bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opioid Consumption after Foot and Ankle Surgery: The Influence of Payer Status
Authors: Acebo Joshua , Lam Kenrick , Khan Shamis , Jain Rishabh , Panchbhavi Vinod 
Published: October 2019

Category: Ankle, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Opioid utilization after foot and ankle surgery has received more attention recently with several papers publishing guidelines on the number of opioids to prescribe following surgery. To our knowledge the patient populations that have been studied in all of these papers are all private payer mixes, with a low amount of indigent patients. Social factors often have a large influence over surgical outcomes and therefore we aimed to see if this held true for post-operative opioid utilization as well. In this study we investigated differences in opioid utilization among patients with either Medicaid, Medicare or commercial insurance. Methods: All bony foot and ankle procedures performed by a single foot and ankle surgeon were reviewed between the dates of 7/1/2017 - 6/30/2018. Inclusion criteria were age over 18, did not have a history of chronic pain, and not incarcerated. Bony procedures included any osteotomy, fracture fixation, or arthrodesis. The number of narcotic prescriptions filled by the patient within 6 months following surgery was retrieved via the Texas Prescription Monitoring Program Database. Patients were also called and surveyed about their post-operative pain. The patients were then divided into 3 groups by payer status: commercial insurance including workman’s compensation, Medicaid including county insurance and self pay patients, and Medicare. Results: 92 patients met inclusion criteria, 22 Medicare, 26 Medicaid, and 44 commercial. Medicaid patients filled more narcotic prescriptions than commercial and medicare patients (870 mg morphine equivalent vs 781 mg morphine equivalent for commercial and 649 mg morphine equivalent for medicare) however this difference was not statistically significant (Medicaid vs Medicare p = 0.07). Medicaid patients also needed a greater number of refills per patient (0.27 for Medicaid vs 0.20 and 0.09 for commercial and Medicare, p = 0.22) and had a larger number of telephone encounters for pain (p = 0.02) than the other payer types. Conclusion: Although not statistically significant, there was a trend toward greater opioid utilization within the Medicaid and county insured patient population.
The Navicular Prosthesis Template: A Cadaveric Study of the Talonavicular Morphometric Profiles and Side-to-side Differences
Authors: Angthong Chayanin , Stufkens Sjoerd Antoine Sebastian , Rajbhandari Prasit 
Published: October 2019

Category: Hindfoot, Midfoot/Forefoot, Trauma Introduction/Purpose: The navicular bone destruction is a challenging condition in the foot surgery. This can be occurred from severe comminuted fracture, avascular necrosis from steroid used or Mueller-Weiss Syndrome, etc. However, little is known about the treatment option which can spare the talonavicular or naviculocuneiform joint regarding this condition. The navicular prosthesis replacement may be the promising option in the future. This study is to present the talonavicular (TN) ratio, other morphometric profiles, and side-to-side differences for the template of customized navicular prosthesis manufacturing. Methods: A total of eight matched pairs of the ankle (16 ankles) were collected in this study. The measurements were performed regarding the morphometric profiles of navicular and talar head. All data were recorded and analyzed to determine the TN ratio to be the template of navicular prosthesis manufacturing. The TN width ratio was calculated as talar head width was divided by navicular width in axial view. The TN height ratios were calculated as talar head height was divided by navicular height at the central arc in sagittal view. Medial and lateral navicular heights were also recorded in sagittal view. The medial, lateral, and central arc lengths of navicular were recorded from the cadaveric specimens. Results: The average talar head width was 28.5 +/- 3.2 mm. The average talar head height at central arc was 26.6 +/- 2.2 mm. The average navicular heights at medial, lateral rims, and central arc were 16.8, 21.4, and 24.5 mm respectively. The average navicular lengths at medial, lateral rims, and central arc were 18.6, 15.3, and 18.4 mm respectively. The average navicular width was 40.4 +/-2.7 mm. The average TN width ratio was 0.7 +/- 0.1. The average TN height ratio at central arc was 1.2 +/- 0.2. The side-to-side differences were insignificantly found on all talonavicular morphometric profiles (P>0.05). Conclusion: Based on this study, the talonavicular ratios and the morphometric profiles were demonstrated in the cadaveric specimens. The contralateral side of navicular can be the template for the manufacturing of the customized navicular prosthesis for the pathologic side due to the insignificant differences of side-to-side morphometric profiles. These data may help develop the customized navicular prosthesis to replace in the challenging pathologic condition of navicular.
Two-Year Follow Up after Autologous Matrix-induced Chondrogenesis (AMIC) in Patients with an Osteochondral Lesion of the Talus
Authors: Anwander Helen , Krause Fabian Götz 
Published: October 2019

Category: Sports Introduction/Purpose: The treatment of osteochondral lesions in the talus remains challenging. In recent years a promising technique, the autologous matrix-induced chondrogenesis (AMIC) has been described, a technique combining micro fracturing with application of a collagen matrix. The aim was to analyze the clinical follow up two years after surgery and define risk factors for inferior outcome. Methods: This prospective study included 16 consecutive patients, who underwent AMIC for an osteochondral lesion of the talus at our institution. We compared preoperative and at two years follow up the following clinical scores: AOFAS (American Orthopeadic foot and ankle score), FFI (foot functional index) and VAS (visual analogue scale) pain and satisfaction. Further, clinical scores at two years were correlated with BMI, age, gender and size and stage osteochondral lesion according to Hepple. Additionally outcome after primary AMIC and revision surgery was compared. Results: FFI increased from 50 ± 16 preoperative to 30 ± 24 at follow-up (p-value: 0.017). VAS pain increased from 5.6 ± 2.0 to 2.8 ± 2.7 (p-value: <0.001). AOFAS (67 ± 12 to 78 ± 21) and VAS satisfaction (7.2 ± 2.6 to 7.6 ± 2.8) change was not significant. AOFAS and FFI did not correlate with BMI, age, gender or size and grade of the osteochondral lesion. Patients with primary AMIC or revision surgery had a similar preoperative AOFAS (69 ± 11 versus 64 ± 14) and FFI (54 ± 14 versus 42 ± 17). At follow-up, patients with primary AMIC showed superior AOFAS (86 ± 11 versus 65 ± 27, p-value: 0.049) and FFI (17 ± 16 versus 52 ± 20; p- value: 0.001). Conclusion: Increased clinical outcome was found two years after AMIC in patients with talus cartilage lesion without previous surgery.
The Impact of Torque on Assessment of Syndesmotic Injuries Using Weightbearing CT Scans: A Cadaver Study
Authors: Barg Alexej , Weinberg Maxwell W. , Davidson Nathan P. , Hintermann Beat , Saltzman Charles L. , Krähenbühl Nicola 
Published: October 2019

Category: Ankle, Basic Sciences/Biologics, Trauma Introduction/Purpose: Injury to the distal tibio-fibular syndesmosis can occur as an isolated ligamentous injury or can be associated with bony ankle trauma. The missed diagnosis of such injuries is believed to lead to chronic pain and early degeneration. Weightbearing CT (WBCT) has increased in popularity among foot and ankle surgeons as it offers an accurate representation of joint alignment under weightbearing conditions. However, the use of this imaging modality to diagnose syndesmotic injuries has not been investigated. The purpose of this study was to assess the influence of torque on the assessment of syndesmotic injuries using axial CT images under weightbearing conditions. We hypothesized that torque application would improve the ability to detect syndesmotic injuries. Methods: Seven pairs of male cadavers (tibia plateau to toe-tip) were included. CT scans with axial load application (85 kilograms, kg) and with (10 newton meters, Nm) or without torque to the tibia (corresponding to external rotation of the foot and ankle) were taken during four test conditions. First, intact ankles (Native) were scanned. Second, one specimen from each pair underwent anterior inferior tibio-fibular ligament (AITFL) transection (Condition 1A) while the contralateral underwent deltoid transection (Condition 1B). Third, the lesions were reversed on the same specimens and the remaining intact deltoid or AITFL was transected (Condition 2). Finally, the distal tibiofibular interosseous membrane (IOM) was transected in all ankles (Condition 3). Eight different measurements were performed to assess the integrity of the distal tibio-fibular syndesmosis on axial CT scans. Results: Torque impacted axial CT scan measurements in almost all conditions (Table I). The ability to diagnose syndesmotic injuries using axial CT measurements improved when torque was applied. No significant syndesmotic morphological change was observed with or without torque for either isolated AITFL or deltoid ligament transection. Conclusion: Low magnitude torque rotational stress application had a notable impact on 2D measurements used to diagnose syndesmotic injuries with axial CT scans (cadaveric model). Two dimensional measurements are not effective to distinguish between single AITFL and single deltoid ligament injuries. Because weightbearing conditions allow for a standardized positioning of the foot while radiographs or CT scans are taken, a combination of axial load and torque application is desirable. Further studies including patients with syndesmotic injuries will be necessary to clarify the clinical potential of WBCT scans with torque applied to identify syndesmotic widening.
Cartiva Synthetic Cartilage Implant Hemiarthroplasty for Treatment of Hallux Rigidus
Authors: Brandao Bernardo , Aljawadi Ahmed , Fox Anna , Pillai Anand 
Published: October 2019

Category: Midfoot/Forefoot Introduction/Purpose: The Cartiva synthetic cartilage implant (SCI) is licenced for use in management of symptomatic hallux rigidus in several countries including the UK. As of now, there are no independent comparative series for treatment of hallux rigidus utilising polyvinyl alcohol implants. Methods: Patients at a single centre with symptomatic hallux rigidus who underwent Cartiva SCI implant procedure were identified. First metatarsophalangeal joint arthritis was radiographically graded according to the Hattrup and Johnson (HJ) classification. Pre-operative and post-operative patient-reported outcomes were evaluated using the Foot and Ankle Ability Measure (FAAM) activities of daily living subscale and the Manchester-Oxford Foot Questionnaire (MOXFQ). Results: 66 patients (19 M, 47F) (43 R and 23 L) were followed up for an average of 14 months (min=2, max=36). 17 patients suffered from HJ2/moderate arthritis and 49 patients with grade HJ3/severe arthritis. Post-operative mean FAAM scores showed statistically significant improvement (p< 0.0001). Patients reported a 40% increase in functionality during activities of daily living. All 3 MOXFQ Domain scores improved significantly (p< 0.02). The Index score improved by 28 points (p< 0.0001). There was no correlation between length of follow up or age and PROMs (r=0.129). No statistical difference was demonstrated between sexes. However clinically, males and older patients exhibit better outcomes. There was a 89.4% patient satisfaction with the use of Cartiva. Conclusion: Our study shows excellent results with statistically significant improvements in functional outcomes, and promising short-term follow-up with low early revision rates. Pain in particular was significantly reduced. One third of patients developed post-operative stiffness requiring a manipulation under anaesthesia. Patient selection is key. Additional imaging may be required to assess sesamoid osteoarthritis. At 3 years the implant has demonstrated to be safe and efficacious in the management of hallux rigidus. Durability and survivability of the implant will continue to be studied in this cohort.
The Anteromedial Cortex of the Calcaneus: A Cadaveric Study
Authors: Briceño Jorge , Moura Bruno , Velasco Brian , McMillan Dayton , Kwon John Y. 
Published: October 2019

Category: Hindfoot Introduction/Purpose: The irregular morphology of the calcaneus obstructs its clear visualization on radiographic imaging. Particularly challenging is identifying the medial cortex given its concavity and bony overlap of the calcaneal body. Iatrogenic screw penetration of the medial wall of the calcaneus comes with increased risk of injuring the neurovascular bundle and the flexor hallucis longus tendon. Despite all intraoperative precautions, it is not infrequent to see misplaced screws in postoperative imaging. The objective of the present study is to evaluate the normal proportion of the calcaneus width to radiographically define the extent of the medial cortex on axial fluoroscopic imaging. Methods: Eight left sided fresh-frozen below-the-knee amputated cadaveric specimens were utilized for this study. Each specimen was dissected on the medial side of the hindfoot to allow visualization of the medial cortex of the calcaneus. A partial cuboid ostectomy was performed to visualize the calcaneocuboid joint and to install radiopaque markers on the borders of the anterior calcaneal facet. Finally, Harris axial views were obtained. Two independent observers measured the widths of the calcaneus on digital fluoroscopic Harris views at two levels: the maximal width at the sustentaculum tali and the maximal width at the anterior process. A ratio was calculated between these measurements. Results: The ratio between the maximal width at the anterior process and the sustentaculum ranged between 0.42 and 0.52 with an average ratio of 0.47 +/- 0.04. Conclusion: Calcaneal screw misplacement, particularly from lateral to medial, can lead to damage of the neurovascular bundle and the flexor hallucis long tendon ultimately affecting clinical outcomes. The measurements in the present study suggest a lower risk of violating the medial cortex when the length of the screw placed in the anterior process of the calcaneus is less than half of the maximal width of the calcaneus at the sustentaculum tali. As the medial cortex is difficult to visualize on intraoperative fluoroscopy, the clinical use of this normal ratio in axial views could help surgeons to avoid calcaneal screw misplacement.
Minimally Invasive Retrograde Method of Harvesting the Flexor Hallucis Longus Tendon: A Cadaveric Study
Authors: Bull Patrick , Goss David , Halverson Adam 
Published: October 2019

Category: Ankle Introduction/Purpose: Utilization of the flexor hallucis longus (FHL) tendon is well described for several tendon augmentation procedures. Recently, several authors have described a minimally invasive (MI) technique to harvest the tendon utilizing a hamstring tendon stripper. The purpose of this study was to evaluate the safety and effectiveness of harvesting the FHL tendon utilizing this novel technique. Methods: The FHL tendon was harvested through a transverse plantar incision over the interphalangeal joint of the great toe in 10 fresh-frozen cadaver lower extremities. Complications, tendon length and interconnections between the FHL and flexor digitorum longus (FDL) were recorded. The specimens were then dissected by a single surgeon in a standardized fashion and damage to any surrounding structures was recorded. Results: The average length of the FHL tendon from the distal stump to the 1st inter-tendinous connection was 13.33 cm (range 8.8-16 cm, SD: 2.28 cm). Eight cadavers demonstrated Plaass Type 1 interconnections while 2 were Type 3. There was no injury to the medial and lateral plantar arteries or nerves, plantar plate or FDL tendons. One FHL tendon was amputated during graft harvesting. Conclusion: Care must be taken when approaching the sustentaculum with the tendon harvester in order to avoid amputation of the graft against a hard bony endpoint. Additionally, flexion and extension of the lateral toes can aid in successful tendon harvest when tendon interconnections are encountered. Utilizing this MI technique appears to be a safe and effective way to obtain a long FHL tendon graft tissue augmentation.
Interpositional Arthroplasty for Hallux Rigidus: A Systematic Review
Authors: Butler James , Shimozono Yoshiharu , Gianakos Arianna L , Kennedy John G 
Published: October 2019

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus is a common degenerative joint condition of the foot. In advanced stages of the disease, extensive procedures have been utilized including Keller arthroplasty, interpositional arthroplasty (IPA), arthrodesis, total joint replacement or synthetic cartilage replacement. IPA is a surgical procedure that attempts to maintain joint motion through insertion of a biologic spacer into the joint. However, there is still a paucity of overall clinical data regarding outcomes and complication rates following IPA procedure for the treatment of hallux rigidus.The purpose of the current study was to systematically review the outcomes of IPA in the treatment of hallux rigidus. Methods: A systematic search of the MEDLINE, EMBASE and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcomes collected and analysed included: AOFAS score, VAS score, SF36 score, range of motion, radiographic parameters, and postoperative complications. The level and quality of evidence were recorded and assessed. Results: Sixteen studies with a total of 433 patients met inclusion/exclusion criteria. The mean AOFAS improved from 56.8±7.3 (range, 43.2-64.3) preoperatively to 84.0±6.7 (range, 71.6-90.0) postoperatively. The preoperative weighted mean total ROM was 37.7±16.2 degrees and the postoperative weighted mean total ROM was 60.3±13.4 degrees. Five studies examined joint space narrowing on plain radiographs. The mean preoperative joint space was 1.2±0.2 mm (range, 1 -1.5) and the mean postoperative joint space was 2.5±0.5 mm (range, 1.9-3). The complication rate was 18.2% with metatarsalgia as the most commonly reported complication. One study was Level III and 15 studies were Level IV. Conclusion: This systematic review demonstrates improvement in functional and ROM outcomes following IPA. The procedure however has a high complication rate. There is a low level and quality of evidence in the current literature with inconsistent reporting of data. Therefore, further well designed studies must be carried out to determine the efficacy of IPA in the treatment of hallux rigidus.
Subtalar Joint Preparation Using 2 Portal Posterior Arthroscopic Technique vs Sinus Tarsi Open Approach: A Cadaveric Study
Authors: Chinnakannu Karthikeyan , Abyar Eildar , McKissack Haley M. , Pinto Martim , Jha Aaradhana J. , Moraes Leonardo V. , Naranje Sameer M. , Shah Ashish B. 
Published: October 2019

Category: Ankle, Arthroscopy, Basic Sciences/Biologics Introduction/Purpose: Subtalar fusion is the treatment of choice for subtalar arthritis when conservative management fails. Subtalar fusion can be done through open approach or arthroscopic technique. Arthroscopic technique is associated with rapid recovery; however, it requires adequate training and skill. Arthroscopic technique can be done through lateral or posterior portals. Sometimes it may be necessary to use accessory portal to open or distract the joint for adequate joint preparation. Use of accessory portal may result in injury to the neurovascular structure. Whatever the technique, one of the most important aspects of fusion is adequate preparation of the joint. Aim of our study is to compare the preparation of subtalar joint using sinus tarsi open approach and posterior subtalar scopy using 2 portal technique in cadaveric specimens. Methods: We used 20 below knee fresh-frozen cadaver legs for this cadaveric study. Subtalar joints of ten specimens were prepared through the lateral approach, while the remaining ten joints were prepared using sinus tarsi incisions. After the completion of preparation, all ankles were dissected open, photographic images of calcaneal and talar articular were taken. (Image)Surface areas of each articular facet and prepared area of the talus, distal tibia, and distal fibula were measured and analyzed. Results: Open technique results in better preparation of joint surface in calcaneus and overall. While open technique results in preparation of 92% joint surface (combined talus and calcaneus), arthroscopic technique results in in 80% of joint surface. Open technique results in better preparation of calcaneus (79vs 94%). The anterolateral corner of calcaneus was difficult to be reached using the scope and unprepared in most cases. There was no significant difference in the preparation of talar articular surface. (Table 1) Conclusion: Open sinus tarsi results in more joint preparation compared to 2 portal posterior arthroscopic technique. The less amount of joint preparation in arthroscopic technique is mostly due to less preparation of AL corner. Of calcaneus. When using posterior arthroscopic technique, it is advisable to use accessory portal to distract the joint to aid in adequate preparation.
The Effects of Lateral Ligaments Augmentation Using Suture-tape on Functional Ankle Instability
Authors: Cho Byung-Ki , Choi Seung-myung 
Published: October 2019

Category: Sports Introduction/Purpose: Although lateral ligaments augmentation using suture-tape has been effective for restoration of mechanical ankle stability, few data are available regarding changes of peroneal strength, proprioception and postural control. The aim of this study was to determine effects of suture-tape augmentation on functional ankle instability (FAI). Methods: Twenty-four patients that underwent suture-tape augmentation were eligible and were followed more than two years postoperatively. Functional outcomes were evaluated with the Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure (FAAM). Changes of peroneal strength, proprioception and postural control were analyzed with an isokinetic dynamometer and a modified Romberg test. Results: CAIT and FAAM significantly improved to average 27.2 points, 86.7 points at final followup. Peak torque for eversion in 60º/sec angular velocity significantly improved to 10.6 Nm at final followup. Deficit ratio of peak torque for eversion significantly improved from mean 39.5% to 20.9%, and significant side to side difference was revealed (P < .001). There were no significant differences in joint position sense. A significant improvement in balance retention time was revealed at final followup and relative deficit ratio compared to unaffected side was 30.9%. Conclusion: Patient-reported functional outcomes significantly improved after lateral ligaments augmentation using suture-tape. Although this procedure demonstrated significant effects on FAI based on improvement of isokinetic peroneal strength and postural control, recovery rates compared to the unaffected side were insufficient at the intermediate-term followup. In addition, there was no significantly positive effect on proprioception of the ankle.