bluuebunny/crossref_metadata_2025_split huggingface dataset:
A 10% Increase in Step Rate Improves Running Kinematics and Clinical Outcomes in Runners With Patellofemoral Pain at 4 Weeks and 3 Months
Authors: Bramah Christopher , Preece Stephen J. , Gill Niamh , Herrington Lee 
Published: October 2019

Background: Aberrant frontal-plane hip and pelvis kinematics have been frequently observed in runners with patellofemoral pain (PFP). Gait retaining interventions have been shown to improve running kinematics and may therefore be beneficial in runners with PFP. Purpose: To investigate whether a 10% increase in the running step rate influences frontal-plane kinematics of the hip and pelvis as well as clinical outcomes in runners with PFP. Study Design: Case series; Level of evidence, 4. Methods: Runners with PFP underwent a 3-dimensional gait analysis to confirm the presence of aberrant frontal-plane hip and/or pelvis kinematics at baseline. A total of 12 participants with frontal-plane hip and/or pelvis kinematics 1 standard deviation above a reference database were invited to undergo the gait retraining intervention. Running kinematics along with clinical outcomes of pain and functional outcomes were recorded at baseline, 4 weeks after retraining, and 3 months. Gait retraining consisted of a single session where step rate was increased by 10% using an audible metronome. Participants were asked to continue their normal running while self-monitoring their step rate using a global positioning system smartwatch and audible metronome. Results: After gait retraining, significant improvements in running kinematics and clinical outcomes were observed at 4-week and 3-month follow-up. Repeated-measures analysis of variance with post hoc Bonferroni correction ( P < .016) showed significant reductions in peak contralateral pelvic drop (mean difference [MD], 3.12° [95% CI, 1.88°-4.37°]), hip adduction (MD, 3.99° [95% CI, 2.01°-5.96°]), and knee flexion (MD, 4.09° [95% CI, 0.04°-8.15°]) as well as significant increases in self-reported weekly running volume (MD, 13.78 km [95% CI, 4.62-22.93 km]) and longest run pain-free (MD, 6.84 km [95% CI, 3.05-10.62 km]). Friedman test with a post hoc Wilcoxon signed-rank test showed significant improvements on a numerical rating scale for worst pain in the past week and the Lower Extremity Functional Scale. Conclusion: A single session of gait retraining using a 10% increase in step rate resulted in significant improvements in running kinematics, pain, and function in runners with PFP. These improvements were maintained at 3-month follow-up. It is important to assess for aberrant running kinematics at baseline to ensure that gait interventions are targeted appropriately. Registration: NCT03067545 (ClinicalTrials.gov identifier)
Utility of Bioabsorbable Fixation of Osteochondral Lesions in the Adolescent Knee: Outcomes Analysis With Minimum 2-Year Follow-up
Authors: Schlechter John A. , Nguyen Shawn V. , Fletcher Katie L. 
Published: October 2019

Background: Osteochondral lesions (OCLs) of the knee, whether occurring secondary to osteochondritis dissecans or a traumatic osteochondral fracture, are commonly encountered in the pediatric and adolescent population. Given the potential for healing in this population, coupled with adequate surgical reduction and stability of OCL fixation, an opportunity exists to avoid a major restorative procedure and the associated substantial costs and potential morbidity. Purpose: To analyze the outcomes of bioabsorbable fixation of OCLs in the adolescent knee at a minimum of 2 years. Study Design: Case series; Level of evidence, 4. Methods: An institutional review board–approved retrospective review was performed of patients younger than 18 years who underwent bioabsorbable fixation of an OCL of the knee with a minimum 2-year follow-up. Patient demographics, operative details, and postoperative clinical findings were detailed and recorded. All cases were performed by a single surgeon. Results: There were 38 patients treated surgically for an OCL between 2009 and 2016. Of these, 38 patients (mean age, 14.7 years) were evaluated at a mean of 59 months. OCL fixation consisted of a mean of 1.4 bioabsorbable screws and 1.5 darts. At final follow-up, mean pre- and postoperative Tegner scores were 6.6 and 6.4, respectively, while Lysholm and Pediatric International Knee Documentation Committee scores were 89.8 and 88.1, respectively. A total of 6 patients underwent secondary procedures postoperatively. One patient required a secondary procedure related to OCL fixation, which was secondary to a proud implant. The other secondary procedures included second-look arthroscopic surgery for pain after an injury postoperatively, planned anterior cruciate ligament reconstruction, staged medial patellofemoral ligament reconstruction, and manipulation under anesthesia for arthrofibrosis (n = 2). None of the 32 patients required a revision cartilage procedure at the time of final follow-up. Conclusion: The use of bioabsorbable implants in the adolescent knee appears to be a safe and efficacious treatment with good functional outcomes at long-term follow-up and a low revision rate. Additional long-term multisurgeon and multicenter trials with a larger cohort are needed to further elucidate the role of bioabsorbable fixation of an OCL in the adolescent knee.
Opioid Consumption and Time to Return to Work After Percutaneous Foot and Ankle Surgery
Authors: Chan Jimmy J. , Guzman Javier Z. , Chen Kevin K. , Chan Jesse C. , Vulcano Ettore 
Published: October 2019

Category: Hindfoot, Lesser Toes, Midfoot/Forefoot Introduction/Purpose: Orthopaedic surgeons are the 5th highest prescriber for narcotics in the USA. Foot and ankle procedures can be amongst some of the more painful procedures in orthopedics. A recent study demonstrated that patient underwent open foot and ankle surgeries averaged 27.2 tablets of narcotics with 37% of patients unwilling to stop at 3-month post-operative visit. Percutaneous techniques for foot and ankle procedures were recently approved in the U.S., which allow for significantly smaller incisions and minimal soft tissue disruption, which may potentially decrease post-operative pain and allow faster recovery. The purpose of this study is to assess the total opioid consumption and time for return to work following percutaneous foot and ankle surgery. Methods: In this prospective cohort study, 50 consecutive patients underwent percutaneous foot surgery (bony procedures with or without soft tissue work) by a single surgeon. All surgeries were outpatient procedures and performed under general anesthesia with a long-acting popliteal nerve block. All patients were prescribed 30 tablets of 5 mg oxycodone, 50 tablets of 500 mg acetaminophen, and 9 tablets of 600 mg ibuprofen post-operatively for pain control. All patients were given a log sheet to record number of pain medications taken during the first 14 post-operative days. The log sheet and leftover pills were collected and counted to confirm the amount of pain medication used at 2-week post-operative visit. Time return to work was also recorded in subsequent follow-up appointment. Results: All 50 patients returned their log sheet at 2-week post-operative visit. Mean age was 47.1 years. N=36 (72%) were forefoot surgeries, N=2 (4%) midfoot, N=9 (18%) hindfoot, and N=3 (6%) combined. Average oxycodone tablets taken during the first 14 days after surgery was 3.3 tablets. By the 14th day, no patient was taking any narcotic medication. The average return to work was 18.9 days post-operatively. Patients with forefoot surgery averaged 2.2 tablets of oxycodone with return to work at 10.4 days. Midfoot surgery patients averaged 3.5 tablets with return to work at 33 days. Hindfoot surgery patients averaged 5.3 tablets with return to work at 38.9 days. Combined foot surgery patients averaged 11 tablets with return to work at 54.3 days. Conclusion: This study demonstrated that percutaneous foot and ankle surgery has significant reduction and cessation in narcotic consumption post-operatively when compared to the reported values with open procedures in current literature.
The Hallux Metatarsophalangeal Capsule: An Anatomic Study with Respect to Percutaneous Hallux Valgus Correction
Authors: Chin Kenneth M. , Richardson Nicholas S. , Campbell John T. , Jeng Clifford L. , Christian Matthew W. , Cerrato Rebecca A. 
Published: October 2019

Category: Bunion Introduction/Purpose: Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux MTP proximal capsular origin on the metatarsal neck is critical for surgeons in planning and executing extra-capsular corrective osteotomies. A cadaveric study was undertaken to further study this anatomic relationship. Methods: Ten nonpaired fresh-frozen frozen cadaveric specimens were used for this study. Careful dissection was performed, and the capsular origin of the hallux MTP joint was measured from the central portion of the metatarsal head in the medial, lateral, dorsal, plantarmedial, and plantarlateral dimensions. Results: The ten specimens had a mean age of 77 years, five female and five male. The mean distances from the central hallux metatarsal head to the MTP capsular origin was 15.2 mm dorsally, 8.4 mm medially, 9.6 mm laterally, 19.3 mm plantarmedially, and 21.0 mm plantarlaterally. Conclusion: The MTP capsular origin at the hallux metatarsal varies at different anatomic positions. Knowledge of this capsular anatomy is critical for orthopaedic surgeons when planning and performing minimally invasive distal metatarsal osteotomies for the correction of hallux valgus.
Postoperative Aspirin Use and Its Effect on Bone Healing in the Treatment of Ankle Fractures
Authors: Hunter Allison , Pitts Charles , Montgomery Tyler , Anderson Matthew , Wilson John T. , Buddemeyer Katherine , McGwin Gerald , Johnson Michael 
Published: October 2019

Category: Ankle, Trauma Introduction/Purpose: There is hesitancy to administer nonsteroidal anti-inflammatories (NSAIDs) within the postoperative period following fracture care due to concern for delayed union or nonunion. However, aspirin (ASA) is routinely used for chemoprophylaxis of deep vein thrombosis (DVT) and is gaining popularity for use after treatment of ankle fractures. We examine the incidence of nonunion of operative ankle fractures and risk of DVT in patients who did and did not receive postoperative ASA. We hypothesize that time to clinical and radiographic union and the risk of DVT are no different. Methods: A retrospective chart review was performed on all patients treated between 2008 and 2018 for ankle fractures requiring operative fixation by three Foot and Ankle fellowship trained orthopaedic surgeons at a single institution with a minimum of 3 months follow up. Demographics, preoperative comorbidities, and postoperative medical and surgical complications were compared between patients who did and did not receive ASA postoperatively. For both groups, union was evaluated by clinical exam as well as by radiograph. Results: 506 patients met inclusion criteria: 152 received ASA and 354 did not. Radiographic healing at 6 weeks was demonstrated in 95.9% (94/98) and 98.6% (207/210) respectively (p-value .2134). There was no significant difference in time to radiographic union between groups. The risk of postoperative DVTs in those with and without ASA was not significantly different (0.7% (1/137) vs 1.2% (4/323), respectively; p-value .6305). Conclusion: Postoperative use of ASA does not delay radiographic union of operative ankle fractures or affect the rate of postoperative DVT. This is the first and largest study to examine the effect of ASA on time to union of ankle fractures.
2019 J. Leonard Goldner Award Winner: A Novel Intraoperative Technique Seeding Morselized Bone Tissue into Pediatric Blood Culture Bottles Improves Microbiological Diagnosis in Patients with Foot and Ankle Osteomyelitis
Authors: Ledermann Gerardo , Klaber Ianiv , Urrutia Julio , Ponce Pablo Mery , Filippi Jorge 
Published: October 2019

Category: Basic Sciences/Biologics, Diabetes Introduction/Purpose: Bone infection in the foot is a challenging pathology that frequently leads to amputation and major disability. Agent identification and antimicrobial susceptibility-guided therapy is the key for a successful treatment. Standard culture methods for bone tissue have demonstrated poor sensitivity. It has been reported that synovial fluid culture sensitivity is enhanced when seeded into pediatric blood culture bottles (PBCB), however, its performance for bone infection has yet to be determined. The aim of this study was to evaluate a novel method to obtain and process infected bone tissue using PBCB and comparing it with the standard technique. Methods: Patients admitted at a single university hospital with foot osteomyelitis between 2008 and 2017 were recruited prospectively. The diagnosis was made by clinical, laboratory and imaging findings. A representative sample of infected bone tissue was obtained for each patient and simultaneously processed using the standard technique for solid tissue cultures (SCM) and a morselized bone sample that was seeded into a PBCB (BacT/ALERT® PF). Culture sensitivity and number of agents detected for each technique were compared using the McNemar and the Mann Whitney tests respectively. Results: Over the period studied, 107 patients fitted the inclusion criteria. Of these, 63 patients had a diabetic-related infection. The causative agent was identified in 60.7% using the SCM and in 97.2% using PBCB (p < 0.001). We detected a mean of 1.05 bacteria species using SCM and 1.67 using PBCB (p<0.01). PBCB retrieved 1 bacterial species in 50.5% of the samples and 2 or more bacterial species in 46.7%. The SCM detected 1 bacterial species in 29% of the samples and 2 or more bacterial species in 31.7%. Conclusion: In this cohort, culture technique using morselized bone tissue seeded in PBCB identified the causative agent in a significantly larger percentage than SCM. Additionally, this method identified a larger number of agents. These findings demonstrate that this novel, simple and reproducible technique for culturing bone tissue samples allows a better microbiological diagnosis, without additional intraoperative risks, compared with standard methods.
Comparison of Visual Analog Pain Score Reported to Physician vs Nurse in Postoperative Foot and Ankle Patients
Authors: McBride Trevor , Martin Kevin , Wilke Aaron Joseph , Chisholm Jamie 
Published: October 2019

Category: Patient Reported Outcome Measures Introduction/Purpose: The relativity of pain adds to the increasing ambiguity of deciding proper treatment procedures. Reliable and validated patient reported outcome measures have attempted to solve this problem, but there are still flaws due to the subjective nature of pain. This study is the third part to two previous studies that found both operative and new nonoperative patients overemphasize their pain scores when reporting to the treating physician as compared to a nurse. This current study aims to examine if this phenomenon holds true with orthopedic postoperative patients. The importance of this study is to observe this phenomenon, as to better understand subjective pain scores. We hypothesize there will be no differences in postoperative patients’ pain scores when reporting to a treating physician versus a nurse. Methods: This study is a retrospective cohort of consecutive postoperative foot and ankle patients treated by a single surgeon. The patients were asked to rate their pain intensity by the nursing staff and then by the surgeon using a standard horizontal visual analog scale (VAS) 0 to 10, from “no pain” to “worst pain” at 2, 6, and 12 weeks postoperatively. Differences in reported pain levels were analyzed within each clinic visit. Results: Two hundred and one patients each with 3 follow up encounters were included in our cohort. The mean 2, 6, and 12- week postoperative VAS scores reported to the physician were 2.85, 2.04, and 2.33 respectively; in comparison, the scores reported to the nurse were 2.52 (p=0.0005), 1.77 (p=0.002), and 2.02 (p=0.005) respectively. There was no significant relationship between time and type of provider. Conclusion: This study found that postoperative patients report their pain more consistently to physicians and nursing staff with no clinically significant differences noted. These findings stand in stark contrast to our two previous studies which noted new and preoperative patients reported significantly higher VAS scores to the physician. The reason for reporting inconstancies is unclear, but postoperatively patients no longer need to emphasize their impairments or injury. Postoperatively, they also have a defined time interval and more acute recollection of their pain potentially leading to more consistency in reporting.
Effect of Ankle Position during Anterior Talofibular Ligament Reconstruction on Ankle Kinematics, Laxity, and In-situ Force
Authors: Sakakibara Yuzuru , Teramoto Atsushi , Shoji Hiroaki , Kamiya Tonmoaki , Watanabe Kota , Yamashita Toshihiko 
Published: October 2019

Category: Ankle, Basic Sciences/Biologics Introduction/Purpose: Anatomical anterior talofibular ligament (ATFL) reconstruction is a standard surgical treatment for chronic lateral ankle instability. The optimal position during ATFL reconstruction is still uncertain. The purpose of this study was to investigate the effect of ankle position during ATFL reconstruction on ankle kinematics, laxity, and in-situ force on the graft. Methods: Twelve fresh-frozen cadaveric ankles were evaluated. First, ankle specimens were subjected to passive plantarflexion (PF)-dorsiflexion (DF) movement, from 15° DF to 30° PF, using a 6-degrees-of-freedom robotic system. Then, 60 N of anterior- posterior (AP) load, 1.7 Nm of inversion-eversion (IV-EV) torque, and 1.7 Nm of internal-external rotation (IR-ER) torque were applied to the ankle. During testing, 3-dimensional paths of the ankle were recorded simultaneously. In-situ forces on the ATFL and reconstructed graft were calculated using the principle of superposition. A repeat experiment was designed with intact (intact), ATFL transection, and ATFL reconstruction conditions, using 3 different flexion angles (Group A: 0°, Group B: PF 15°, Group C: PF 30°). Results: In ATFL transection condition, the talus was significantly translated anteriorly with internal rotation during PF-DF motion, compared to that in intact condition. In addition, laxity in AP, IV-EV, and IR-ER conditions was significantly greater than in intact condition. In each ATFL reconstruction group, kinematics and laxity showed no significant difference compared to that in intact condition. In intact condition, in-situ force was maximal at PF 30° (19.0±12.0 N). The in-situ force on the reconstructed graft in Group A, B, and C at PF 30° was 50.0±12.4 N, 33.7±13.0 N, and 21.9±7.5 N. The in-situ force in Group A and B was significantly greater than in intact condition. The in-situ force in Group C was not significantly different compared to that in intact condition (Figure 1). Conclusion: Ankle position during ATFL reconstruction affected in-situ force on the reconstructed graft. ATFL reconstruction at PF 30° is recommended to avoid excessive in-situ force on the reconstructed graft.
Consumer Prices for Surgical Management of End-Stage Hallux Rigidus
Authors: Smyth Niall A. , Krishnan Vaishnavi , McCormick Johnathon R. , Kaplan Jonathan R. , Aiyer Amiethab A. 
Published: October 2019

Category: Midfoot/Forefoot, Healthcare economics Introduction/Purpose: Hallux rigidus is the most prevalent arthritic condition of the foot. Treatment of end-stage disease traditionally consists of a first metatarsophalangeal joint (MTPJ) arthrodesis, however the use of a synthetic cartilage implant is becoming more common. With the high prevalence of disease and implementation of new treatment modalities, healthcare consumers should be aware of the costs associated with management. The purpose of this study was to determine access to the cost and variability in price of first MTPJ arthrodesis and synthetic cartilage implantation. Methods: Forty academic centers were contacted using a standardized patient script. The patient was a 59-year-old female who had failed conservative treatment of hallux rigidus. Each institution was contacted up to three times in an attempt to obtain a full bundled operative quote for a first MTPJ arthrodesis and synthetic cartilage implantation. Results: Twenty centers (50%) provided a quote for first MTPJ arthrodesis and 15 centers (38%) provided a quote for synthetic cartilage implantation. Only 14 centers (35%) were able to provide a quote for both procedures. The mean bundled price for MTPJ arthrodesis was $21,767 (range, $8,417 – $39,265). The mean bundled price for synthetic cartilage implantation was $21,546 (range, $4,903 – $74,145). There was no statistically significant difference between the bundled price for first MTPJ arthrodesis and synthetic cartilage implantation. Conclusion: There was limited availability of consumer prices for first MTPJ arthrodesis and synthetic implantation, therefore impeding healthcare consumers’ decision making. There was a wide range of quotes for both procedures, indicating potential cost savings.
Talocalcaneal Coalition Resection with Corrective Osteotomies in Symptomatic Adolescents
Authors: Abd-Ella Mohamed Mokhtar 
Published: October 2019

Category: Hindfoot Introduction/Purpose: Resection of a symptomatic talocalcaneal coalition in an adolescent without correction of the planovalgus deformity aggravates the problem because the tight peroneal tendons and triceps surae pull the heel into more valgus after release of the subtalar joint. This study aims to evaluate the clinical results of resection of symptomatic talocalcaneal coalition in adolescents with simultaneous correction of the planovalgus deformity using combined bony and soft tissue procedures. Methods: In 24 feet in 21 adolescents (age 13 to 17) with symptomatic talocalcaneal coalition and planovalgus deformity, resection of the coalition was performed together with simultaneous medial displacement calcaneal osteotomy, lateral column lengthening, Cotton osteotomy if needed, gastrocnaemius recession, and peroneal tendon fractional lengthening. Follow up evaluation was done using the AOFAS hindfoot score and subjective patient satisfaction. Complications and reoperation were reported. Results: After a minimal follow up of one year (range 1 to 5 years), the results were classified excellent in 12 feet, good in 8 feet, and fair in four feet using the AOFAS hindfoot score. Subjective patient satisfaction was graded excellent in 14 feet, good in 6 feet and fair in four feet. Two patients underwent subsequent subtalar fusion with subsequent improvement and satisfaction. Other complications included superficial wound problems in 5 feet, and talar incomplete fracture during coalition resection which was fixed in one foot. Conclusion: Resection of a symptomatic talocalcaneal coalition with simultaneous correction of pes planovalgus deformity is a good option for management of such problem in adolescents.