alexandre Godoy , Pinto Martim , Araoye Ibukunoluwa , Hudson Parke , Shah Ashish
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

During internal fixation of ankle fusions, besides the standard crossed screw fixation pattern, the use of a percutaneously placed augmenting screw, directed from the posterolateral tibial metaphysis proximally across the ankle into the talar neck (“ankle fusion home run screw”), is a widely used technique. The placement of this screw is technically demanding and multiple attempts under fluoroscopy guidance are frequently needed to achieve a perfect positioning of the implant. Injuries to local neurovascular and tendinous structures might happen. The objective of this cadaver study was to identify the number of attempts necessary for a perfect positioning of the ankle fusion home run screw and the neurovascular and tendinous structures at risk.

Methods:

Eleven fresh frozen cadaver limbs were used. Guide wires (3.2 mm) from the Stryker (Selzach, Switzerland) 7.0-mm headless cannulated set were percutaneously placed into the distal posterolateral aspect of the leg, under fluoroscopic guidance, with the ankle held in neutral position. Mal positioned pins were not removed and served as guidance for the following pins. The number of guide wires needed to achieve an acceptable positioning of the implant was noted. After a layered dissection from the skin to the tibia, we evaluated neurovascular and tendinous injuries, and measured the shortest distance between the closest guide pin and the soft tissue structures, using a precision digital caliper.

Results:

The mean number of guide wires needed to achieve and acceptable positioning of the implant was 2.09 (SD 0.83, range 1- 4). The mean distances between the closest guide pin and the soft tissue structures of interest were: Achilles tendon 6.90 mm (SD 3.74 mm); peroneal tendons 9.65 mm (SD 3.99 mm); sural neurovascular bundle 0.97 mm (SD 1.93 mm); posteromedial neurovascular bundle 14.26 mm (SD 4.56 mm). Sural bundle was in contact with the guide pin in 5/11 specimens (45.5%) and transected in 3/11 specimens (27.3%).

Conclusion:

The placement of percutaneous ankle fusion home run screws is technically demanding and multiple guide pins are needed. Our cadaveric study showed that important tendinous and neurovascular structures are in close proximity with the guide pins and that the sural bundle is injured in approximately 73% of the cases. Caution should be taken during percutaneous placing of screws and an appropriate approach and surgical dissection to bone is advised.