bluuebunny/crossref_metadata_2025 huggingface dataset:
Classification of the Os Calcis Subtalar Morphology in Symptomatic Flexible Pediatric Pes Planus Deformity Using Weight-Bearing CT and Distance Mapping
Authors: Efrima Ben , Barbero Agustin , Indino Cristian , Maccario Camilla , Ovadia Joshua , Usuelli Federico Giuseppe
Published: December 2023

Category:

Basic Sciences/Biologics; Hindfoot

Introduction/Purpose:

The etiology of symptomatic pediatric pes planus (PP) deformity, is unclear. Reduced os calcis subtalar joint (OCST) anterior facet morphology has been suggested to result in less support to the talar head and a higher propensity to develop PP deformity. Weight Bearing Computed Tomography (WBCT) and Distance Mapping (DM) offer new opportunities to investigate PP deformity and the OCST specifically. The purpose of this study is to examine the OCST morphology using DM and to classify PP subtalar subtypes with DM using Bruckner's A-D classification system.

Methods:

Forty feet in 25 patients in a national referral center were evaluated for symptomatic PP deformity that failed nonoperative treatment. A WBCT scan was performed as part of the preoperative evaluation. Visualization of the distance distribution between the articulating surfaces of the subtalar joint was based on a DM technique. Intra- and interobserver agreement of the subtalar morphology was assessed using Bruckner's classification system.

Results:

The mean age was 10.7 ± 1.4 years. The following mean ± s.d and median +-ranges. Measures were semiautomatically measured for this group: Meary’s angle -21 ± 8, calcaneal inclination 15 ± 4 degrees, talar coverage angle 39 (range 32.6- 49) degrees, and hind-foot moment-arm 16 ± 5 millimeters. Classifying subtalar morphology using DM yielded an excellent intra- and interobserver agreement.The individual percentages of each individual subtype were calculated; type A 5%, type B 38%, type C 4%, type D in 44%.

Conclusion:

This study demonstrated excellent intraobserver and interobserver agreement in classifying the OCST using DM. A higher prevalence of types B and D were observed compared to types A and C in this PP cohort.
Clinical Outcomes of Insertional Achilles Tendinopathy Patients Treated with Reattachment and Dorsal Closing Wedge Calcaneal Osteotomy: A Meta-analysis
Authors: Karaismailoglu Bedri , Subasi Omer , Sharma Siddhartha , Peiffer Matthias , Guss Daniel , Kwon John , DiGiovanni Christopher W. , Ashkani-Esfahani Soheil
Published: December 2023

Category:

Hindfoot; Sports

Introduction/Purpose:

Posterior heel pain at the Achilles tendon insertion is a prevalent and debilitating condition that is not yet fully understood. It results from a combination of bony and soft tissue abnormalities, including insertional Achilles tendinopathy, retrocalcaneal bursitis, and posterosuperior bony prominence. While the most commonly used surgical technique for treatment is debridement and reattachment of the tendon, dorsal closing wedge calcaneal osteotomy (DCWCO) has recently gained popularity. In this meta-analysis, we aimed to analyze the published literature related to both surgical techniques and compare their outcomes. Our hypothesis was that DCWCO can provide similar clinical outcomes with a lower complication rate.

Methods:

We conducted a literature search in Medline, Embase, and Scopus databases. Clinical studies reporting at least one of the clinical outcomes among AOFAS score and complications, with an open technique and sufficient data to extract and pool, were included. The extraction was made by two users using the Covidence platform. Studies with less than 10 patients or less than 12 months follow-up were excluded. Initial search yielded 329 papers, and after excluding duplicates and irrelevant studies, 43 papers were left. After a full-text review of these 43 papers, we found 15 papers eligible for meta-analysis. We used the Modified Coleman Methodology to assess the quality of papers.

Results:

Out of the 15 articles, seven included reattachment patients, while eight included DCWCO patients. 171 feet underwent reattachment, while 239 feet underwent DCWCO. The average follow-up of patients was significantly higher in the DCWCO group (42.2 months) than reattachment group (23.2 months). The average AOFAS score improvement was similar between the groups. The total complication numbers were 30 (16.6%) in the reattachment group and 28 (9.2%) in the DCWCO group, but the difference did not reach significance since the confidence intervals were overlapping. However, wound complications were significantly more common in Reattachment group (10.1%) compared to DCWCO (2.5%). The number of revision surgeries and neurological complications (sural neuritis, hypersensitivity, etc.) were similar between the groups. The average AOFAS score improvement was similar between the groups.

Conclusion:

Both techniques yielded comparable clinical outcomes. The overall complication rate was similar, but DCWCO exhibited a lower wound complication rate than reattachment. Therefore, the study results imply that DCWCO can provide similar clinical outcomes with fewer wound complications. However, further well-designed studies are necessary to reach a definitive conclusion on this matter and compare both techniques in the same study setting.
Comparison of Clinico-Radiographic Outcome of the 3-Component Salto Total Ankle Arthroplasty According to Degree of Ankle Varus Deformity for End-Stage Ankle Arthritis
Authors: Lim Jung-Won , Jung Hong-Geun , Im Je-Min
Published: December 2023

Category:

Ankle Arthritis

Introduction/ Purpose:

As the popularity of total ankle arthroplasty (TAA) increases, indication of TAA also expands. Recently, the ankles more than 20º of varus or valgus deformity in the coronal plane are treated with TAA. Commonly, patients with ankle osteoarthritis have preoperative varus deformity. However, preoperative varus deformity should be corrected in the coronal plane to avoid residual mal-alignment that leads to instability, insert wear, and clinical failure. In this study, we compare the clinical and radiologic outcome of the Salto mobile bearing 3-component total ankle prosthesis for ankles according to preoperative degree of ankle varus deformity.

Methods:

TAA was performed in 106 ankles using 3-component Salto total ankle implant from June 2014 to October 2019. A prospectively collected database was used to identify all patients who underwent primary TAA with a minimum 1-year follow-up. All patients were followed up at postoperative three months, six months, at one year and yearly thereafter. Clinical outcome scoring was done pre-operatively and post-operatively. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional score, pain VAS, satisfaction score and clinical range of motion (ROM) were collected along with weight-bearing radiographs of the ankle. Post-operative coronal alignment of the component were evaluated with radiographs. More than 10º of tibial anterior surface angle, talta tilt angle (TTA), tibial axis-talar dome angle (T-TDA), talar dome-ground surface angle (TD- GSA), or tibio-calcaneal angle (TCA) was defined as varus deformity. We classified the enrolled ankles as neutral ( < 10 º), moderate varus (10º~20º), and severe varus groups (>20º).

Results:

The average follow-up was 21.9 months (range, 12-72). Preoperatively, there were 37 ankles (35%) with neutral alignment, 48 ankles (45%) with moderate varus deformity, and 21 ankles (20%) with severe varus deformity. There were no significant differences in mean pain VAS, AOFAS score, and ROM among the groups (p > 0.05). Overall satisfaction rate (more than satisfied) was 87%, and no significant differences were found among the groups. As to radiographic alignment, there were no significant differences among the groups in T-TDA and TD-GSA (p > 0.05). Concomitant additional procedures such as deltoid release, calcaneal osteotomy, and first tarsometatarsal dorsiflexion arthrodesis were more significantly performed in preoperative varus groups.

Conclusion:

There was no significant difference in clinical and radiographic outcomes a according to degree of ankle varus deformity in the TAA series using single Salto 3-componenet implant. Postoperative neutral alignment was achieved in all ankles. For favorable long-term outcomes, coronal alignment should be corrected with proper additional procedures in TAA.
Comparison of Outcomes Between Fixed and Mobile-Bearing Total Ankle Arthroplasty: A Systematic Review and Meta-Analysis
Authors: Butler James J. , Chin Lana-Kailey , Konar Kishore , Randall Grace W. , Azam Mohammad T. , Walls Raymond J. , Kennedy John G.
Published: December 2023

Category:

Ankle Arthritis; Other

Introduction/Purpose:

End stage ankle osteoarthritis is a significantly debilitating pathology that is most commonly preceded by trauma. The emergence of 3rd and 4th generation total ankle arthroplasty (TAA) implant designs have led to more favorable outcomes compared to its predecessors. TAA implants can be broadly divided into fixed bearing and mobile bearing implant designs, however, no consensus has been reached regarding the optimal TAA implant design for the management of end stage ankle arthritis. The purpose of this systematic review and meta-analysis was to compare outcomes between patients who received fixed bearing TAA implants and mobile bearing TAA implants.

Methods:

During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies comparing outcomes between patients who underwent fixed bearing TAA implant and patients who underwent mobile bearing TAA implant for the management of end stage ankle arthritis. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, failure rates and complications were extracted and analysed.

Results:

Overall, 13 studies were included in this review. In total, 2793 patients underwent mobile bearing TAA implant and 2241 patients underwent fixed bearing TAA implant for the management of end stage ankle arthritis. No difference existed between the 2 cohorts with regards to post-operative subjective clinical outcome scores nor radiological outcomes. The mobile bearing TAA implant cohort was associated with higher complications (RR = 1.4710; [1.0375-2.0857]; p = 0.0373) and failures (RR = 1.3916; [1.2038 - 1.6086]; p = 0.0032) compared to the fixed bearing TAA implant cohort.

Conclusion:

This systematic review and meta-analysis found no difference in subjective clinical outcomes and radiological outcomes between patients who underwent mobile bearing TAA implant and fixed bearing TAA implant for the management of ankle arthritis. Interestingly, the mobile bearing TAA implant cohort was associated with higher complications and failures compared to the fixed bearing TAA implant cohort. Due to the marked under-reporting of data and significant heterogeneity between the included studies, further high quality research is warranted to determine the optimal TAA implant type for the management of end stage ankle arthritis.
Complications and Radiographic Outcomes of Operatively Treated Navicular Fractures
Authors: Johnston Thomas R. , Donley Connor , McCormick William , Schick Samuel , Johnson Michael
Published: December 2023

Category:

Midfoot/Forefoot; Trauma

Introduction/Purpose:

Navicular fractures are uncommon foot fractures and there is scarce literature exploring the complications and radiologic outcomes of these fractures. The aim of this study is to examine fracture patterns and surgical data to see the effect they have on complications and radiographic outcomes after open reduction internal fixation of the navicular.

Methods:

A retrospective study was performed to identify patients who underwent operative treatment of a navicular fracture over a nine-year period (2013-2022). Patients were screened by review of CPT codes that included tarsal fractures and imaging review was used to identify those with navicular fractures. Minimum follow-up for inclusion was 6 months. Patient demographics were recorded and radiographs were reviewed and fractures were classified per the Sangeorzan and Schmid classification systems. Surgical data including approach(es), implants, and supplemental fixation was recorded. Postoperative radiographs were assessed for the presence of union, avascular necrosis, foot collapse, and arthritis. Complications defined as infection, unanticipated reoperation, and amputation were recorded.

Results:

38 patients met inclusion criteria. 8 patients had a postoperative complication (21.1%). There was 1 superficial infection (2.6%) and 7 patients needed unanticipated reoperations: 2 (5.3%) for wound dehiscence, two (5.3%) for secondary arthritis, and 3 for symptomatic hardware removal (7.9%). Radiologic outcomes consisted of 7 cases of TNJ arthritis (18.4%), 6 cases of avascular necrosis (15.8%), and 7 cases of foot collapse (18.4%). There were significantly increased rates of TNJ arthritis in Schmid type III navicular fractures compared to type I and II (7 vs 0 vs 0, respectively; p=0.021), with 35% of Schmid type IIIs going on to develop TNJ arthritis. The need for reoperation of the navicular was increased if patients required a TNJ spanning construct [2 (50%) vs 2 (5.9%), p=0.007].

Conclusion:

Navicular fractures that require ORIF have a high complication rate and a likelihood of developing suboptimal radiographic outcomes. We found that patients who dislocate their TNJ (Schmid Type-III), had an increased rate of TNJ arthritis which likely stems from the more severe nature of the injury, the keystone role of the navicular and the instability present across Chopart’s joint. For patients requiring a TNJ spanning construct there was an increased risk for unanticipated reoperation likely due to the size and nature of the spanning construct hardware. Patient education on these risk factors will guide treatment options and set proper expectations.
Conservative Treatment Outcomes for Achilles Tendon Re-Rupture Occurring in the Subacute Phase after Primary Repair
Authors: Choi Jun Young , Suh JinSoo , Kim Min Jin
Published: December 2023

Category:

Ankle; Sports

Introduction/Purpose:

Achilles tendon re-rupture (ATRR) during the subacute postoperative phase is the rupture of the repaired site combined with suture material failure induced by an unexpected traumatic event during postoperative months one to three after primary Achilles tendon repair. This study aimed to determine the effectiveness of conservative treatment for subacute ATRR.

Methods:

We retrospectively reviewed 390 cases (385 patients) who underwent primary Achilles tendon repair between January 2010 and August 2021. All patients had more than 12 months of follow-up and were divided into two groups based on the development of subacute ATRR (Group 1: 370 cases without ATRR; Group 2: 20 cases with ATRR). Then, we compared several outcome parameters between the groups after administering conservative treatment to those with ATRR. The baseline timepoints in Groups 1 and 2 were the primary repair and re-injury dates.

Results:

After primary Achilles tendon repair, 5.13% of patients experienced subacute ATRR. The time to performing a single heel raise (SHR) and performing ten repetitive SHRs did not differ between the groups (P = 0.281, 0.486). Likewise, isokinetic dynamometer results showed that the peak torque of 30o/s and 120o/s plantar flexions (the absolute value and the percentage to the contralateral side) also did not differ between the groups (P >0.05, each). However, the early Achilles tendon Total Rupture Score scale and the Foot and Ankle Ability Measure scores before six months were significantly lower in Group 2 than in Group 1 (both P < 0.05); at 12 months, the scores did not differ between the two groups (both P >0.05).

Conclusion:

Conservative treatment for subacute ATRR after primary Achilles tendon repair has comparable clinical outcomes to those without ATRR.
Deltoid Ligament Release for Varus Deformity Correction in Total Ankle Arthroplasty
Authors: Duff Joseph R. , Sarfani Shumaila , Ward Tyler , Doty Jesse F. , Murphy Garnett
Published: December 2023

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Total ankle arthroplasty (TAA) with severe varus ankle deformity is balanced in the coronal plane by releasing medial soft tissue constraints. There are no previous reports examining the impacts of TAA with concomitant release of the deltoid. Progressive talar tilt and progressive collapsing foot deformity were evaluated.

Methods:

A retrospective review included patients undergoing TAA with confirmed preoperative varus deformity. Patients underwent complete soft tissue release of the deltoid ligament complex. Pre- and post-operative weightbearing radiographs quantified Meary’s angle, lateral talo-1st metatarsal angle, calcaneal pitch, talar coronal alignment, and the lateral distal tibial angle. The primary endpoints were degrees of coronal plane correction, longitudinal arch position, and complication rates.

Results:

Thirty-two patients were included with median 12.5 month follow-up. Coronal plane alignment and VAS pain scores improved significantly in all patients, and statistical analysis revealed that complete deltoid ligament release had no bearing on calcaneal pitch and Meary’s angle at final follow-up. Posterior tibial tenotomy was performed on 3 (9.3%) patients. Median coronal plane alignment correction averaged 17.5° improvement (X2(2)= 50.358, P<.001) from 19.5° varus (11.2-24.5°) to 2.0° varus (0.5- 3.5°)(P <.001). Two degrees of coronal plane varus alignment without tilt progression (0.6-3.4°)(P <.001) was maintained through follow-up. Final calcaneal pitch of 18.2° (14.4-23.2°) mirrored initial median measurement of 18.3° (15.7-21.1°). No significant differences were found between Meary’s angle measurements at any time points (P=.568). Eight of 32 patients had complications with five requiring further ankle surgery.

Conclusion:

Complete release of the deltoid ligament may improve coronal malalignment when performing TAA. Release did not lead to radiographic or clinical medial instability, valgus talar tilt, or medial arch collapse.
Do Patients who Undergo Fixation for Pilon Fracture Develop Symptoms Comparable to Primary Ankle OA?
Authors: Nicholson Alys , Nicolas Andrea Pujol , Ramaskandhan Jayasree R. , Siddique Malik , Qasim Sultan , Alkhreisat Mohammad , Chambers Simon
Published: December 2023

Category:

Ankle Arthritis

Introduction/Purpose:

Pilon fractures are challenging to manage and have poor functional outcomes and high complication rates. A significant proportion of these patients go on to develop post-traumatic ankle arthritis. Our aim was to assess the long term patient reported outcomes following pilon fracture fixation and how this compares to patients with end stage ankle osteoarthritis requiring surgical intervention in the form of total ankle arthroplasty.

Methods:

We retrospectively identified all patients who underwent pilon fracture fixation between April 2012 and December 2015 (Group A). Group B consisted of patients with primary ankle osteoarthritis awaiting elective total ankle replacement between 2015 and 2017. Patients completed a Patient Reported Outcome Measures questionnaire (MOX-FQ, EQ-5D and FAOS scores) pre and post-operatively. The average follow up was 8 years.

Results:

There were 18 patients in Group A and 22 in Group B. Ankle arthritis patients reported significantly worse score for MOXFQ Pain (P vs. AA; 39.0 ±29.5 vs. 68.0 ±27.1; p=0.001), Difficulty with Walking/ Standing (38.3±26.0 vs. 56.4±26.5; p=0.037) and difficulty with social activities (24.0 ±25.6 vs. 49.4 ±31.3; p=0.007) and FAOS domains of symptoms (68.7 vs. 52.1; p=0.005), ability to do Activities of Daily Living (18.9 vs. 27.5; p= 0.003) and Quality of life (56.6 vs. 32.5; p=0.012). There was no difference between groups for EQ-5D general health scores (78.8 vs. 68.8; p=0.156). Ankle arthritis group patients reported worse scores for mobility, ability to self-care and performed activities of daily living (p=0.012) compared to the pilon fracture group.

Conclusion:

Our 8 year follow up demonstrate good long term outcomes for patients following pilon fracture fixation. Patients did not develop symptomatic arthritis comparable to end stage ankle arthritis requiring surgical intervention and we therefore recommend primary treatment with fixation, irrespective of fracture severity.
Does Hallux Valgus Correction with Chevron-Akin Osteotomies Reduce the Length of the First Ray
Authors: Horani Keenan , Black Natalie R. , Panchbhavi Vinod , Chen Jie
Published: December 2023

Category:

Bunion; Midfoot/Forefoot

Introduction/Purpose:

Patients who undergo a successful surgical correction of hallux valgus have relieved toe pain and improvements in foot appearance. Prior studies have shown hallux valgus correction using a distal Chevron osteotomy with a concomitant Akin osteotomy has the potential to reduce forefoot width. There are no studies evaluating if similar changes occur in the length of the foot. The objective of this study is to check if similar reduction occurs in the patient's foot length.

Methods:

The operating room schedule of Dr. Panchbhavi and Dr. Chen were reviewed for Chevron/Akin Osteotomies from 2017-2022. Patient charts were excluded for contaminant operations of the foot. The preoperative and postoperative radiographs were then evaluated by one medical student with oversight from a Board-Certified Foot and Ankle Orthopedic Surgeon. The Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), Metatarsal Span (MS), first/second ray of the foot, and difference between first and second ray were all be measured based on predetermined methods. All variables were analyzed utilizing an unpaired t-test.

Results:

In total 12 Chevron/Akin patients met the criteria. The results indicated that with chevron/akin osteotomy measurements of the foot were affected in HVA, IMA, MS, and length of first ray relative to second ray. The average results for each of these values were a decrease of 9.2 degrees (SD 4.32), 7.93 degrees (SD 4.33), 11.63mm (SD 2.26) respectively. For results of change in difference of first and second ray, average results for those who underwent Chevron/Akin Osteotomy was -2.23mm (SD 2.23, p = 0.0281). Both changes to MS and length were statistically significant (p < 0.05).

Conclusion:

Our results were consistent with existing evidence, Chevron with contaminant Akin Osteotomy will produce statistically significant changes in width of the foot; however, also a significant decrease in the length of the first ray relative to the second ray. All measurements were done utilizing PACS software and can be reliably used in clinics as a clinical tool to gauge post- operative outcomes alongside providing adequate patient education on the potential changes in foot length and width.
Does the Radiographic Lateral View of Toes Matter? - A Retrospective Analyses of 378 X-Rays
Authors: de Britto Costa Lucas Plens , Gonçalves Joao Paulo , Foni Noel Oizerovici , Mansur Nacime Salomao Barbachan
Published: December 2023

Category:

Lesser Toes; Trauma

Introduction/Purpose:

Because lateral toes are anatomically on the distal aspect of foot, they are more exposed to axial load (stubbed toe) and crushing injuries. In this context, correct obtainment of imaging exams is fundamental for proper diagnosis of MSI. In the X-ray room, however, due to overlapping of smaller fingers or because the patient`s pain, most common practice is to suppress the lateral view. The purpose of this study is to demonstrate the importance of toe radiographs in diagnosis of interphalangeal fractures and dislocations, emphasizing need for lateral view for diagnosis of these injuries.

Methods:

378 radiographs of 126 patients treated between Jan/2018 and Mar/2018 in an emergency care clinic of a Brazilian hospital were retrospectively evaluated for presence of fractures. Patients were selected from a search on medical records using ICD. After, the radiographs of the same patient were duplicated and divided in two groups: standard group (AP and Oblique) and complete profile group (standard views plus lateral view). They were examined by four independent examiners of different degrees of experience. Each examiner randomly evaluated the same patient twice (1 in each group). Kappa index was used to evaluate intra and inter-examiner concordance, and the two-proportion equality test was used to calculate statistical significance.

Results:

Mean age of patients was 37,2 years (4-85yr). 144 fractures were diagnosed in standard group (28,6%) and 266 fractures (52,8%) in complete profile group (p < 0,001). Individually evaluating each examiner, everyone had had an improvement in number of fracture diagnostics when compared the complete profile group with the other (p < 0,001). Kappa index was superior to 0,60 for all examiners in pattern group.

Conclusion:

Addition of true lateral view was able to improve the number of diagnosed fractures on patients with lesser toes trauma.
Does the Underlying Cause of Arthritis Affect the Outcome of Total Ankle Replacement? A 10 Year Follow Up Study
Authors: Nicolas Andrea Pujol , Porter Anna , Ramaskandhan Jayasree R. , Hakeem Samir , Abdul Nicole , Alkhreisat Mohammad , Chambers Simon , Qasim Sultan , Torres Paulo , Siddique Malik
Published: December 2023

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Total ankle replacement (TAR) is gaining popularity as a treatment option for end stage arthritis. We analysed whether the underlying pathology leading to the arthritis has any bearing on patient reported or clinical outcomes.

Methods:

Patient-reported outcome measures (PROMs) for TAR performed from 2006 to 2010 by a single surgeon were reviewed. This included WOMAC score, SF-36 and patient satisfaction scores. Data was collected preoperatively and post- operatively at 1, 2, 5 and 10 year. The indications for TAR were obtained by review of clinical notes and radiographs and these included osteoarthritis (OA), inflammatory arthritis (IA), pilon fracture (PF), ankle fracture (AF), and post-traumatic arthritis without previous fracture (PTOA).PROMs were available for 156 TARs: 81 (51.9%, mean age 65.29) for OA, 28 (17.9%, mean age 65.29) for AF, 23 (14.7%, mean age 64.28) for IA, 11 (7%, mean age 55.01) for PF, and 13 (8.3%, mean age 51.08) for PTOA.

Results:

At 1 year WOMAC score showed significant worsening pain and stiffness on PTOA group (p=0.023, p=0.001) and worse general health and vitality for the IA group (p=0.0025, p=0.005). At 5 years The PTOA group showed significant worsening stiffness (p=0.048), social and emotional domains (p=0.004, P=0.029) and worsening pain, return recreational activities and surgery dissatisfaction (p < 0.05, p=0.032, p=0.023). At 10 years 50% of IA patients were unhappy with return to ADLs but no other difference were found between groups. There was a higher revision rate at 10 years in the PTOA group with 30.7% of patients being revised (4/13) compared to other groups (OA-6.17%, AF-3.57%, IA-4.35%, PF-9%)

Conclusion:

Similar outcomes in all groups were seen at 10 years but higher revision rates were present in PTOA group. In patients with PTOA careful consideration and counselling is needed prior to proceed with TAR.
Early-to-Intermediate Clinical and Radiographic Outcomes of the Vantage Total Ankle Arthroplasty
Authors: Anastasio Albert T. , Kim Billy I. , Wixted Colleen M. , Adams Samuel , DeOrio James K. , Nunley James A. , Easley Mark
Published: December 2023

Category:

Ankle Arthritis

Introduction/Purpose:

The Vantage total ankle arthroplasty (TAA) features a design based on careful study of arthritic ankles and current ankle biomechanics, with theoretical advantages of a vertically-oriented tibial fixation and a fully congruent talar dome bone-implant interface. In this design-team, single-institution investigation, we report early-to-intermediate term clinical and radiographic outcomes, implant survivorship, and complications of the Vantage TAA.

Methods:

We retrospectively reviewed prospectively collected data for 278 consecutive patients undergoing Vantage fixed-bearing TAA. Ankles with coronal plane deformity > 25 degrees and suspected poor bone quality were prospectively excluded. Prospectively collected data includes: PROMIS, SF-36, SMFA, VAS and AOFAS hindfoot-ankle scores. Using previously published and commonly accepted evaluation methods, independent radiographic analysis, performed by a non-design surgeon investigator, included pre-operative, 1-year, and most recent follow-up assessments of 2-plane alignment, component position, and the bone- implant interface. A non-design surgeon investigator with dedicated training in statistics performed the statistical analysis using descriptive statistics to report PROM and radiographic measures and Kaplan-Meier survivorship analysis.

Results:

Mean patient age was 64.8yrs (range:33-86), 44.2% were female, and mean follow-up was 3.1yrs (2.0-5.5). Mean preoperative and postoperative PROMs were as following: PROMIS-Depression 50.3+/-4.2 and 45.6+/-9.8, PROMIS-Physical Function 39.0+/-3.4 and 45.0+/-7.8, SF-36 total score 55.8+/-15.3 and 73.2+/-20.0, SMFA-Function 29.0+/-13.5 and 15.9+/-5.4, VAS 15.8+/-24.8 and 3.1+/-10.1, and AOFAS hindfoot-ankle 46.3+/-16.5 and 81.1+/-16.3 (Table 1). Radiographic lucency at the bone- implant interface was noted in 33 (18.5%) TAAs at final follow-up; 20 (11.2%) were progressive. Lucency was almost exclusive to the tibial component. Implant survivorship was 99.6% [98.9-100.0] at 1-year and 93.3% [88.7-98.2] at the 5-year mark (Table 2, Figure 1). We identified suboptimal bone preparation, initial component alignment and/or component position in all 11 implant failures (Table 3).

Conclusion:

At early-to-intermediate followup, we observed favorable clinical outcomes, radiographic results and implant survivorship for the fixed-bearing Vantage TAA, especially with optimal bone preparation and component position. Tibial component lucency remains a concern and warrants further investigation. Suboptimal bone preparation, initial component alignment and/or component position was observed in all implant failures.
Effect of Medial Closing Wedge Distal Femoral Varization Osteotomy on Coronal Ankle and Hindfoot Alignment
Authors: Choi Jun Young
Published: December 2023

Category:

Hindfoot; Ankle

Introduction/Purpose:

To date, only a few studies have reported postoperative changes in coronal ankle alignment after valgus knee correction through Medial Closing Wedge Distal Femoral Varization Osteotomy (MCWDFO). This study aimed to measure the changes of MCWDFO on coronal ankle and hindfoot alignment.

Methods:

We retrospectively reviewed the radiographic findings of 27 consecutive patients (34 cases) with knee valgus malalignment who underwent MCWDFO for either lateral knee joint osteoarthritis (OA) or recurrent patellar subluxation/dislocation (RPD) . Several radiographic parameters were measured and compared based on the reason for operation, followed by the status of preoperative hindfoot alignment (hindfoot alignment angle [HAA] > 4°, varus; -4° HAA 4°, neutral; HAA < -4°, valgus) in each group.

Results:

Overall, pre- and postoperative hindfoot alignments were within the neutral alignment range and were not significantly changed after the operation (P > 0.05). Nineteen cases were for lateral knee OA and 15 were for RPD, respectively. In both groups, preoperative neutral hindfoot alignments accounted for the largest portion (52.6% in the lateral OA group; 80.0% in the RPD group). Postoperatively, regardless of the reason for operation, hindfoot alignments changed toward the neutral range in all subgroups (i.e., no changes in the preoperative neutral group; increased in the valgus group; decreased in the varus group).

Conclusion:

We recommend that surgeons leave the hindfoot untouched when they plan the MCWDFO to correct knee joint valgus malalignment concomitant with hindfoot valgus or varus deviation as the hindfoot malalignment appears to change towards neutral range postoperatively.
Effects of Soccer Cleats Worn vs Lower Extremity Injuries in the English Premier League
Authors: DeShazo Sterling , Pescatore Sabrina M. , Weiss William M.
Published: December 2023

Category:

Sports; Trauma

Introduction/Purpose:

As the most popular sport in the world, soccer has driven increased physical demands and higher levels of intensity, resulting in higher injury incidence amongst players. Biomechanical and epidemiological studies suggest that cleats likely play a significant role in the risk of lower extremity injuries for soccer players. The purpose of our study is to analyze cleat models and stud patterns worn by players who sustained lower extremity injuries during the English Premier League (EPL) 2021-22 season.

Methods:

Player injury data for 20 soccer teams was analyzed from the EPL 2021-22 season, which spanned from August 13, 2021 to May 22, 2022. The injured player cohort was established using Transfermarkt.com , a large, European-based website specializing in soccer-related news, scores, and statistics. Player injuries were separated into seven categories: ankle, calf, foot, hamstring, knee, lower leg, and thigh. Soccer cleat data was obtained from footballbootsdb.com, a publicly available, statistical database that includes information from the top European-based leagues and from major soccer tournaments such as the World Cup. Product attributes including the number of studs, stud geometry, upper material, upper thickness, upper fit, lacing mechanism, and weight were collected and confirmed using the product websites along with online third-party cleat reviews. After exclusions, a total of 221 EPL players and their respective cleats were analyzed.

Results:

Our results suggest that certain cleat models and stud patterns have higher associated risk of lower extremity injuries. Very aggressive stud patterns were found to have significantly more injuries when directly compared to mildly aggressive stud patterns (p=0.005). Additionally, the odds of a player sustaining an injury to their ankle (OR=1.394, p=0.042), hamstring (OR=0.892, p=0.027), or knee (OR=1.595, p=0.037) were significant with very aggressive stud patterns, while the odds of a player sustaining a hamstring injury were significant with non-aggressive stud patterns (OR=1.297, p=0.037). When considering specific cleat models, there were significantly higher odds of a player sustaining a lower extremity injury in Nike Mercurial (OR=1.256, p=0.007), Adidas X (OR=1.622, p=0.008), Nike Phantom GT (OR=0.924, p=0.018), Adidas Predator (OR=1.290, p=0.030), and Nike Tiempo (OR=0.714, p=0.048).

Conclusion:

In the EPL 2021-2022 season, players that wear very aggressive stud patterns may be at higher risk for lower extremity injuries, when compared to those who wear mildly aggressive stud patterns. We suggest that players, clubs, and manufacturers should evaluate their choice in footwear to best mitigate their risk of lower extremity injury.
Expanding the Surgical Options for Young Craniofacial Patients: Bilateral Alloplastic Temporomandibular Joint Reconstruction
Authors: Harmon Kelly A. , Alba Brandon E. , Frauchiger-Ankers Reilly , Figueroa Alvaro A. , Tragos Christina
Published: December 2023

In skeletally immature patients, costochondral grafts (CCG) are the standard of care for temporomandibular joint (TMJ) reconstruction; however, CCGs may undergo resorption or ankylosis, resulting in reoperation and a greater risk of surgical morbidity. While TMJ reconstruction with an alloplastic implant is done in skeletally mature patients, its use in pediatric patients has been limited, particularly in those with craniofacial conditions. Recent evidence has revealed that alloplastic TMJ replacement is safe and effective in skeletally immature patients without adversely affecting the natural growth of the joint, although studies investigating their use in younger patients is still limited. In this report, we present the case of an 8-year-old female with a history of TMJ ankylosis who underwent bilateral TMJ replacement with custom prosthetic joints.
Systematic analysis of Mendelian disease-associated gene variants reveals new classes of cancer-predisposing genes
Authors: Song Seulki , Koh Youngil , Kim Seokhyeon , Lee Sang Mi , Kim Hyun Uk , Ko Jung Min , Lee Se-Hoon , Yoon Sung-Soo , Park Solip
Published: December 2023

Background

Despite the acceleration of somatic driver gene discovery facilitated by recent large-scale tumor sequencing data, the contribution of inherited variants remains largely unexplored, primarily focusing on previously known cancer predisposition genes (CPGs) due to the low statistical power associated with detecting rare pathogenic variant-phenotype associations.

Methods

Here, we introduce a generalized log-regression model to measure the excess of pathogenic variants within genes in cancer patients compared to control samples. It aims to measure gene-level cancer risk enrichment by collapsing rare pathogenic variants after controlling the population differences across samples.

Results

In this study, we investigate whether pathogenic variants in Mendelian disease-associated genes (OMIM genes) are enriched in cancer patients compared to controls. Utilizing data from PCAWG and the 1,000 Genomes Project, we identify 103 OMIM genes demonstrating significant enrichment of pathogenic variants in cancer samples (FDR 20%). Through an integrative approach considering three distinct properties, we classify these CPG-like OMIM genes into four clusters, indicating potential diverse mechanisms underlying tumor progression. Further, we explore the function of PAH (a key metabolic enzyme associated with Phenylketonuria), the gene exhibiting the highest prevalence of pathogenic variants in a pan-cancer (1.8%) compared to controls (0.6%).

Conclusions

Our findings suggest a possible cancer progression mechanism through metabolic profile alterations. Overall, our data indicates that pathogenic OMIM gene variants contribute to cancer progression and introduces new CPG classifications potentially underpinning diverse tumorigenesis mechanisms.
Effects of early postnatal gastric and colonic microbiota transplantation on piglet gut health
Authors: Larsen Christina , Offersen Simone Margaard , Brunse Anders , Pirolo Mattia , Kar Soumya Kanti , Guadabassi Luca , Thymann Thomas
Published: December 2023

Background

Diarrhea is a major cause of reduced growth and mortality in piglets during the suckling and weaning periods and poses a major threat to the global pig industry. Diarrhea and gut dysbiosis may in part be prevented via improved early postnatal microbial colonization of the gut. To secure better postnatal gut colonization, we hypothesized that transplantation of colonic or gastric content from healthy donors to newborn recipients would prevent diarrhea in the recipients in the post-weaning period. Our objective was to examine the impact of transplanting colonic or gastric content on health and growth parameters and paraclinical parameters in recipient single-housed piglets exposed to a weaning transition and challenged with enterotoxigenic Escherichia coli (ETEC).

Methods

Seventy-two 1-day-old piglets were randomized to four groups: colonic microbiota transplantation (CMT, n = 18), colonic content filtrate transplantation (CcFT, n = 18), gastric microbiota transplantation (GMT, n = 18), or saline (CON, n = 18). Inoculations were given on d 2 and 3 of life, and all piglets were milk-fed until weaning (d 20) and shortly after challenged with ETEC (d 24). We assessed growth, diarrhea prevalence, ETEC concentration, organ weight, blood parameters, small intestinal morphology and histology, gut mucosal function, and microbiota composition and diversity.

Results

Episodes of diarrhea were seen in all groups during both the milk- and the solid-feeding phase, possibly due to stress associated with single housing. However, CcFT showed lower diarrhea prevalence on d 27, 28, and 29 compared to CON (all P < 0.05). CcFT also showed a lower ETEC prevalence on d 27 (P < 0.05). CMT showed a higher alpha diversity and a difference in beta diversity compared to CON (P < 0.05). Growth and other paraclinical endpoints were similar across groups.

Conclusion

In conclusion, only CcFT reduced ETEC-related post-weaning diarrhea. However, the protective effect was marginal, suggesting that higher doses, more effective modalities of administration, longer treatment periods, and better donor quality should be explored by future research to optimize the protective effects of transplantation.
Exploring the applicability of a lesion segmentation method on [18F]fluorothymidine PET/CT images in diffuse large B-cell lymphoma
Authors: Pitarch Germán , Rotstein Habarnau Yamila , Chirico Roxana , Konowalik Brenda , Pérez Amalia , Valda Alejandro , Bastianello María
Published: December 2023

Background and purpose

The determination of the total metabolic tumour volume based on [18F]fluorothymidine ([18F]FLT) PET/CT images in diffuse large B-cell lymphoma has a potential clinical value for detecting early relapse in this type of heterogeneous lymphoproliferative tumours. Tumour segmentation is a key step in this process. For this purpose, our objective was to determine a segmentation threshold of [18F]FLT PET/CT images, based on a reference tissue uptake, on a cohort of patients with diffuse large B-cell lymphoma (DLBCL) that have been scanned at different stages of the treatment.

Methods

We enrolled 23 adult patients with DLBCL confirmed in II-IV stages without nervous system compromise. All patients were scanned using [18F]FLT PET/CT at the time of diagnosis (baseline PET), interim PET (iPET), and at the end of treatment (fPET). The administered activity was 1.8–2.6 MBq/kg body weight, performed 60–70 min after injection and without use of contrast-enhanced CT. First, we assessed the [18F]FLT uptake stability in liver and bone marrow along the patient follow-up. For the lesion segmentation, three threshold values were assessed.

Results

Both, liver, and bone marrow can be indistinctly taken as reference tissue. The SUV threshold for a voxel to be considered as belonging to a lesion is expressed in terms of a percentage relative to the patient’s uptake in the reference tissue. Found thresholds were: for liver, 62%, 33%, 27%; and for bone marrow, 35%, 21% and 22%, for baseline, iPET and fPET stages, respectively. The relative threshold throughout the treatment has a decreasing tendency along the stages.

Conclusion

Based on the results obtained with [18F]FLT PET/CT during staging and follow-up in patients with DLBCL, reference values were obtained for each stage referring to liver and bone marrow uptake that could be used in clinical practice oncology.
The Role of DNMT1 and C/EBPα in the Regulation of CYP11A1 Expression During Syncytialization of Human Placental Trophoblasts
Authors: Zhu Ya-Nan , Pan Fan , Gan Xiao-Wen , Liu Yun , Wang Wang-Sheng , Sun Kang
Published: December 2023

Progesterone synthesized in the placenta is essential for pregnancy maintenance. CYP11A1 is a key enzyme in progesterone synthesis, and its expression increases greatly during trophoblast syncytialization. However, the underlying mechanism remains elusive. Here, we demonstrated that passive demethylation of CYP11A1 promoter accounted for the upregulation of CYP11A1 expression during syncytialization with the participation of the transcription factor C/EBPα. We found that the methylation rate of a CpG locus in the CYP11A1 promoter was significantly reduced along with decreased DNA methyltransferase 1 (DNMT1) expression and its enrichment at the CYP11A1 promoter during syncytialization. DNMT1 overexpression not only increased the methylation of this CpG locus in the CYP11A1 promoter, but also decreased CYP11A1 expression and progesterone production. In silico analysis disclosed multiple C/EBPα binding sites in both CYP11A1 and DNMT1 promoters. C/EBPα expression and its enrichments at both the DNMT1 and CYP11A1 promoters were significantly increased during syncytialization. Knocking-down C/EBPα expression increased DNMT1 while it decreased CYP11A1 expression during syncytialization. Conclusively, C/EBPα plays a dual role in the regulation of CYP11A1 during syncytialization. C/EBPα not only drives CYP11A1 expression directly, but also indirectly through downregulation of DNMT1, which leads to decreased methylation in the CpG locus of the CYP11A1 promoter, resulting in increased progesterone production during syncytialization.
The state of civil solidarity in urban and rural areas of Southern Russia
Authors: Rusiya N. , Rakachev D.
Published: December 2023

At the moment, the task is to scientifically comprehend successful methods and technologies for updating civil solidarity in the context of social disorganization of society and the search for unifying grounds for the country's citizens. Mobilization of community resources at the local level in conditions of heterogeneity of socio-economic and socio-cultural space is possible only through the practice of civil solidarity built on the basis of civic identity. The purpose of this study is to identify and describe geopolitical, socio-economic, political-legal and socio-cultural factors that influence the formation of civil solidarity in urban and rural areas of the regions of Southern Russia, as well as formats for including residents in solidarity practices. We have studied rural and urban areas of the regions of the South of Russia (Krasnodar Territory, Republic of Crimea, Republic of Adygea) in order to characterize the entire set of factors influencing the formation of civil solidarity in the territories of Russia. The choice of the object of study is determined by a wide range of destabilizing, polarizing factors that are currently being recorded in the Southern Federal District. Transcripts of 45 expert interviews (15 experts from each selected region of the Southern Federal District) and the results of a questionnaire survey (969 respondents in 3 regions) were used as an empirical basis. The study identifies and describes the most significant factors in the formation of civil solidarity: institutional, value-based, external challenges and threats, the mobilization potential of residents of the territory, formats of interaction in the existing settlement structure and the leadership factor.