bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary Arthrodesis Compared with Open Reduction and Internal Fixation for Lisfranc Injuries with the First Tarsometatarsal Joint Dislocation
Authors: Zhang Ming-Zhu , Yu Guang-rong , Myerson Mark
Published: September 2018

Category:

Trauma

Introduction/Purpose:

The first tarsometatarsal (TMT) joint is very crucial for midfoot stability. To address its importance, retrospective analyses of treatment for the first TMT joint dislocation with Lisfranc injury was performed in a multi-center manner. Comparison of open reduction internal fixation (ORIF) and primary arthrodesis was conducted for the injury.

Methods:

This multi-center study was involved ten clinical institutions in different area of China. .From January 2003 to June 2015, 126 Lisfranc injuries with first TMT joint dislocation underwent surgical intervention. Of this group, forty one (32.5%) feet were first TMT joint dislocation only. Eighty five feet were first TMT joint dislocation and fractures. They were 76 males (60.3%) and 50 females (39.7%) with a mean age of 45.5 (range, 20-87) years. The duration from injury to surgery is 11.7 (range, 4-26) days. Two groups were divided by surgery methods as open reduction internal fixation (ORIF) group and primary arthrodesis group. Ninety two patients were performed by ORIF, while primary arthrodesis group including 34 cases. Outcome measures included clinical examination, radiographs, AOFAS ankle-hindfoot scores, visual analogue scale (VAS) and SF-36 scores. Complications and revision rate were analyzed as well.

Results:

126 patients were followed up for 29.5 months. At 1.5 years postoperatively, the AOFAS score was 79 and 85 in ORIF group and arthrodesis group.The VAS score was 3.1 separately in two groups.The mean Physical Functioning sores of SF-36 was 80.3 points and 83.5• points. The Bodily Pain score of SF-36 was 76.1 points and 84.6• points.Redislocation of first tarsometarsal joint were observed in 16 cases among ORIF group.36 patients in ORIF group had pain in midfoot, eight of them had persistent pain with the development of deformity or osteoarthrosis.No redislocation and no hardware failure was identified in arthrodesis group

Conclusion:

Primary stable arthrodesis of the first ray gives a better short and medium term outcome than open reduction and internal fixation for Lisfranc injury with the first ray dislocation. Possible complication and revision could be avoided by primary arthrodesis for dislocated first ray injuries.
Peroneal tendon dislocation in Talus fracture and diagnostic value of fleck sign
Authors: Attia Ahmed , Khamis Karim Mahmoud , Taha Tarek , Aldahamsheh Osama , Mekhaimar Mohamed Maged
Published: September 2018

Category:

Trauma

Introduction/Purpose:

INTRODUCTION: Talus fractures are not uncommon and one of the serious fractures in foot and ankle. Peroneal tendon dislocation is one of the commonly missed soft tissue injuries which may have significant impact on the outcomes including persistent pain and swelling. AIM: To report the incidence of peroneal tendon dislocation in talus fracture and the significance of fleck sign in the diagnosis of peroneal tendon dislocation.

Methods:

We retrospectively reviewed 100 consecutive talus fractures in the period between 1/1/2011 to 1/7/2017. Inclusion criteria were: The patient underwent open reduction and internal fixation, had pre-operative CT scan that is available for review and 3 views ankle plain radiographs. 2 independent authors review the radiographs for peroneal tendon dislocation, fleck sign and fracture classification if any. Any dispute was resolved by the senior author. Patient records were reviewed for laterality, age, sex, mode of injury, associated injuries and operative interventions. 43 ankles met inclusion criteria. 42 were males, mean age was 31 year and the predominant modes of injury were fall from height or unknown.

Results:

Peroneal tendon dislocation was found in 9 patients out of 43. (20%). All dislocations were found in talar neck fractures, and up to 67% of Hawkins type III and IV Talar neck fractures were associated with peroneal tendon dislocation. Risk of dislocation increased with severity of the fracture. 5 cases of peroneal tendon dislocation out of 9 were associated with lateral or bimalleolar fractures. Most of the dislocations were missed and no additional procedures were done to address such injury. Fleck sign sensitivity was 44.4% while specificity was 88%. The Negative Predictive Value (PPV) was 86%.

Conclusion:

Peroneal tendons dislocation is associated with 20% of talus fractures. The incidence of dislocation increases with neck fracture and severity of these fractures. Fleck sign is highly specific radiographic sign and hence we recommend intra-operative assessment of peroneal tendons in patients with fleck sign.
Prevalence of Hallux Rigidus in Patients with Ankle Arthritis
Authors: Bejarano-Pineda Lorena , Easley Mark , Adams Samuel , Nunley James
Published: September 2018

Category:

Midfoot/Forefoot

Introduction/Purpose:

Hallux rigidus (HR) is a degenerative disease of the first metatarsalphalangeal (MTP) joint, and the most common type of foot arthritis. It affects 2.5% of population aged over 50 years. During the gait cycle, the MTP joint normally carries a force of about 119% body weight. We hypothesize that the altered gait mechanics in patients with end stage ankle arthritis would increase the stress on the MTP joint resulting in hallux rigidus. The purpose of the study was to evaluate the prevalence of radiographic hallux rigidus in a population with ankle arthritis, its association with factors such as gender, age, and severity of the disease compared to the normal population.

Methods:

Patients from a prospectively-collected total ankle database were screened for the inclusion in the present study. All patients with ankle arthritis who underwent a primary total ankle arthroplasty (TAA) between November 2006 and November 2017 with anteroposterior and lateral views on foot x-rays within 3 months pre or postoperative were included. Foot x-rays were reviewed to assess the prevalence of radiographic hallux rigidus and to grade the severity of diagnosis according to Couglin and Shurnas Radiographic Classification. The association among the grades of severity, demographics, and bilateral involvement were evaluated.

Results:

A group of 870 patients out of 1044 patients who underwent TAA were included in the study. The mean age was 63 years (standard deviation 10.3). The prevalence of HR in the total group was 72.9% with a slightly higher proportion in males compared to females (51.7% versus 48.3%). The distribution among the grades of severity was grade 1, 58%; grade 2, 24%; and grade 3, 18%. Although, we did not find an association between prevalence and gender (P=0.2) or severity (P=0.37); HR grade 2 and grade 3 were higher in females. Bilateral involvement was found in 16.4% of patients with HR.

Conclusion:

The prevalence of radiographic hallux rigidus in a population with altered gait mechanics was significantly higher compared to that reported in the literature in the normal population. However, no association among demographic factors such as age or gender was found. Women tended to present a more severe diagnosis compared to men but the difference was no statistically significant.
Transverse versus longitudinal incision for minimally invasive Achilles tendon repair
Authors: Bohl Daniel , Barnard Eric , Movassaghi Kamran , Hamid Kamran , Schiff Adam
Published: September 2018

Category:

Sports

Introduction/Purpose:

The rate of wound complications following traditional open Achilles tendon repair is reported at 7-8%. In an effort to reduce the rate of wound complications, orthopaedic surgeons have adopted novel minimally invasive techniques. The purpose of this study is to characterize the rate of wound and other early complications following a minimally invasive Achilles tendon repair, to identify any factors associated with increased risk.

Methods:

The postoperative courses of 55 patients who underwent minimally invasive Achilles tendon repair by two surgeons at separate academic medical centers were retrospectively reviewed. Repair technique was similar in all cases, making use of the same commercially available suture-guidance jig, silicone-impregnated deep suture material, and locking stitch technique. However, 31 procedures used a longitudinal incision and a tourniquet (one surgeon’s preference), while 24 procedures used a transverse incision and no tourniquet (the second surgeon’s preference). Of the 24 procedures using transverse incisions, 2 had to be converted to L-shaped incisions to achieve better access to the tendon. The rates of early complications within 3 months after surgery were characterized and compared between patients with differing procedural characteristics.

Results:

Of the 55 patients included in the study, 2 (3.6%) developed wound complications. Both wound complications appeared to be reactions to the deep suture material (see Table 1 for details). There was no statistical difference in the rate of wound complications between patients in the longitudinal incision/tourniquet group and patients in the transverse incision/no tourniquet group (6.5% versus 0.0%; p=0.499). Three patients (5.5%) developed sural neuropraxia, which manifested as mild-to-moderate subjective numbness with sensation remaining intact to light touch. There were no cases of re-rupture. At 3-month follow-up, all 55 patients had intact Thompson tests and well-healed wounds.

Conclusion:

The rate of wound complications following minimally invasive Achilles repair is low at 3.6%. The present study could not demonstrate a difference in risk for wound complications between patients treated with a longitudinal incision and tourniquet and patients treated with a transverse incision and no tourniquet. The wound complications we observed were primarily attributable to inflammatory reactions to the silicone-impregnated deep suture material. Patients should be counseled that although risk for wound complications may be lower with minimally invasive techniques, such techniques do risk sural neuropraxia and deep suture reaction. Further prospective analysis is warranted.
Syndesmotic Anatomy as a Risk Factor for Syndesmotic Injury and Syndesmotic Malreduction
Authors: Boszczyk Andrzej , Rammelt Stefan
Published: September 2018

Category:

Trauma

Introduction/Purpose:

The anatomy of the syndesmosis is variable, yet little is known on the correlation between morphology and the risk of syndesmotic disruption and malreduction with operative fixation. The study aims at (1) comparing the bony anatomy of the syndesmosis in patients who sustained a high fibular fracture with syndesmosis disruption and that of the non-injured population and (2) at identification of certain anatomical features correlating with syndesmotic malreduction.

Methods:

For the first research question, the CT examinations of 75 patients who sustained a high fibular fracture with syndesmosis disruption and a control group of 75 patients with unrelated foot problems and without ankle pathology were compared. For the second research question, the bilateral postreduction ankle CTs of 72 patients were analyzed. Incisura depth, fibular engagement into the incisura and incisura rotation (Figure) of the injured patients were compared with those of uninjured controls and correlated with degree of syndesmotic malreduction in the coronal plane, sagittal plane, and rotational malreduction.

Results:

With the median values of the control group as cutoff there were 71% shallow, 71% disengaged and 77% retroverted syndesmoses in the injury group. The differences between the groups were statistically significant for every measure (P< .002 to P> .0001). Clinically relevant syndesmosis malreduction in coronal plane, sagittal plane and rotation affected 8.3; 27.8; and 19.4% of, patients, respectively. The syndesmoses with a deep incisura and the fibula not engaged into the tibial incisura were at risk of overcompression (P< .05). Syndesmosis with an anteverted incisura were at risk of anterior fibular translation and those with a retroverted incisura were at risk of posterior fibular translation (P< .05).

Conclusion:

Patients with a shallow, disengaged and retroverted bony configuration of the tibial incisura at the syndesmosis are overrepresented among patients with syndesmotic disruption. Intraoperative overcompression of the syndesmosis is significantly more common in patients with a deep and less engaged incisura. Anteversion of the incisura correlates with anterior displacement of the fibula while retroversion of the incisura is correlated with posterior fibular displacement. Knowledge of the individual incisura morphology could be helpful when planning and performing reduction of an unstable syndesmosis.
Treatment of osteochondral lesions in the ankle with a particulated juvenile cartilage allograft
Authors: Boukhemis Karim , Kreulen Christopher , Coetzee J. Chris , Neufeld Steven , Berlet Gregory , Dowd Thomas , Ryan Paul , Robbins Justin , Giza Eric
Published: September 2018

Category:

Ankle

Introduction/Purpose:

Numerous treatment modalities are in use today to treat symptomatic osteochondral lesions in the ankle; however, there are ongoing challenges with the treatment of certain types of lesions and concern regarding the long-term effectiveness of current common techniques.

Methods:

The purpose of this study was to collect mid and long-term clinical outcomes of pain, function, and activity level (VAS, SF-12, FAAM ADL, FAAM sports) Single-arm, multi-center study collected outcomes prospectively in standard clinic patients who would be undergoing or who had previously undergone treatment with DeNovo NT. The main exclusion criteria were high surgical risk, clinically diagnosed autoimmune diseases, or an active joint infection; all other patients receiving DeNovo NT could be approached for the study. The outcome analysis for this abstract focused on enrolled subjects’ final follow-up to date.

Results:

Clinical outcomes have been prospectively collected for 24 subjects with a total of 48 months follow-up. Twenty four of the treated lesions were located on the talus, none on the tibia. Out of the 24 patients, 23 had a single lesion and 1 had more than one. The average lesion size was 108.1 mm +/- 60.0 [23]. The Hepple classification was used to categorize each lesion. Interestingly, 19/24 were classified as 3 or higher. Cartilage ICRS was also used for classification. Out of the subjects, 23/24 were ICRS grade 3 or 4. There was also a concomitant procedure for 22/24 patients. Pre and post op VAS scores of 47.5 (+/- 23.1) and 12.2 +/- 17.8. SF-12 scores pre and post of 38.0 +/- 8.5 and 50.1 +/- 8.2. FAAM ADL’s pre and post 60.4 +/- 16.3 and 90.4 +/-11.8. FAAM sport scale scores pre and post 28.8 +/- 16.7 and 74.5 +/- 22.4. all outcome measures were statistically significant.

Conclusion:

Four year complete data is a challenge in this particular clinical population. This data set encompasses symptomatic osteochondral lesions of the talus treated with particulated juvenile cartilage allograft. The outcomes reflect an improvement in symptoms and patient satisfaction when treated with this technique. Based on these final outcome measures (V AS, SF-12, FAAM ADL’s, FAAM sport scale score) and satisfaction, it can be concluded that this is a viable option to get patients back to their pre-injury state.
3-D Morphometric Analysis of Talocalcaneal Joint in Stage II Posterior Tibial Tendon Dysfunction
Authors: Cain Jarrett D. , Lewis Gregory , Kunselman Allen
Published: September 2018

Category:

Hindfoot

Introduction/Purpose:

Posterior Tibial Tendon Dysfunction (PTTD) is common disorder that can lead to changes in function during the gait cycle due to decreased arch, increased hindfoot valgus, and forefoot abduction. These kinematic changes can have a structural impact on the joints throughout the foot. While previous studies have evaluated anatomical three-dimensional (3D) position of the subtalar joint, the purpose of this study was to perform morphological analysis of the anterior, middle and posterior facets in patients with stage II posterior tibial tendon dysfunction compared to normal controls.

Methods:

Clinical computed tomography images from 10 matched feet (i.e., 10 normal and 10 stage II PTTD) were obtained and used for 3D reconstruction in Mimics software (Materialise). From the3D reconstructions, morphometric evaluations of the subtalar joint were completed including 3D anatomic point placement and measurements of the length and width of the anterior, middle and posterior facets (Fig. 1) by 3 independent evaluators. Evaluators were blinded to experimental groups and to one another’s measurements. A linear mixed-effects model was used to assess the differences between control and PTTD subtalar joints with respect to morphometric measurements (mm). The concordance correlation coefficient (CCC) was used to assess the agreement between the 3 evaluators with respect to their recorded morphometric measurements per location (e.g., anterior, middle, posterior).

Results:

Although the mean distance of the length and width of the middle facet trended higher in the stage II PTTD compared to controls, this difference was not statistically significant (Table 1). Similarly, there was no difference detected between control and PTTD with respect to morphometric measurements in the anterior and posterior facets (Table 1). The agreement among the 3 evaluators with respect to morphometric measurements was the strongest in the length and width of the middle facets.

Conclusion:

Stage II posterior tibial tendon dysfunction has been shown to cause increase subtalar joint kinematics, joint contact pressure. Based on the results, there is a positive correlation involving morphologic changes of subtalar joint with the middle facet measurements being larger in the PTTD group. Further studies are needed with weight bearing CT scans in correlation with advance stages of posterior tibial tendon dysfunction.
Is Generalized Ligamentous Laxity a Prognostic Factor for Recurred Hallux Valgus Deformity?
Authors: Cho Byung-Ki , Choi Seung-myung
Published: September 2018

Category:

Bunion

Introduction/Purpose:

It is still unclear whether generalized ligamentous laxity is a risk factor for recurred hallux valgus deformity. This study was performed to evaluate the intermediate-term clinical outcomes after proximal chevron osteotomy for hallux valgus in patients with generalized ligamentous laxity, and to determine the effect on postoperative recurrence of deformity.

Methods:

A total of 198 feet from 169 female patients were treated with a proximal chevron osteotomy for hallux valgus with a mean follow-up of 46.3 months. When generalized ligamentous laxity was defined as Beighton score ≥ 5 points, there were 18 patients (10.7%) in laxity group and 151 patients (89.3%) in non-laxity group. Clinical evaluation consisted of the American Orthopaedic Foot and Ankle Society (AOFAS) scores, Foot and Ankle Ability Measure (FAAM), and radiographic measurement of hallux alignment. Risk factors associated with postoperative recurrence were evaluated using univariate analysis.

Results:

Recurrence rates were 21.7% in the laxity group and 17.1% in non-laxity group (p = 0.218), when defined as hallux valgus angle ≥ 20°. No significant differences of measurement at final follow-up were found between the 2 groups in terms of AOFAS score, FAAM, recurrence rate, hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA). Preoperative HVA and IMA were found to be predictive factors of recurrence (OR = 6.3, 4.2; P = .001, .018, respectively).

Conclusion:

There were no statistical differences in the clinical and radiographic outcomes between hallux valgus with and without generalized ligamentous laxity. Generalized ligamentous laxity demonstrated no definitive effects on postoperative recurrence of hallux valgus deformity.
Technique
Authors: Danna Natalie , Rizkalla James , Brodsky James
Published: September 2018

Category:

Midfoot/Forefoot

Introduction/Purpose:

Sesamoidectomy is most often indicated for sesamoid fractures. The procedure may also be a useful option for cases of recalcitrant sesamoiditis, osteochondritis dissecans, and osteoarthritis. In instances of concomitant arthritis of the first metatarsophalangeal joint and the sesamoids, sesamoidectomy may be performed in tandem with first metatarsophalangeal joint fusion. This carries the additional benefit of harvesting bone graft from the excised sesamoid to include in the fusion construct. Though sesamoidectomy is commonly performed through a medial or plantar approach, neither of these approaches are suited to fusion of the first metatarsophalangeal joint. Sesamoidectomy can be performed effectively through a dorsal approach and is the preferred technique when performed in conjunction with first metatarsophalangeal joint fusion.

Methods:

A dorsal midline incision is made over the first metatarsophalangeal joint. Care is taken to protect the extensor hallucis longus tendon while dissection proceeds to the joint capsule. The capsule is incised and released so that the first metatarsophalangeal joint can be sufficiently mobilized. Next, the opposing joint surfaces are prepared, increasing the mobility of the joint and exposure of surrounding structures.

Results:

(technique, continued) A sharp retractor is used to elevate the metatarsal head. Hyperflexion of the metatarsophalangeal joint may increase visualization of the sesamoids. A fresh knife is used to tease the sesamoid away from the flexor hallucis longus tendon, beginning at one edge of the sesamoid. The bone is carefully elevated off the tendon while dissection proceeds around the perimeter. Once the sesamoid has been freed and excised, the tendon is examined for injury. The excised sesamoid can then be cleared of soft tissue and cartilage and morselized for bone graft.

Conclusion:

The dorsal approach is effective for sesamoidectomy and efficient when performed as an adjunct to first metatarsophalangeal joint fusion.
The Relationship Between Vertical Loadrates and Tibial Acceleration Across Footstrike Patterns
Authors: Davis Irene , Hayano Todd , Tenforde Adam
Published: September 2018

Category:

Other

Introduction/Purpose:

While the etiology of injuries is multifactorial, impact loading, as measured by the loadrate of the vertical ground reaction force has been implicated. These loadrates are typically measured with a force plate. However, this limits the measure of impacts to laboratory environments. Tibial acceleration, another measure of running impacts, is considered a surrogate for loadrate. It can be measured using new wearable technology that can be used in a runner’s natural environment. However, the correlation between tibial acceleration measured from mobile devices and vertical ground reaction force loadrates, measured from forceplates, is unknown. The purpose of this study was to determine the correlation between vertical and resultant loadrates to vertical and resultant tibial acceleration across different footstrike patterns (FSP) in runners.

Methods:

The study involved a sample of convenience made up of 169 runners (74 F, 95 M; age: 38.66±13.08 yrs) presenting at a running injury clinic. This included 25 habitual forefoot strike (FFS), 17 midfoot strike (MFS) and 127 rearfoot strike (RFS) runners. Participants ran on an instrumented treadmill (average speed 2.52±0.25 m/s), with a tri-axial accelerometer attached at the left distal medial tibia. Only subjects running with pain <3/10 on a VAS scale during the treadmill run were included to reduce the confounding effect of pain. Vertical average, vertical instantaneous and resultant instantaneous loadrates (VALR, VILR and RILR) and peak vertical and resultant tibial accelerations (VTA, RTA) were averaged for 8 consecutive left steps. Correlation coefficients (r) were calculated between tibial accelerations and loadrates.

Results:

All tibial accelerations were significantly correlated across all loadrates, with the exception of RTA with VILR for FFS (Table 1) which was nearly significant (p=0.068). Correlations ranged from 0.37-0.82. VTA was strongly correlated with all loadrates (r = 0.66). RTA was also strongly correlated with both loadrates for RFS and MFS, but only moderately correlated with loadrates for FFS (r = 0.47). Correlations were similar across the different loadrates (VALR, VILR, RILR).

Conclusion:

The stronger correlation between vertical tibial acceleration and all loadrates (VALR, VILR, RILR) suggests that it may be the best surrogate for loadrates when studying impact loading in runners.
Percutaneous Tendon Achilles Lengthening
Authors: de Cesar Netto Cesar , Phillips Sierra , Dos Santos Alexandre Godoy , Pinto Martim , Staggers Jackson , Smith Walter , Araoye Ibukunoluwa , Hudson Parke , Sahranavard Bahman , Naranje Sameer , Shah Ashish
Published: September 2018

Category:

Hindfoot

Introduction/Purpose:

Percutaneous Achilles tendon lengthening (TAL) is a common procedure used to address equinus contracture of the foot. A triple hemisection technique has become popular due to its ease and efficiency. Several studies evaluate the surgical outcomes of this procedure, but currently, descriptive anatomical studies are lacking. The objective of the study was to evaluate the accuracy of performing Achilles tendon percutaneous hemisections, the amount of tendon excursion in the tensile gaps of the cuts after forced dorsiflexion and the improvement in the range of motion for dorsiflexion of the ankle joint.

Methods:

Ten fresh-frozen above-knee cadaveric specimens were used. A percutaneous triple hemisection of theAchilles tendon (proximal, intermediate, and distal) was performed. Maximum ankle dorsiflexion was evaluated pre- and postprocedure with a digital goniometer. After proper dissection, the relative width of the cuts was noted. Followingforced ankle dorsiflexion, displacement in the tensile gaps was measured in all 3 cuts with a precision digital caliper.

Results:

The overall relative width of the percutaneous cut was 51.3% ± 16.3% of the Achilles tendon diameter, 44.3%± 13.6% for the proximal cut, 50.3% ± 15.6% for the intermediate cut, and 59.3% ± 18.4% for the distal cut. Tendonexcursion averaged 13.0 ± 3.8 mm for the proximal cuts, 12.5 ± 4.7 mm for the intermediate cuts, and 8.2 ± 3.7 mm forthe distal cuts. One cadaver had a complete rupture of the Achilles tendon and was excluded from the excursion dataanalysis. The mean range of motion for ankle dorsiflexion was 8.1 ± 3.9 degrees preprocedure and 27.6 ± 5.3 degreespostprocedure. The dorsiflexion angle significantly increased (P < .0001) at an average of 19.5 ± 5.0 degrees following TAL.

Conclusion:

Our cadaveric study demonstrated that the percutaneous triple hemisection of the Achilles was an accuratetechnique that provided successful lengthening of the tendon and increased ankle dorsiflexion. Complete ruptures arepossible complications. Our cadaveric study showed that in a clinical situation, triple hemisections of the Achilles tendon can be performed reliably, with significant improvement of the ankle dorsiflexion, mainly through increased tendon excursion at the proximal and intermediate cuts, and with low risk of complete ruptures.
A Comparison of Kinesiology and Athletic Taping on Ankle Range of Motion
Authors: Folmar Eric , Thomas Adam
Published: September 2018

Category:

Other

Introduction/Purpose:

A high prevalence of ankle sprains exists in athletic and non-athletic populations. White athletic tape (WAT), commonly used for prevention and treatment, provides ankle stability while limiting mobility. Athletic taping has demonstrated the ability to limit ROM in all directions, particularly ankle inversion, as inversion injuries represent a vast majority of ankle sprains. Use of kinesiology taping (KT) for the purpose of limiting mobility in the ankle has not been examined. While limiting inversion range of motion may be beneficial in prophylactic management of ankle injuries, limiting ROM in other directions may impact kinematics of other joints in the kinetic chain. To determine the effectiveness of an innovative KT technique for limiting ankle inversion ROM while allowing movement in the other movements of the ankle.

Methods:

Fifty-three healthy 18-25 year old college students were recruited for this study. Subjects received each of the taping conditions (traditional basket weave WAT, a novel KT method, and no tape) in a randomized order. Manual goniometer measurements were taken in non-weight bearing in the inversion, eversion, dorsiflexion and plantarflexion directions. A handheld inclinometer was used to measure weight bearing ankle dorsiflexion. Measures for each were compared across each taping condition. A repeated measures ANOVA was performed.

Results:

Significant decreases in ankle ROM (p <.01) were observed in all measures between WAT and no tape. KT demonstrated significant decreases in all ROM compared to no tape (p <.01), except for a minimal decrease in weight bearing ankle dorsiflexion (p>.05). WAT demonstrated significantly greater ROM restriction in all directions than did KT (p<.01), including weight-bearing ankle DF.

Conclusion:

These results suggest that KT allows for more ankle ROM than traditional WAT in non-weight bearing and weight bearing measures, while still providing significant motion limitation in all motions except weight bearing dorsiflexion (in comparison to no tape). Limiting excessive inversion while simultaneously allowing closer to normal ROM in all other planes may decrease the risk of negatively impacting kinetic chain kinematics associated limited mobility of the ankle.
Performance Function Tests in Healthy Athletes
Authors: Greisberg Justin , Vosseller J. Turner , Gould Peter , Ahmad Christopher
Published: September 2018

Category:

Sports

Introduction/Purpose:

A challenge for physicians is determining when an injured athlete is ready to return to competition. While a wide variety of ankle strength and fitness tests have been described, there are no norms or minimum performance thresholds for any of them. In this study, healthy athletes were given a series of functional tests to complete. We propose that there will be a minimum performance level for each of the tests that all athletes can complete. We also propose, for tests which assess the right and left legs independently, that performance of the right leg will consistently be within 10% of the left. Finally, we propose that performance on one of the functional tests will be predictive of function on all of the tests.

Methods:

Healthy college athletes were put through a testing protocol, beginning with simple range of motion assessment and progressing through a series of functional ankle tests of increasing difficulty. The athlete began with the dorsiflexion lunge test, and then progressed to single leg heel raising, single leg hopping, side hopping, front-back hopping, functional hop test, and finally 180 degree rotational jump. Right and left legs were recorded separately for the first five tests. For each test, means, ranges, and standard deviations were calculated.

Results:

Eighty-one athletes (male and female from different sports) completed the protocol; no athlete was unable to finish the testing sequence. There was a wide variation in performance ability between athletes; the standard deviation for any of the individual tests was too high to determine a minimum threshold of normal performance. However, when comparing right to left leg in any one athlete, the difference in performance testing was always less than 10%. Furthermore, performance on any of the hopping tests was predictive of performance on all of them.

Conclusion:

Ideally, an athlete could be deemed ready to return to sports activity if he or she performed above a certain threshold on a performance test. Unfortunately, athletes had such a wide range of performance that it is not possible to define a minimum threshold for any of these tests. However, right and left leg performance was always within 10% of each other. For an athlete with a single leg injury, we propose that performance on a functional hopping test less than 10% different from the uninjured leg should be the standard.
A 27-year Meta-analysis of Ankle Arthroplasty
Authors: Gross Christopher , Haddad Steven , Morris Jesse , Durante Elizabeth , Kirn Philip
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

Total ankle arthroplasty is an alternative to ankle arthrodesis for the treatment of end-stage arthritis while maintaining greater ankle motion and functionality. Early generation implants had unacceptably high complication rates. However, increasing surgical experience and newer third-generation designs have the potential to offer better outcomes. A previous systematic review reported results from studies published between 1990 and 2005, focusing on second-generation implants. We performed a systematic review of the literature addressing the intermediate-long-term outcomes of interest in total ankle arthroplasty studies published since 2006, and we compared our findings to those from earlier generation implants.

Methods:

A comprehensive search of MEDLINE for all articles published from 3/25/2006 to 2/1/2017 was conducted with a minimum two-year follow-up. Two reviewers evaluated each study to determine whether it was eligible for inclusion and abstracted the data of interest. Meta-analytic pooling of group results across studies was performed. The analysis focused on third-generation ankle implants.

Results:

The previous systematic review identified 10 studies (n=852), whereas we identified 40 studies (n=4835). The prior study showed a five and ten-year survival rate of 78% and 77%, respectively; respective rates were 86% (p=0.001) and 76% (p=0.53) in ours and similar to the previous study. The revision rate following TAR was 7% in the earlier review (loosening/subsidence, 28%). In ours, the revision rate following TAR was 9.6% (p=0.10) (component loosening, 37%); 3.4% (p=0.02) of ankles were converted to arthrodesis. The mean post-operative Ankle-Hindfoot score was 78.2 points in the prior review and 80.1 (p=0.20) points for ours. There is significant (p<0.0001) heterogeneity (I2=92.94%) between the studies; a meta-analysis of proportions showed that 81.6%of subjects had good outcomes while 46.6% had an excellent outcome.

Conclusion:

Based on these findings, the outcomes for third-generation total ankle arthroplasty have no significant differences in survival rates when compared to second-generation implants. However, functional scores, range of motion, and overall patient outcomes were significantly higher in the third-generation implants. However, data from early generation studies were sparse in comparison, so direct comparative studies are needed to strengthen this conclusion.
Deformity and Clinical Outcomes for Surgical Correction of Charcot Ankle
Authors: Harkin Elizabeth , Schneider Andrew , Murphy Michael , Schiff Adam , Pinzur Michael
Published: September 2018

Category:

Diabetes

Introduction/Purpose:

Charcot Foot is a complex neuro-arthropathy associated with acquired progressive deformity and a significant impact to patients’ quality of life. Recent reports have suggested that preoperative deformity is predictive of clinical outcomes following surgical correction of the acquired deformity associated with midtarsal diabetes-related Charcot Foot arthropathy.

Methods:

A retrospective analysis was performed of 56 patients who underwent surgical reconstruction of Charcot ankle arthropathy by a single surgeon over a 14-year time period. Preoperative tibiotalar alignment was reviewed in the coronal and sagittal plane. Preoperative patient characteristics including age, sex, hemoglobin A1c, BMI, insulin use, and presence of a wound or infection at the time of surgery were also recorded. Preoperative coronal plane deformity was observed as valgus 16/56 (28.6%), varus 31/56 (55.4%), and neutral 9/56 (16.1%). Surgery included debridement of active infection when present, corrective osteotomies, and an attempt at ankle arthrodesis with application of a ringed external fixator (39 of 56, 69.6%) when infection was present or retrograde intramedullary nail (17 of 56, 30.3%). Clinical outcomes of excellent, good, or poor were based on limb salvage, resolution of infection and chronic wounds, and the ability to ambulate with either a CROW, AFO, or therapeutic diabetic footwear.

Results:

The average total patient follow-up time from index surgery was 115.4 weeks. One patient died after 134.3 weeks of follow-up and 8 underwent amputation. The post-operative complication rate was 69.6% (39 of 56), 79.5% (31 of 39) of which underwent re-operation. Ultimately, only 25 of 55 patients (45.5%) achieved a favorable (excellent or good) clinical outcome. There was no meaningful association between surgical outcome, post-operative complication, reoperation, and amputation and patients’ pre-operative alignment, final alignment, treatment with either ex-fix or IMN, the presence of a wound or infection, age, HgA1c, or BMI. However, compared to insulin dependent diabetics, those not taking insulin were only 0.34 times as likely to have a poor outcome.

Conclusion:

Operative fixation of Charcot ankle arthropathy was performed with a goal of achieving a plantigrade post for ambulation void of infection or chronic wounds and easily accommodated with a supportive orthosis. This retrospective case series demonstrates a high complication rate in this complex patient population. Clinical outcomes of Charcot ankle can be used to counsel patients on the risks of surgical correction and as a benchmark for improved treatment strategies.
Sports and physical activity after osteochondral talar reconstruction with arthroscopic autologous matrix-induced chondrogenesis
Authors: Indino Cristian , D’Ambrosi Riccardo , Maccario Camilla , Usuelli Federico Giuseppe
Published: September 2018

Category:

Sports

Introduction/Purpose:

Osteochondral talar lesions (OLTs) are common entities in active patients who practice sports. Degenerative changes and development of osteoarthritis can occur in up to 50% of non-treated patients, due to poor chondral tissue healing abilities. In recent years, autologous matrix-induced chondrogenesis (AMIC) repair has been introduced for OLTs with satisfactory results through medium-term follow-up. The aim of the study was to evaluate the return to sport and physical activities in patients underwent arthroscopic autologous matrix-induced chondrogenesis (AT-AMIC) 2 years after surgery.

Methods:

This is an observational cross-sectional study. Informed consent was obtained from all participants, and procedures were conducted according to the Declaration of Helsinki. Twenty-seven consecutive patients, 62.9% (17) male (mean ± SD age: 33.7±11.2 years), that underwent AT-AMIC were included in the study. All patients were assessed with the American Orthopaedic Foot & Ankle Score (AOFAS), physical component score of the 12-Item Short Form Health Survey (PCS-SF-12), HALASI ankle activity score and University of California, Los Angeles (UCLA) activity scale preoperatively and at 24 months after surgery.

Results:

Overall, 81.48% of the patient group returned to the same preinjury sport. Mean follow-up was 42.7 ±11.1 months. A significant interaction with time (from pre-operative to the final follow-up) for the clinical parameters UCLA, Halasi, AOFAS and SF-12 was found, P<0.001). In addition, there were significant differences between preoperative versus last follow-up (all, P <0.001),

Conclusion:

A high percentage of patients return to their sport activity after osteochondral talar reconstruction with AT-AMIC technique; furthermore AT-AMIC improve quality of life in young and active patients, allowing return to sport.
New “Freer test” for assessment of syndesmotic diastasis -Cadaveric study
Authors: Kim Jinsu , Park Young-uk , Lee Kyung-tai , Young Kiwon , Lee Sang
Published: September 2018

Category:

Sports

Introduction/Purpose:

Syndesmotic stability is usually assessed arthroscopically by an arthroscopic probe insertion between the anterolateral tibio-fibular recess. This probe test can predict the syndesmotic instability, however, is difficult to determine syndesmotic fixation. The syndesmosis has dynamic motion and fairly firm structure, 2 mm thin probe cannot make syndesmotic dynamic diastasis. We proposed a new “Freer test” for diagnosis of syndesmosis injury which performed to insert a 2 mm diameter freer elevator between tibio-fibular lateral gutter while keeping the ankle at the plantigrade. The purpose of the present study was to evaluate the diagnostic value of freer test for anterior inferior tibiofibular ligament (AITFL) complete tear, interosseous ligament (IOL) tear and Weber type B fibular fracture.

Methods:

Ten fresh ankle cadaveric specimens were used. Operative procedures progressed as below; firstly, exposed antero-lateral ankle joint with direct lateral longitudinal incision, incised AITFL, incised IOL, performed Weber type B osteotomy at fibular, fixed the osteomized fibular with 8-hole locking plate and fixed the AITFL with suture anchors. In each procedure, freer tests with ankle dorsiflexion (DF, plantigrade) and plantarflexion (PF) were performed with freer elevator linked 3 kgf compression gauge. A negative test was defined as the freer did not insert with a more than 3 kgf. A positive test was defined lesser than 3 kgf, and measured the force at the insertion.

Results:

All freer test was negative with DF before procedures. Six ankles with PF were positive with average 1.5 kgf. All freer test positive has shown after AITFL cutting in DF, PF(mean 1.76 kgf, 1.19 kgf). After IOL cutting, all freer tests were positive in DF, PF(mean 1.46, 0.79 kgf). After fibular osteotomy, all freer tests were positive in DF, PF (mean 0.83,0.18 kgf). After fibular fixation with plate, all freer tests were positive in DF, PF (mean 1.26, 0.97 kgf). After syndesmotic fixation with anchors, 8 freer tests were positive in DF. 2 negative in PF, 4 negative in PF and 6 positive in PF. 2 positive in DF had partial breakage on anchor footprint due to weak bone.

Conclusion:

The “freer test” is useful diagnostic tool which test positive means AITFL rupture.
Comparison of Time-dependent Changes in Syndesmotic Reduction Between Suture-button and Screw Fixation for Ankle Malleolar Fractures with Tibiofibular Diastasis
Authors: Kimura Seiji , Yamaguchi Satoshi
Published: September 2018

Category:

Trauma

Introduction/Purpose:

Reduction of the tibiofibular syndesmosis is one of the most important factors that affect the clinical outcome after ankle malleolar fractures with syndesmotic diastasis. Recent studies have shown that suture-button fixation can yield better syndesmotic reduction than screw fixation immediately after surgery. However, the time-dependent change in the reduction for each fixation method has not been well studied. The purpose of this study was to compare the postoperative changes in the syndesmotic reduction after surgical treatment of ankle malleolar fractures between suture-button fixation and screw fixation using bilateral computed tomography.

Methods:

Patients who sustained ankle malleolar fractures with tibiofibular diastasis and underwent tibiofibular fixation were included. Suture-button fixation (Group B; n=14; age, 39 years) was used between 2015 and 2016, and syndesmotic screw fixation (Group S; n=20; age, 35 years) was used between 2012 and 2014. The syndesmotic screws were routinely removed. Patients underwent CT scanning of the bilateral ankles at 2 time points: at 2 weeks and 1 year after fracture fixation. Side-to-side differences in the anterior and posterior tibiofibular distances, and anteroposterior fibular translation were measured. Syndesmotic melreduction was defined as a side-to-side difference?2 mm in either of the measurements. The changes in each measurement and incidence of malreduction for each group were assessed using the Wilcoxon signed-ranks test and McNemar’s test. Differences between the two groups at each time point were also compared.

Results:

At 2 weeks after fracture fixation, the side-to-side difference in anterior tibiofibular distance was significantly wider in Group B (1.9 mm) than in Group S (0.7 mm) (p=0.03). Additionally, the fibulas were more translated posteriorly in Group B (1.5 mm) than in Group S (0.2 mm). At 1 year, the anterior tibiofibular distance decreased to 0.8 mm in Group B (p=0.09). On the contrary, it significantly increased to 1.9 mm in Group S (p=0.002). In Group B, the incidences of malreduction were 4/14 and 2/14 at 2 weeks and 1 year, respectively (p=0.74). Two ankles, which were malreduced at 2 weeks, changed to a reduced syndesmosis at 1 year. In Group S, the incidences were 8/20 and 9/20 at 2 weeks and 1 year, respectively (p=0.35).

Conclusion:

Syndesmotic alignment changed over time in both fixation methods, however, the patterns of change were different. Using suture-button fixation, the anterior tibiofibular distance decreased over time. As a result, the widened syndesmoses at 2 weeks changed to reduced syndesmoses at 1 year. On the contrary, using tibiofibular screw fixation, the anterior tibiofibular distance widened after screw removal. Our result suggests that the flexible suture-button fixation allows the fibula to move to the optimal location over time.
Assessment of Variables that Influence Agreement Amongst Reviewers for Foot & Ankle International
Authors: Kwon John , Gonzalez Tyler , Miller Chris , Cook Shera Palmer , Thordarson David
Published: September 2018

Category:

Other

Introduction/Purpose:

The peer-review process is a rigorous process under which manuscripts are assessed for their overall scientific quality and is generally accepted as the highest standard of scientific scrutiny with regard to medical publishing. A common criticism regards the often disparate nature of reviewer recommendations when a decision is rendered which belies the supposed uniformity of the review process. The purpose of this investigation was to: (1) examine the historic level of agreement amongst reviewers for Foot & Ankle International (FAI) and (2) to assess variables which may influence agreement in order to improve the peer-review process.

Methods:

Approval to conduct this study was obtained from the Editorial Board of FAI. All manuscripts submitted to FAI during 2015 which underwent peer-review were included in the analysis. For each reviewed manuscript, demographic data was collected regarding specific reviewer and manuscript characteristics in a de-identified manner. Univariate analysis was performed.

Results:

442 manuscripts underwent peer-review by 198 reviewers during the study period. During this time period, other papers were reviewed by the Editor-in-Chief and rejected prior to being sent out for review. Of the 884 reviews performed, 339 (38%) recommended rejection, 353 (40%) recommended revision and resubmission and191(22%) recommended accept. Only 199 manuscripts (45%) had a decision rendered in which both reviewers agreed on the initial recommendation.The most common initial decision was rejection (52.7%) followed by revise and resubmit (42.8%). Only 20 manuscripts (4.5%) received an outright acceptance upon initial review. Comparing the agreeing versus disagreeing reviewers, there was no difference in demographic data such as reviewer age or experience. When examining key words (designated by reviewers as a particular area of interest within foot and ankle), there was no association between shared interests and level of reviewer agreement. Overall, for all reviewers, mean acceptance rate was19% (+/- 16%), mean reject rate 37% (+/- 20%) and mean revise 44% (+/- 19%).

Conclusion:

Regarding initial decision for publication in FAI, there was only 45% agreement amongst reviewers for manuscripts which underwent peer-review in 2015. However, no reviewer-specific variables examined in this investigation were found to correlate with agreement. Despite reviewers having similar interests in various aspects of foot and ankle surgery, this did not lead to an increased likelihood of agreement. Agreement and more uniform assessment of manuscripts by reviewers may be increased by specific education.