bluuebunny/crossref_metadata_2025 huggingface dataset:
First Tarsometatarsal Joint Shape and Orientation
Authors: de Cesar Netto Cesar , Staggers Jackson , Smith Walter , Lee Sung , Phillips Sierra , Pinto Martim , Dos Santos Alexandre Godoy , Roberts Lauren , Sahranavard Bahman , Shah Ashish
Published: September 2018

Category:

Bunion

Introduction/Purpose:

Studies have demonstrated that patients with hallux valgus (HV) deformities have increased mobility in the first tarsometatarsal (TMT) joint. Anatomical factors widely considered to play a role in the instability are shape and frontal plane orientation of the joint. An oblique rather than horizontal orientation of the articular surfaces and a round shape, rather than a flat shape, are believed to predispose to the deformity. The purpose of this study was to assess whether the shape and angulation of the first TMT joint are affected by the positioning of the foot and orientation of the x-ray beam.

Methods:

Ten adult above knee fresh frozen cadaveric specimens were used, with a mean age of 79.9 (range, 54-88) years. There were no clinical forefoot deformities noted in any of the feet. One of the specimens had moderate ankle arthritis and one had a mild cavus-varus. A radiolucent loading apparatus was built that, allowing neutral positioning of a plantigrade foot and controlled angulation of 5o, 10 o, 15o and 20o in dorsiflexion, plantarflexion, inversion and eversion. Fluoroscopic images were obtained of each cadaveric specimen in all seventeen different positions, with the x-ray beam perpendicular to the floor and aiming to the base of the 1st metatarsal. Two blinded orthopaedic surgeons independently measured the 1st tarsometatarsal (TMT) joint angle and graded the distal articular cartilage of the medial cuneiform as flat or curved. Readers also graded the image quality into assessing the joint into “Low”, “Intermediate” and “Good”.

Results:

1st TMT joint angle was 112.92o ± 6.89o. Values were significantly different between cadaveric specimens (p<.0001). There was a tendency for increased valgus angulation of the joint in images positioned in neutral, plantarflexion and inversion and decreased valgus angulation with dorsiflexion and eversion.Regarding the shape of the distal articular cartilage of the medial cuneiform, joints with flat configuration showed significantly increased mean 1st TMT joint angle when compared to curved surfaces (115.9o vs. 110.7o, p<.0001). In 8 out of 10 of the cadaveric specimens (80%) the shape of the 1st TMT joint changed between curved or flat configuration depending on the positioning of the foot. In only 2/10 (20%) the joint configuration remained the same for all different positions (one flat and one curved).

Conclusion:

Our cadaveric study found that the shape and angulation of the first TMT joint is affected by the positioning of the foot and orientation of the x-ray beam. Clinical usefulness of the 1st TMT radiographic anatomical characteristics is limited and should not influence in the treatment of patients with possible instability the first tarsometatarsal (TMT) joint.
Midfoot power during walking and stair ascent in healthy adults
Authors: DiLiberto Frank , Houck Jeff , Nawoczenski Deborah
Published: September 2018

Category:

Midfoot/Forefoot

Introduction/Purpose:

Intrinsic foot muscles have the capacity to attenuate and reverse arch deformation under loaded conditions. This function is proposed to be an important component in generating the midfoot power and stability requisite for gastroc-soleus muscle action at the ankle during forward propulsion. Synergistic activation of intrinsic foot muscles is proposed to function as a ‘foot core’ during weightbearing activity that is analogous to the function of the smaller muscles at the spine. If this theory were sound, midfoot power would be expected to increase, potentially in proportion to ankle power, as the muscular demand of a task increases. The purpose of this study was to explore the nature and behavior of midfoot and ankle power during walking and stair ascent in healthy adults.

Methods:

Twelve healthy adults [Mean (SD): Age 31.3 (4.9) years; BMI 25.2 (3.4) Kg/m2; 50% female] walked, ascended a standard step, and ascended a high step. An electromagnetic sensor motion capture system and force plate were used to record multi-segment foot motion and ground reaction force data. Subject-specific three segment foot models (tibia, rearfoot, forefoot) were derived. Inverse dynamic calculations were performed to obtain ankle and midfoot positive total power. Positive total power, calculated as the sum of positive power (joint torque x segmental velocity) after heel off, reflects the entire amount of ankle or midfoot push-off power generated for a given task. The proportion of midfoot to ankle positive total power was also calculated. Multiple one-way repeated measures ANOVAs were conducted to evaluate differences in power variables across tasks. Bonferroni adjusted pairwise comparisons were made to assess differences in main effects. Effect sizes between conditions were also examined (Cohen’s d).

Results:

Significant main effects were found for both ankle and midfoot positive total power [ankle F = 29.8 (p < 0.01); midfoot F = 63.1 (p < 0.01)]. Pairwise comparisons revealed that total power significantly increased across each activity at both the ankle (d range: 0.09 - 2.3) and midfoot (d range: 1.4 - 2.9) [all p < 0.05]. Interestingly, a main effect was not observed in the proportion of midfoot to ankle total power across activity [F = 1.2 (p = 0.33)] (Figure 1).

Conclusion:

The findings of this study provide preliminary support for the idea of a midfoot ‘foot core’ system. While increased ankle and midfoot power is required as the muscular demand of activity increases from walking to standard step and high step ascent, the proportion of midfoot to ankle total power remains the same. Study findings may assist practitioner understanding in addressing regional foot muscle imbalances and advancing patients to higher-level functional activities.
Trampoline Related Injuries
Authors: Doty Jesse , Voskuil Ryan , Swafford Rachel
Published: September 2018

Category:

Trauma

Introduction/Purpose:

Jump parks (or trampoline parks) have become one of the fastest growing recreational businesses in the United States. With their increasing popularity, notable changes in trampoline related injuries might be evident, particularly involving the lower extremity. There is no published data dedicated to adult trampoline injuries and little information regarding the safety profiles of commercial jump parks.

Methods:

We conducted a retrospective review including all patients sustaining trampoline related injuries presenting during a two-year period. Data collection included patient demographics and injury characteristics of trampoline injuries in the domestic setting and at commercial jump parks.

Results:

One hundred fifty patients (34%) sustained injuries at commercial jump parks versus 289 patients (66%) on home trampolines. Fifty-five percent of the jump park injuries were fractures/dislocations, compared to 44% of the home trampoline injuries. Eighteen adults sustained fractures or dislocations at the jump park (45%), while only five adults sustained fractures or dislocations using home trampolines (17%). Seventeen (94%) and 2 (40%) represented adult lower extremity injuries in jump parks and home trampolines respectively. In children, 47 (72%) of the jump park fractures/dislocations were lower extremity, and 41 (33%) of the home trampoline fractures/dislocations were lower extremity. Ten (9%) pediatric and 9 (23%) adult jump park patients required operative intervention, compared to 17 (7%) pediatric and 3 (10%) adult home trampoline patients requiring surgery.

Conclusion:

Emergency room visits, hospital admissions, and surgical intervention secondary to jump park related injuries are not uncommon in children and adults. There were a higher percentage of total fractures or dislocations, adult fractures, lower extremity fractures, and operative interventions among patients with commercial jump park injuries compared with those who sustained home trampoline injuries.
A Computer Model Assessment of the Effect of Hindfoot Alignment on Mechanical Axis Deviation and Ankle Fractures
Authors: Duggal Naven , Williamson Patrick , Nazarian Ara
Published: September 2018

Category:

Basic Sciences/Biologics

Introduction/Purpose:

Conventional mechanical axis is calculated from the center of the femoral head to the center of the ankle. Mechanical axis deviation of the lower limb can be associated with a pes planus hindfoot. Malalignment of the lower limb has been shown to increase progression of osteoarthritis of the knee and ankle and decrease joint arthroplasty longevity. Clinically, a pes planus hindfoot has also been seen with patients who present with a stress fracture of the lateral malleolus. This biomechanical study aims to utilize computer modeling to evaluate the hypothesis that altered force transmission on the lateral malleolus with resultant stress fractures in a pes planus model is attributable to mechanical axis deviation.

Methods:

A free-body diagram of the fibula in single leg stance was generated by modeling the fibula as a uniform cylinder. It includes the axially applied load and a single evertor muscle force as an eccentric load applied to the mid-diaphysis . Previously derived relationships between body weight (BW = 667 N, 150lbs) and a) normal axial fibula load (BW*0.17) and b) muscle force (BW*0.25) were used. Fibula length (286.5 mm) and diameter (8 mm) were derived from anthropological data. Mechanical axis deviation in pes planus was simulated in two manners: 1) increased (2 and 3 times normal) axial fibula load and 2) increased evertor muscle force. The compressive stress along the length of the bone was determined through static analysis and the total applied load was compared to theoretical Euler buckling load.

Results:

Increasing the load on the fibula, either by increasing the axial load (Figure 1A) or the muscle load (Figure 1B), increases the maximum compressive stress below the lateral muscle origins, namely the section between the distal tibiofibular ligaments and the evertor muscles. The compressive stress for both cases was less than the compressive yield stress of cortical bone (200 MPa) and cancellous bone (100 MPa) even as the force was increased to the critical buckling value. This model serves as a first attempt to relate the spatial distribution of stress in the fibula with muscle force, axial load, and compressive stress in light of distal fibular fractures associated with pes planus.

Conclusion:

The importance of lower extremity mechanical axis deviation is well established in the progression of arthritis in the knee and ankle. The role of the mechanical axis in the predisposition of stress fractures around the ankle has not been evaluated in the literature. This biomechanical study represents the first attempt to understand how deviation of the mechanical axis can result in stress fractures of the lateral malleolus. Future studies including a finite element analysis will provide further information and the results of these studies may alter how clinicians treat patients with stress fractures of the fibula.
Successful Treatment Of Advanced Freiberg’s Disease With A Dorsal Closing Wedge Osteotomy
Authors: Halai Mansur , David-West Kenneth
Published: September 2018

Category:

Lesser Toes

Introduction/Purpose:

Treatment for Freiberg’s disease is largely conservative. For severe disease and refractory cases, there are various surgical options. Most studies are from the Far-Eastern population and have short follow-up. The purpose of this study was to report the 5 year clinical outcomes of a dorsal closing wedge osteotomy in the treatment of advanced Freiberg’s disease in a Caucasian population.

Methods:

Twelve patients (12 feet), with a mean age of 30.7 years (range 17-55), were treated with a synovectomy and a dorsal closing wedge osteotomy of the affected distal metatarsal. There were 10 females and 2 males. All patients were born in the United Kingdom. Clinical outcomes were independently evaluated pre and postoperatively using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and a subjective satisfaction score. Nine (75%) feet involved the 2nd metatarsal and 3 feet (25%) involved the 3 rd metatarsal. According to the Smillie classification, 6 feet were Grade IV and 6 feet were grade V. Radiological union was evaluated postoperatively.

Results:

No patients were lost to follow up and the mean follow-up time was 5.2 years (4-7). AOFAS scores improved from 48.1 +/- 7.4 to 88.9 +/- 10.1 postoperatively (p<0.001) giving a mean improvement of 40.8. 92% of patients were satisfied with their operation at latest follow-up, reporting excellent or good results. All patients had postoperative radiological union. One patient had a superficial postoperative infection that was successfully treated with oral antibiotics.

Conclusion:

A dorsal closing wedge osteotomy is an effective treatment of advanced Freiberg’s disease in a Caucasian population, with good outcomes and few complications.
Muller-Weiss Disease
Authors: Harnroongroj Thos , Chuckpaiwong Bavornrit
Published: September 2018

Category:

Midfoot/Forefoot

Introduction/Purpose:

Numerous surgical treatments for Muller-Weiss Disease(MWD) have been reported. However, up to presence, there is no study about the natural history of the conservative treatment in MWD. Our objective is to provide the survival analysis of the conservative treatment in MWD to 5-year follow up and to identify the factors that correlated to the failure of conservative treatment.

Methods:

This retrospective cohort review examined 32 MWD patients, age > 18 and at least Maceira’s stage 3, received conservative treatment with follow-up period to 5 years. Demographic data; pretreatment visual analogue scale(VAS) for pain on walking; foot and ankle outcome scores(FAOS); and radiographs were reviewed. A survival analysis of successful conservative treatment was done using Kaplan-Meier Curve. The “starting-point” was the time started conservative treatment. The “end-point” was the time converted to surgery. “Failure of conservative treatment” was defined as conversion to surgery due to significant pain and disability within 5-Year follow up. Patients were divided into “Successful conservative group”(A) and “Conversion to surgery group”(B). The comparison of variables between 2 groups were done to identify the factor correlated to failure of conservative treatment.

Results:

Mean age was 57.5±10.4 years. Average body mass index was 24.3±3.4. According to survival analysis, mean follow up period was 43.1±21.0 months . Fourteen patients(43.75%) required subsequent conversion to surgery. Survivorship of conservative treatment was 56.3%(95%CI, 47.5- 65.1) with mean survival time of 43.1 months(95%CI, 35.9- 50.3). VAS of pain on walking, FAOS in subscale of pain and quality of life(QoL) were 6.2±2.5, 58.1±24.7 and 52.8±16.6, for group A; 7.9±1.6, 33.5±16.6 and 28.9±19.0, for group B. There were significant worse of both clinical scores in group B compared to A(p<0.05). The radiographic anteroposterior Meary angle in group A and B were abducted 4.8±12.6 and 13.7±10.0. The statistical analysis showed significant more midfoot abduction in group B than A, hazard ratio 1.056(95% CI,1.003 -1.111, p=0.04).

Conclusion:

Survivorship of conservative treatment in MWD is only 56.3% at 5-year follow up. The failure of conservative treatment associates with degree increment of midfoot abduction.
Total Ankle Arthroplasty for Rheumatoid Arthritis
Authors: Hirao Makoto , Hashimoto Jun , Tsuboi Hideki , Noguchi Takaaki
Published: September 2018

Category:

Ankle

Introduction/Purpose:

Outcomes after total ankle arthroplasty (TAA) combined with additive techniques (1. augmentation of bone strength, 2. control of soft tissue balance, 3. adjustment of the loading axis) for rheumatoid arthritis (RA) cases were evaluated after mid to long-term follow-up. The influences of biologic treatment on the outcomes after TAA were also evaluated.

Methods:

We performed a retrospective observational study involving 50 ankles (44 patients) that underwent TAA for the treatment of rheumatoid arthritis. The mean duration of follow-up was 7.1 years. Clinical outcomes were evaluated with use of the Japanese Society for Surgery of the Foot (JSSF) scale score and a postoperative self-administered foot-evaluation questionnaire (SAFE-Q). Radiographic findings were evaluated as well. These parameters also were compared between patients managed with and without biologic treatment.

Results:

This procedure significantly improved the clinical scores of the JSSF rheumatoid arthritis foot and ankle scale (p < 0.0001). Forty-eight of the 50 ankles had no revision TAA surgery. Subsidence of the talar component was seen in 8 ankles (6 in the biologic treatment group and 2 in the non-biologic treatment group); 2 of these ankles (both in the biologic treatment group) underwent revision TAA. The social functioning score of the SAFE-Q scale at the time of the latest follow-up was significantly higher in the biologic treatment group (p = 0.0079). The dosage of prednisolone (p = 0.0003), rate of usage of prednisolone (p = 0.0001), and disease-activity score (p < 0.01) at the latest follow-up were all significantly lower in the biologic treatment group.

Conclusion:

TAA is recommended for RA cases, if disease control, augmentation of bone strength, control of soft tissue balance, and adjustment of loading axis are taken into account. The prevention of talar component subsidence remains a challenge in patients with the combination of subtalar fusion, rheumatoid arthritis, and higher social activity levels.
Long-Term Outcomes of Total Ankle arthroplasty with mobile bearing in 124 ankles, Over eight years of follow-up
Authors: Hwang Yeokgu , Park Kwang Hwan , Han Seung Hwan , Lee Jin Woo
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

Total ankle arthroplasty (TAA) is increasingly recommended for patients with end-stage ankle osteoarthritis. However, there were few studies which had investigated long-term clinical outcomes with mobile baering system. We analyzed the patient reported results of 124 arthroplasties performed with one type of three-component total ankle prosthesis. This prospective cohort study analyzed long-term outcomes of total ankle arthroplasty with use of the Hintegra prosthesis at one center.

Methods:

Consecutive patients who received the hintegra prosthesis between September 2004 and December 2009 were enrolled at one large, university hospitals. Patients were annually evaluated clinically, and the patients reported survey with visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS) and revision rate. Kaplan-Meier survival result showed survival outcomes of TAA in long-term follow-up.

Results:

One hundred and twenty-four ankles underwent arthroplasty with the Hintegra prosthesis. The mean age of patient at operation time was 64.2 years old (range, 47 to 84 years old). The mean duration of follow-up for all living patients without revision (Eighty-six ankles) was 10.0 ± 1.3 years. The mean change from baseline to final follow-up was -6.7 ± 4.3 points for Visual analog scale, and 26.1 ± 10.3 points for the AOFAS score. . Seven (5.6%) of the ankles required metal component revision at a mean of 2.9 ± 1.8 years (range, 0.5 to 5.8 years). Ten (8%) of the prostheses underwent polyethylene bearing exchange, mostly due to asymmetric wear, at a mean of 2.8 ± 1.8 years (range, 0.1 to 9.1 years).

Conclusion:

Long term outcomes were good after ankle arthroplasty with the Hintegra prosthesis performed by experienced surgeons, and long-term outcomes demonstrated. The revision rate was substantially higher among the first fifty ankles than among subsequent ankles. Further study to elucidate possible reasons for osteolysis and subjective pain after TAA is warranted.
Diagnosis, Physical Exam, and Imaging for Osteochondral Lesions of the Talus
Authors:   International Consensus Group on Cartilage Repair of the Ankle
Published: September 2018

Category:

Ankle

Introduction/Purpose:

Cartilage lesions of the talus are a challenging clinical pathology for orthopaedic surgeons. To date, the treatment guidelines for these lesions have been based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions on key topics regarding cartilage lesions of the talus. Diagnosis, physical exam and imaging were discussed as one portion of the first International Consensus Meeting on Cartilage Repair of the Ankle. The purpose of this abstract is to explain the process and delineate the consensus statements derived from this consensus meeting on the diagnosis, physical exam and imaging for osteochondral lesions of the talus.

Methods:

75 national and international experts in cartilage repair of the ankle, representing 25 countries and all six continents, were convened and participated in a process based on the Delphi method of achieving consensus. Experts were assigned to groups separated by topics, including diagnosis, physical exam and imaging. Questions and statements were drafted within the groups and a comprehensive literature review was performed and, where possible, used to confirm or dispute the recommendations made. In addition, the available evidence for each statement was graded. Once the statements achieved majority vote within the working groups, a vote to the overall group was undertaken. The statements were then further edited on the basis of the discussion and votes within the entirety of the consensus group. A final vote then occurred, and the strength of consensus was characterized as follows: consensus: 51 - 74%; strong consensus: 75 - 99%; unanimous: 100%.

Results:

12 statements addressing diagnosis, physical exam and imaging for cartilage lesions of the talus reached some degree of consensus. These included conclusions on how suspected lesions should be evaluated. There was a consensus that: [1] Weight-bearing AP, lateral, and mortise radiographs should be utilized to evaluate a known or suspected cartilage lesion of the ankle. [2] Lesion size should be estimated in three planes including surface area and depth of the lesion. [3] If precise measurement is required including depth, the use of CT is recommended, but for daily practice, a size estimate using MRI is appropriate. [4] Diagnostic arthroscopy is of limited value and seldom influences treatment approach in the assessment of a known or suspected cartilage lesion of the ankle.

Conclusion:

There is a lack of evidence-based guidelines available to direct treatment for clinicians when managing cartilage lesions of the ankle. This international consensus derived from leaders in the field will assist clinicians with a combination of expert- and evidence-based guidelines to consider in the evaluation of a cartilage lesion of the talus including diagnosis, physical exam and imaging.
Relationship between osteophyte and arthroscopic findings in osteoarthritis of ankle
Authors: Kanemitsu Munekazu , Nakasa Tomoyuki , Sawa Mikiya , Yoshikawa Masahiro , Tsuyuguchi Yusuke , Ota Yuki , Adachi Nobuo
Published: September 2018

Category:

Ankle

Introduction/Purpose:

Mortise view weight-bearing radiograph is widely used for the diagnosis of osteoarthritis of ankle. Thickness of the articular cartilage cannot be accurately evaluated in the evaluation of joint space from weight-bearing radiograph, because lateral tibiotalar joint space is maintained in valgus type osteoarthritis in some cases. There are few reports on the relation between osteophyte and the articular cartilage injury. We considered that it might be possible to estimate the cartilage injury more accurately by examining osteophytes. The purpose of this study is to analyze the relationship between the location and grade of osteophytes in weight-bearing radiograph and cartilage injury in arthroscopic findings was analyzed.

Methods:

Twenty-one anklets of 21 patients consisted of 10 males and 10 females, with mean age of 61.4 years (31-79 years), who underwent arthroscopic surgery for osteoarthritis in our department were included. Weight-bearing radiograph were taken before surgery. Location and grade of osteophytes were evaluated using Ankle and Hindfoot Radiographic Osteoarthritis Scoring reported by Kraus et al. Arthroscopic findings were evaluated with International Cartilage Repair Society (ICRS) Grade at a total of 20 sites (9 areas of tibia and talar in tibiotalar joint, medial malleolus and lateral malleolus). The correlation between radiographic findings and arthroscopic findings were analyzed.

Results:

In Mortise view, strong correlations were found between lateral tibial osteophyte grade and ICRS grade of the center (talus R = 0.69, tibia R = 0.76), the central lateral (tibia R = 0.79), the posterior center (talus R = 0.72, tibia R = 0.74) and the posterior lateral of the tibiotalar joint (talus R = 0.63, tibia R = 0.76). There are moderate correlations between distal fibular osteophyte grade and ICRS grade of the medial inner (tibia R = 0.74) and the posterior medial of the tibiotalar joint (talus R = 0.61, tibia = 0.63). In lateral view, there are moderate correlations between posterior talar osteophyte grade and ICRS grade at the center of the tibiotalar joint (talus R = 0.61, tibia R = 0.60).

Conclusion:

From this study, there was a strong correlation between location and grade osteophyte and the articular cartilage injury. Osteoarthritis progression is caused by degeneration of the cartilage because of the joint instability, and osteophytes were formed by traction force or impaction. This study showed that local cartilage injury is thought to be related to osteophytes. By evaluating the location and size of osteophytes, the articular cartilage injury might be predicted accurately before arthroscopic surgery.
The Efficacy of Different Ropivacaine Concentrations (0.5%, 0.6% vs 0.75%) for Regional Nerve Block in Lower Extremity
Authors: Kang Chan , Lee Gi-Soo , Lee Jeong-kil , Kim Dong Yeol , Seo Gangwon , Choi Bo Sung , Hwang Sungjin , Ahn Ki jun , Song Jae-Hwang , Song Seokhwan
Published: September 2018

Category:

Basic Sciences/Biologics

Introduction/Purpose:

There have only been a few studies on optimal concentrations, doses, and volume of injection material in the regional nerve block for lower extremity operations. The purpose of this study was to evaluate the efficacy of different concentrations of ropivacaine with respect to anesthetic time, intraoperative, postoperative pain, and patient’s satisfaction.

Methods:

A total of 339 patients underwent lower extremity surgery under ultrasound-guided nerve block (combined femoral and sciatic nerve block) at a single institution between March 2016 and February 2017 and were randomly assigned to three groups: Group A (0.5% 42 ml), B (0.6%, 30 ml), and C (0.75%, 30 ml). The interval between nerve block procedure and onset of the complete anesthetic effect (complete anesthetic time) was investigated. The degrees of intraoperative pain (during the first 10 minutes of the surgical procedure), and postoperative pain (6, 12 hours after operation) were evaluated using a visual analog scale (VAS) score. Patient’s satisfaction (0~10) was investigated 12 hours after the operation. To evaluate the efficacy in accordance with the concentration under the same dose and same volume, group A and B were compared with group C respectively.

Results:

There were 108, 118, and 113, in groups A, B, and C, respectively. The complete anesthetic times were 78.5, 76.4, and 58.6 minutes, respectively. The intraoperative VAS scores were 2.04, 0.62, and 0.24; and the postoperative VAS scores (6hours / 12hours) were 2.41 / 4.08, 0.26 / 1.24, and 0.38 / 1/53. The patient’s satisfactory scores were 8.53, 9.38, and 9.4 respectively. Compared with group C, group A showed significantly longer complete anesthetic time (p<0.05) and higher intra, postoperative VAS scores (all p<.05). Group B showed longer complete anesthetic time (p<0.05), but no significant difference of intra, postoperative VAS scores (all p>.05). Patient’s satisfactory scores in both group A and B were similar to group C(p>.05, p>.05). There were no adverse reactions in all groups.

Conclusion:

Ropivacaine 0.6% as well as 0.75% are safe and effective anesthetics under the same volume (30 ml) for regional nerve block of the lower extremity. However, taking into account of the longer complete anesthetic time, the operation start time must be adjusted.
Comparison of the period of return to practice in All-Inside Arthroscopic and Open Techniques for the Modified Broström Procedure for Ankle Instability
Authors: Lee Young Koo , Lee Sun Geun
Published: September 2018

Category:

Arthroscopy

Introduction/Purpose:

Lateral ankle instability (LAI) is common injury in general population and open modified Broström operation (OMBO) is standard treatment of lateral ankle instability. Recently arthroscopic modified Broström operation (AMBO) is performed and many studies show that there are no difference in clinical & radiologic outcomes between open and arthroscopic operation. But not previously reported, comparison between OMBO and AMBO with the period of return to practice. The purpose of this study is to evaluate the time of return to practice in patients with clinical functional outcomes.

Methods:

From January 2012. to July 2014. 60 patients were included. They were divided into 2 groups: AMBO (30 patients) and OMBO (30 patients.). All patients followed a standardized treatment and rehabilitation program. We measured the period of return to practice by 7 Questions asked in each groups to compare period of return to practice. Survey is consisted of about time of walking, running, jumping, squatting, climbing stairs, rising up heels and toes without pain. And we also compared the time from the symptom of instability onset to date of operation. And for clinical outcome, evaluations were performed preoperatively, postoperatively, and 6months postoperatively using the AOFAS ankle-hindfoot score, pain VAS score and subjective satisfaction for rehabilitation, activity level of patients.

Results:

For comparison of the dates of operation, the average period of AMBO was faster (6.37±3.378 weeks) than OMBO (14.47±5.794 weeks). And for return to practice, AMBO showed faster return to practice (7.07±2.96 weeks) in walking without pain than OMBO (11.03±8.58 weeks). And other survey showed no difference in period of return to practice between OMBO and AMBO. There were no difference in postoperatively 6 month AOFAS and VAS score, but postoperatively VAS score showed significantly lower in AMBO than OMBO. AMBO was found to be faster return to practice in 2 out of 7 questions in high physical activity group, and also subjective satisfaction rate for rehabilitation of AMBO was higher than OMBO.

Conclusion:

For general population, except walking, there was no difference in the period of return to practice and clinical outcomes between the AMBO and OMBO for the treatment of lateral ankle instability. However, this study showed that AMBO was able to receive the surgery more quickly than OMBO. and AMBO can be a treatment option and should be considered carefully in atheletes who have lateral ankle instability that AMBO showed good results in higher activity level group for period of return to practice, subjective satisfaction, lower postoperatively pain.
Comparison of Mid-term Outcomes Between an Arthroscopic and an Open Modified Broström Procedure for Ankle Instability
Authors: Lee Young Koo , Park SungBum , Lee SangWoo
Published: September 2018

Category:

Arthroscopy

Introduction/Purpose:

Although the short-term results of an all-inside arthroscopic Modified Broström operation (MBO) have been as satisfactory as open MBO, there is always a concern about the long-term stability of an arthroscopic MBO. The purpose of this study was to compare clinical and radiologic outcomes of all-inside arthroscopic and open MBOs at mid-term follow up.

Methods:

From August 2012 to July 2014, totally 87 patients underwent an arthroscopic MBO and an open MBO. Of these, we retrospectively reviewed 48 patients who had a more than 3 years follow-up period. They were divided into two groups: all-inside arthroscopic MBO goup (26 patients), open MBO group (22 patients). The American Orthopaedic Foot & Ankle Society (AOFAS) ankle–hindfoot score, visual analog scale (VAS) score, and Karlsson score were used to evaluate clinical outcomes. Anterior talar translation and talar tilt were used to evaluate radiologic outcomes. Clinical and radiologic outcome evaluations were performed preoperatively, at 12 months postoperatively, and at a final follow-up at a minimum of 36 months postoperatively.

Results:

Evaluations were performed for 26 ankles in the all-inside arthroscopic MBO group and 22 in the open MBO group. There was no difference in age, gender, symptom duration, preoperative AOFAS, VAS, Karlsson scores, anterior talar translation, or talar tilt between the 2 groups (all P > .05). At the final follow-up, the AOFAS, VAS, and the Karlsson scores had improved significantly in both groups (P < .001). There was no difference in the Karlsson, AOFAS, or VAS scores, anterior talar translation, or talar tilt between the 2 groups at final follow-up (all P > .05).

Conclusion:

There was no difference in the clinical and radiologic outcome between the all-inside arthroscopic MBO and open MBO for the treatment of lateral ankle instability at up to 3 years after surgery. An all-inside arthroscopic MBO should be a good treatment option in patients who have lateral ankle instability.
Identification of the Medial Column Line collapse variation is Crucial in Flat Foot Management
Authors: Mason Lyndon , Alsousou Joseph , Ellison Phil , Molloy Andrew
Published: September 2018

Category:

Midfoot/Forefoot

Introduction/Purpose:

The incompetence of both dynamic and static structures in the foot is responsible for acquired pes planus deformity. The aim of this study was to identify the anatomical location of the midfoot break in symptomatic pes planus deformity, and its relationship with other pes planus radiographic foot measurements.

Methods:

We completed the radiographic evaluation of 75 feet diagnosed with symptomatic pes planus. The break in the medial column line (Meary’s line) was measured on the lateral radiograph at the intersection of the anatomical axis of the talus and the first metatarsal. Pes planus measurements were performed on each the weight-bearing AP and lateral radiographs, including talonavicular coverage angle, talar – first/ second metatarsal angle, talar uncoverage, talocalcaneal angle, Meary’s angle line break, calcaneal and talar inclination, talocalcaneal angle, cuneiform - metatarsal, tarsal joints angles and distances. Due to Gaussian distribution, unpaired t-test and ANOVA tests were used.

Results:

The medial column line collapse was at the talonavicular joint in 77.3%, naviculocuneiform in 20%, and cuneiform metatarsal in 2.6%. The line angle severity was proportional to the talonavicular coverage angle and talar uncoverage (p 0.001, R2 0.4915 and P 0.003, R2 0.223). On comparison of the 3 line-break groups, the talocalcaneal angle was significantly higher when the line break was at talonavicular joint (P 0.001) although Meary’s angle was not significantly more severe.

Conclusion:

The apex of the medial column collapse occurs not only at the talonavicular joint but also distal to the spring ligament and tibialis posterior insertion. Foot abduction increases with the increase in the line collapse regardless of the breaking point. Talus flexion is worse if the arch collapse is at the talonavicular joint, suggesting incompetency of the spring ligament. Assessing the apex of deformity is essential to decide the correct operative strategy.
Risk Factors for Non-union in First MTPJ Arthrodesis
Authors: Molloy Andrew , Butcher Clifford , Mason Lyndon
Published: September 2018

Category:

Midfoot/Forefoot

Introduction/Purpose:

Hallux rigidus occurs in up to 1 in 40 adults with 1st MTPJ arthrodesis being the gold standard operation for advanced disease. Our aim was to retrospectively identify risk factors for delayed / non-union of first metatarsophalangeal joint arthrodesis using a dorsal plate with cross screw.

Methods:

Case note and radiograph analysis was performed for operations between April 2014 and April 2016 with at least 6 months post-operative follow up. Union was defined as bridging bone across the fusion site on AP and lateral radiographic views with no movement or pain at the MTPJ on examination. All patients operations were performed or directly supervised by one of three fellowship trained consultant foot surgeons. Surgery was performed through a dorsal approach using a dorsal locking plate with compression screw. Blinded preoperative AP radiographs were analysed for the presence of a severe hallux valgus angle equal to or above 40 degrees. Intra-observer reliability was acceptable (95% CI: 1.6-2.3 degrees). Smoking and co-morbidities underwent univariate analysis for significance. Following initial result results, surgery in patients with arthritic hallux valgus were fixed using a separate plantar to dorsal / medial to lateral lag screw and dorsal locking plate

Results:

71 patients with a mean age of 61 years (range, 29 to 81) comprised the initial patient group. Mean follow up time was 13 months for both union and nonunion groups (range 6 to 30 months). 7 patients were identified as delayed or nonunion (9.9%). All had hallux valgus angles of >25%. Age, diabetes, COPD and rheumatoid arthritis did not show significant associations with non-union. All smokers progressed to union (n = 17). Moderate to severe hallux valgus (relative risk: 1.29, p < 0.005) and under correction of >25 valgus at the MTPJ (relative risk: 14.44, p < 0.001) were significantly associated with non/delayed union. In the second group, 18 patients of similar demographics, there were no failure of reductions and 100% union rate

Conclusion:

Preoperative moderate to severe hallux valgus and under-correction of deformity are the most significant risk factors for non-union. The construct used for fixation needs to be chosen on the basis of the deforming forces. If so, excellent union rates can be achieved
Outcomes of spring ligament reconstruction for idiopathic flexible flatfoot deformity
Authors: Molloy Andrew , Swanton Eric , Mason Lyndon
Published: September 2018

Category:

Hindfoot

Introduction/Purpose:

Idiopathic flatfeet are usually caused by attenuation of the medial soft tissues rather than a lateral osseous deficiency. Our prospective study aimed to quantify the functional and radiological outcome of a new technique for spring ligament reconstruction using a hamstring graft for idiopathic flat feet

Methods:

Our prospective study included 17 feet in 14 patients, from 05/14 to 05/17, on which a spring ligament reconstruction was performed. This pre-tensioned allograft reconstruction was performed using a blind talar tunnel, with the graft being passed deep to the navicular tuberosity, through a tunnel in the medial cuneiform and then sutured back onto its proximal limb to control abduction. Additional procedures included medial head of gastrocnemius recession (17), calcaneal osteotomy (16), FDL transfer (3), tibialis posterior synovectomy (2), peroneus longus to brevis transfer (2). There was a minimum of 6 months follow-up. Radiographic analysis was performed for standardised parameters. Paired t-test was used for analysis

Results:

The average age was 41 (range 23 -65). The mean BMI was 31.1 (range 24.6 – 37.3). Mearys line improved from a mean of 24.1 (9 – 36.4) to a mean of 13.8 (-3.1 – 26.7). This was statistically significant (p<0.001). Talar uncoverage angle improved from a mean of 39.5 (27.7 – 55.8) to 23.9 (3.5 – 39.7). First metatarsal talar angle improved from a mean of 18.9 (8.4 – 33.9) to 10.3 (-6.1 – 21.5). There were no wound infections. There was one revision (5.9%) to a triple arthrodesis; at revision it was found that the allograft had attenuated to incompetency. Of the patients that improved the least, 80% (4/5) were over the age of 49. Our numbers are insufficient to statistically analyse this

Conclusion:

This new method of spring ligament reconstruction provides a predictable solution for more anatomical reconstruction of idiopathic flatfoot deformity, with statistically significant improvements in all radiographic parameters. Further numbers will be needed but we would exercise caution in using this technique in older patients.
Should the Tibiotalar Angle Be Measured Using an AP or Mortise X-ray?
Authors: Najefi Ali-Asgar , Buraimoh Olatunbosun , Goldberg Andrew
Published: September 2018

Category:

Basic Sciences/Biologics

Introduction/Purpose:

The tibiotalar angle(TTA) is an important radiographic tool to determine alignment or malalignment of the ankle and hindfoot.Two methods of measuring the TTA have been described. The midline TTA(MTTA) is when the first line is along the anatomical axis of the tibia, and the second line is along the superior articular surface of the talus. Another method measures a line along the lateral border of the tibia, and a line along the superior articular surface of the talus (the lateral TTA, LTTA). The aims of the study were to compare the two angles as measured on mortise and AP radiographs in normal and pathological cases.We also compared the MTTA and LTTA, to see if they are comparable and if both methods are reliable and reproducible.

Methods:

A retrospective radiograph review was performed of sequential ankle radiographs taken between 2016 and 2017 across 4 specialist orthopaedic centres in the United Kingdom. Patients were categorised into two distinct groups. In the Normal Group (NG), patients had no evidence of injury and normal radiological appearances. In the Arthritis Group (AG), patients had radiographic changes as per the Kellgren-Lawrence scale 2 to 4. All radiographs were weightbearing and classified as either AP or mortise views based on the position of the talus and overlap of the tibia and fibula. The MTTA and the LTTA were measured on each radiograph.

Results:

There were 320 radiographs for review;158 normal radiographs and 162 radiographs had arthritis.There were 117 AP and 203 mortise radiographs. The overall mean MTTA was 88.7±5.1 degrees(range 77-104), and the mean LTTA was 87.5±5.2 degrees(range 73-104);p<0.01.There was no significant difference between the MTTA and LTTA in the normal group. There was a significant difference(p<0.01) when comparing the MTTA and LTTA in the arthritis group(Table 1). There was no significant difference when the MTTA was measured between the AP and Mortise radiographs. There was a significant difference in the LTTA between AP and mortise radiographs(p=0.04). There was no significant difference between the MTTA or LTTA when measuring the angles on AP radiographs(p=0.09).However, there was a significant difference when measuring these angles in the mortise radiographs(p=0.02).

Conclusion:

Understanding the tibiotalar angle is key to planning for deformity correction. It is important that consistency of methods for measurement are used for reporting. In this paper we have shown the MTTA to be a reliable and reproducible tool for measuring the TTA, in both normal ankle radiographs and in patients with ankle arthritis. There is no significant difference when the MTTA is measured using an AP or a mortise radiograph. In contrast, we have shown that the LTTA to be unreliable and statistically different when measured on both AP and mortise radiographs.
Midfoot Angle Changes During Running After an 8-week Foot Strengthening Program
Authors: Ridge Sarah , Henderson Adrienne , Bruening Dustin , Jurgensmeier Kevin , Olsen Mark , Griffin David , Johnson Aaron , Davis Irene
Published: September 2018

Category:

Other

Introduction/Purpose:

The arch has been referred to as the core of the foot. The arch’s structure, movement, and integrity during running gait largely depends on the function of intrinsic and extrinsic foot muscles. There are many injuries that can be associated with a dysfunctional medial longitudinal arch. Improving the strength of the foot muscles could help improve arch function during running. The purpose of this study was to compare changes in arch deformation after eight weeks in a foot strengthening exercise group (FS), a group walking in minimalist shoes (MSW), and a control group (C).

Methods:

24 healthy runners (average of 15-30 miles/week, no experience with minimalist footwear) were randomly assigned to FS (n=9), MSW (n=7) or C (n=8). FS subjects followed a series of progressive exercises designed to strengthen the intrinsic and extrinsic foot muscles. MSW subjects walked in minimal footwear, increasing from 2,500 to 7,000 steps/day over an 8 wk period. All runners maintained their pre-study mileage in conventional running shoes throughout the 8-week study Three-dimensional motion analysis data was collected at the beginning of the study and after week 8. Passive-reflective markers were placed according to the Oxford Foot Model. Subjects ran at a self-selected pace on a treadmill while data were collected for at least 10 strides. Peak midfoot angles were extracted and averaged within each trial. Group means at week 0 and week 8 were compared using paired t-tests with alpha set at 0.05.

Results:

While all groups experienced a decrease in midfoot angle, only the FS group experienced a significant change (see table). These results suggest that the foot exercise intervention resulted in more arch control during running than the progressive walking in minimal shoes. Greater changes may have been found if the subjects progressively ran in the minimal shoes which would have placed greater demands on the arch musculature.

Conclusion:

Based on these data, it seems possible for patients to reduce the amount of arch deformation during running by using targeted foot exercises. This could help with patients who have overuse injuries associated with increased arch deformation. These results also suggest that foot strengthening may be an effective way to prepare for minimal footwear running.