bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of Contact and Non-Contact Ankle Injuries in Collegiate Athletes
Authors: Guzman Javier Z. , Chen Kevin K. , Chan Jimmy J. , Vulcano Ettore 
Published: October 2019

Category: Ankle, Sports Introduction/Purpose: Ankle injuries can often have profound implication in the potential careers of National Collegiate Athletic Association (NCAA) athletes. Accordingly, a more thorough characterization of these injuries and insight into injury etiology is warranted. In addition, a more comprehensive understanding will allow proper education of athletes when injuries do occur. Here we review the incidence and effect of ankle injuries on NCAA athletes and their athletic season. Methods: Ankle injuries across 16 collegiate sports played by men and women from 2004-05 to 2013-14 academic years were surveyed from the NCAA Injury Surveillance Program (NCAA-ISP). Ankle injury rates per 10,000 athlete-exposures (IR), operative rate, annual injury rate trends, re-injury rates, in-season status (pre/in/post-season) at time of injury, and time loss distributions were perused. In effort to include both male and female atheletes equally, a sub-group analysis of contact sports played by both genders (C-BG) was performed to determine if there was a significant difference in risk when compared to those athletes that did not play contact sports. These sports included basketball, soccer, lacrosse, and ice hockey. Types of ankle injuries (soft tissues or bony) were also sub-classified and counted. Results: Over the course of 10 years, there were 14,080 ankle injures identified (IR=11.9). There were 8,978 (IR=12.1) injuries in males and 5,102 (IR=11.7) injuries in females. The rate of injuries that occurred in C-BG cohort (IR=14.5) was greater than that of the total group of noncontact participants (IR=7.6). When comparing injury rates between all contact sports(IR=14.1) and all noncontact sports (IR=7.6) the difference was found to be statistically significant(p <0 .0001). In the C-BG group, 1.4% of injuries were operative (N=93). The overall mean time loss for C-BG was 10.9 days when excluding patients who had season ending injuries. Across all atheletes, the top three contact sports with season ending ankle injuries were football, basketball, and lacrosse. Importantly,16.8% of all injuries were classified as re-injuries. Conclusion: Ankle injuries represent a common and broad spectrum of injuries in collegiate athletes. A majority of ankle injuries occurred during the regular season with sprains, strains, contusions, and fractures representing the most common types of injuries. Contact sports tend to have higher rates of ankle injuries than noncontact sports. As the consequence of index ankle injury appears to be higher predisposition to reinjury, a better understanding of the kinds of ankle injuries and their respective causes may help elucidate trends useful in the development of various prevention strategies.
Diagnosing Syndesmotic Instability with Dynamic Ultrasound: Establishing Natural Variations in Normal Motion
Authors: Hagemeijer Noortje , Chang Song Ho , Saengsin Jirawat , Waryasz Gregory , Kerkhoffs Gino , DiGiovanni Christopher , Guss Daniel 
Published: October 2019

Category: Ankle Introduction/Purpose: Syndesmotic instability, when subtle, is challenging to diagnose and often requires visualization of the syndesmosis during applied stress. Ultrasound is a dynamic, non-invasive diagnostic tool that can achieve this at the point of care, although accurate assessment requires better understanding of normal physiologic motion. The aim of this study is to assess normal distal tibiofibular motion in the sagittal plane using ultrasound during applied stress. Methods: Patients with no history of injury to either ankle were included in this study. The distal tibiofibular joint was examined using an ultrasound probe placed anteriorly with the patient in supine position and posteriorly with the patient in prone position. Sagittal fibular translation was simulated by applying an increasing manual force to the fibula in the sagittal plane: 1) in the supine position, anterior to posterior (SAP), 2) in the prone position, posterior to anterior (PPA), and 3) in the prone position, anterior to posterior (PAP) (Figure 1). The relative position of the fibula and tibia were subsequently measured without force application and then at maximum force application, defined as the end point at which increased force did not result in additional fibular translation. Fibular displacement in cm was thereafter calculated. A linear mixed effect model was built for analysis, wherein subject, examiner, experiment and side were random factors. Results: A total of 34 ankles were included. Mean age was 25.0±5 years and 71% were male. After adjusting for gender and side, the model showed that the application of force led to fibular motion in the sagittal plane for each measurement technique. SAP, coef. 0.06 [0.06-0.07], p-value < 0.001. PPA, coef. 0.04 [0.03-0.05], p-value < 0.001. PAP, coef. -0.16 [-0.17- -0.15], p-value < 0.001. The model also showed similar fibular motion values for left and right measurements, SAP p-value 0.589, PPA p-value 0.236, PAP p-value 0.104. Fibular movement values also were not influenced by gender, SAP p-value 0.348, PPA p-value 0.613, PAP p-value 0.714. Conclusion: Alterations of syndesmotic motion in the sagittal plane can be successfully identified using dynamic ultrasound under stressed conditions. On average, 0.6 mm of A to P translation and 0.4 mm of P to A translation were found. Equivalent translation values between the left and right side in each patient underscores that, in the injured setting, the contralateral ankle may be used as a reliable control. This establishes a normal value for ultrasound examination of the syndesmosis, allowing future studies examining the injured state.
The Ankle-Hindfoot Kinematics of Current Generation Total Ankle Replacement: A Cadaveric Gait Simulation
Authors: Harnroongroj Thos , Sturnick Daniel , Ellis Scott J. , Demetracopoulos Constantine , Deland Jonathan 
Published: October 2019

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) has developed as a standard treatment option for end-stage ankle arthritis with the primary benefit of pain relief and ankle-hindfoot motion preservation. The current generation of TARs features limited bone resection and improved initial fixation of components to restore physiologic constraint and the anatomic articulation of the ankle. However, the ankle-hindfoot kinematics of current TAR designs compared to the baseline native ankle have not yet been extensively studied. Cadaveric gait simulation is a valuable tool for investigating direct effects of surgical procedures on foot and ankle biomechanics. The objective of this study was to assess whether this current generation TAR system could provide normal ankle-hindfoot kinematics as the baseline native ankle using cadaveric gait simulation. Methods: Eleven mid-tibia cadaveric specimens were secured to a static mounting fixture with a six-degree of freedom robotic platform to simulate gait in native-intact and TAR conditions. A force plate was moved relative to the stationary specimen through an inverse tibial kinematic path calculated from in vivo data while extrinsic tendons were actuated using physiologic loads (Figure 1A). Ankle-hindfoot kinematics were measured from reflective markers attached to bones via surgical pins. TAR was performed using a current generation, fixed-bearing system by a fellowship-trained foot-ankle surgeon using the manufacturer described protocol (PROPHECY Patient-specific instrumentation, Infinity, Wright Medical Technology). Ankle-hindfoot joint kinematics were measured using the same tibial kinematic inputs and muscle forces as the intact condition. Non-parametric, bias-corrected bootstrapping was used to calculate 95% confidence intervals to compare motion between intact and total ankle replacement. Results: Analyses demonstrated no significant difference in average ankle-hindfoot joint kinematics between the intact and TAR conditions (Figure 1B). The result was consistent for the ankle, subtalar, and talonavicular joints, in each plane of motion. Conclusion: These findings demonstrate that the current generation of fixed-bearing TAR can recreate normal ankle-hindfoot kinematics patterns seen in normal ankles. Restoring ankle kinematics can be a significant factor in slowing down the progression of adjacent joint arthritis in the foot. However, it is still inconclusive whether ankle-hindfoot kinematics can be restored in patients with long standing ankle arthritis, and this should be addressed in future studies.
Does the Presence of Pes Planus Deformity Increase Recurrence of Hallux Valgus Deformity Following Surgery?
Authors: Heyes Gavin , Swanton Eric , Mason Lyndon , Molloy Andrew P. 
Published: October 2019

Category: Bunion Introduction/Purpose: Factors linked with increased risk of developing Hallux Valgus include; shod footwear, genetic factors, metatarsal morphology, ligamentous laxity and Pes Planus. With regards to Pes planus, it has been suggested that the loss of the medial longitudinal arch in Pes Planus increases Hallux plantar medial pressures and drives deformity during heel rise. There is little in the literature regarding whether Pes Planus is associated with increased recurrence rates. Given this is a potentially modifiable risk factor we believe the risk of recurrence should be studied. This paper reports the results of a retrospective study following up 183 consecutive Hallux valgus cases. The primary objective is to evaluate whether pes planus is associated with increased recurrence following treatment. Methods: Retrospective review of consecutively treated patients from 07/03/2008 to 05/12/2017. Patients were typically followed up for six to twelve months depending on any additional factors that require follow up. X-rays were performed routinely at six weeks, three months and many had x-rays at six and/or 12 months for additional pathology. We examined radiological markers including Sesamoid location (using the Hardy and Clapham Classification), Hallux Valgus Angle (HVA), Intermetatarsal Angle, Meary’s angle and Talonavicular uncovering. 183 cases were reviewed, 12 were excluded due to previously amputated second toes, Hallux Varus, revision surgery and only 6 weeks follow up. This left 171 cases of which 75 had Pes Planus (Meary’s angle < -4°). Results: Table 1 describes the preoperative HVAs we encountered and the correction achieved along with frequencies. Postoperative measurements were taken off weight bearing x-rays. The incidence of recurrent HVA > 15° was significantly higher in those with Meary’s angle < - 4° (Chi-Sq 22.6 P-value 0.000002). Those with a Meary’s angle -20° to -10° had a significantly higher rate of recurrence than ones measuring -10° to -4° (Chi-Sq 9.7 P-value 0.0018 There was no difference in progression of recurrent deformity between those initially corrected to HVA < 15° (Chi-Sq 0.26 P- value 0.61) and those not. Multiple regression analysis revealed there was no meaningful association with sesamoid location or pes planus with recurrence of Hallux Valgus deformity. Conclusion: Our results demonstrate a link between Preoperative Pes Planus deformity and increased recurrence rates of Hallux Valgus deformity following surgery. Consideration of correction of pes planus and appropriate consent of recurrence rates should therefore be undertaken in treatment of hallux valgus in the presence of pes planus
Posterior Approaches to the Ankle: An Analysis of 3 Approaches for Access to the Posterior Distal Tibia
Authors: Heyes Gavin , Philpott Matthew , Jayatilaka Lara , Molloy Andrew P. , Mason Lyndon W 
Published: October 2019

Category: Ankle, Trauma Introduction/Purpose: With the increase in the use of CT scanning and fragment specific fixation for complex ankle fractures, utilisation of multiple surgical approaches has increased. The posterolateral approach has been advocated by many, however in our experience, a large proportion of these fractures are not attainable by this approach. Our aim in this study was to analyse three posterior ankle approaches to find their use and efficacy in accessing the posterior tibia in the fixation of posterior malleolar fractures. Methods: We examined 5 fresh frozen cadaveric lower limbs. Three posterior ankle approaches (posterolateral (PL), posteromedial (PM) and medial posteromedial (MPM) approaches were performed, using a consistent repeatable incision of 7 cm extended proximal from the palpable distal extent of the medial malleolus. In both the PL and PM approaches, the flexor hallucis longus (FHL) was taken medially. In the MPM approach, the access was anterior to tibialis posterior (TP). K-wires were then placed parallel to one another at the 4 extremities of the approach. The ankles were imaged using an image intensifier and the distances measured. Our database of 172 consecutively treated posterior malleolar fractures in our department, was used to analyse the fracture fragment size and compare these fracture patterns to the approaches. The fractures were categorised using the Mason and Molloy classification. Only type 2 and 3 fractures were included, leaving 101 in the study. Results: On radiographic analysis, the type 2B and type 3 fractures incorporate 100% and 83% of the posterior width of the tibia respectively. Considering the PL approach only allows access to 40% of the posterior width of the tibia, another approach is required for these fracture patterns. Only 65% of fractures could be adequately exposed using the PL incision. In comparison, 78% of fractures could be exposed using the PM incision. The MPM incision gave the largest area for access to the posterior tibia, however it did not allow access to the constant posterolateral fragment. Only 35% of patients had posteromedial fractures that could be dealt with using the MPM incision, thus its usage is primarily as a supplementary incision, in conjunction with the PL incision. Conclusion: We conclude that the most commonly used approach (the PL approach) gives the least amount of access to the posterior tibia. In comparison to fracture fragment size, almost half of fractures would not be adequately exposed through the PL approach, and if fixing such fractures the surgeon should be comfortable with multiple approaches.
A Prospective Randomized Controlled Trial Comparing Physical Therapy with Independent Home Stretching for Plantar Fasciitis
Authors: Kaiser Philip B. , Crawford Alexander M. , Bluman Eric M. , Smith Jeremy T. , Chiodo Christopher P. 
Published: October 2019

Category: Hindfoot, Heel pain, plantar fascia Introduction/Purpose: Physical therapy (PT) is an effective treatment modality for patients with plantar fasciitis (PF) however it is unclear how this compares to a home-based plantar fascia-stretching (HS) protocol. We hypothesized there would be no difference in pain scores or clinical outcomes in patients treated with formal PT compared to those who performed HS. Methods: Fifty-seven patients with PF for at least three months were enrolled in a prospective randomized controlled trial comparing formal PT, using any and all modalities deemed clinically necessary, to a standardized HS protocol. Pain scores using a visual analog scale (VAS) and clinical patient reported outcomes including the Foot and Ankle Ability Measures (FAAM) and the Short Form (36) Health Survey (SF-36) were recorded and analyzed at 6 weeks, 3 months, 6 months, and 1 year after treatment commenced. Results: There were no significant differences in pain scores (VAS) or patient reported outcomes (FAAM and SF-36) at any follow-up time point between patient groups. At 6-months pain scores had improved in both the HS group (35% decrease, p<0.001) and PT group (26% decrease, p=0.002) relative to baseline without a significant intergroup difference (p=0.32). FAAM- activities of daily living (ADL) scores improved 13.0% (p=0.005) in the HS group and 21.3% (p<0.001) in the PT group at 6-months relative to baseline without a significant intergroup difference (p=0.84). The Physical Component Summary (PCS) Scores of the SF- 36 demonstrated improvement at the six week, three month, and one year time points in both groups. Conclusion: A home-based stretching therapy program demonstrated equivalent improvements in pain scores and clinical outcomes compared to formal PT in the treatment of PF. Most patients with PF who perform daily plantar fascia stretching exercises can expect substantial durable clinical improvement in their symptoms.
The Augmentation Technique for Anatomical Reduction of Shortened Lateral Ligament Complex in Modified Broström Procedure
Authors: Kang Chan , Lee Gi Soo , Lee Jeong-kil , Ahn Ki Jun , Hwang Sung Jin , Park Young Cheol , Chung Hyung Jin , Song Jae Hwang 
Published: October 2019

Category: Ankle, Sports Introduction/Purpose: The modified Broström procedure(MBP) is clinically standard surgical treatment of lateral ankle instability with or without subfibular ossicle. But if there is a large ossicle or distal malposition of lateral ligament complex(LLC), it can result in a lack of remnant ligamentous tissue and leave gap that may not be approximated. Thus, we have proposed an augmentation technique for anatomical reduction of shortened LLC in MBP and evaluated radiologic and clinical findings. Methods: From December 2013 to February 2018, fifty two of fifty six patients who had shortened LLC treated with the augmentation technique with MBP using absorbable suture material. LLC(anterior talofibular ligament(ATFL) and calcaneofibular ligament(CFL)) was exposed after inferior extensor retinaculum(IER) was incised. Then, we identified shortened LLC. Then, we incised just distal part of connecting soft tissue of ATFL and CFL additionally for reduction to anatomic footprint. After confirmation of reduction, 4 or 5 bone tunnels were made and deep fiber of LLC was repaired tightly with foot in neutral dorsiflexion and 5° eversion by using horizontal mattress and simple stitch. Then, superficial fiber with capsule of LLC was repaired by priorly tied suture without cutting. Finally, IER was reinforced. Results: Mean AOFAS scores improved from 59.2 to 91.4 at final follow-up. Mean Karlsson scores also improved from 61.3 to 89.5 at final follow-up. Mean talar tilt angles were 13.4° preoperatively and 5.8° postoperatively. Mean anterior talar translations were 9.1 mm preoperatively and 5.7 mm postoperatively. There was significant improvement between preoperative & final follow- up in all parameters (all p < .05). During follow up, no clinical symptom like experience of instability or irritation of skin were encountered after surgery, and no patient underwent revision lateral ligament surgery. Conclusion: Augmentation technique of LLC flap in MBP enabled anatomical reduction of shortened LLC to footprint, and provided good clinical and radiographic outcomes. If further comparative and mechanical study is supported, this technique would be a good treatment option.
The Effect of Medial Displacement Calcaneal Osteotomy on Tarsal Tunnel Volume
Authors: Kim Jae Young , Chun Dong-II , Cho Jaeho , Yi Young 
Published: October 2019

Category: Hindfoot Introduction/Purpose: Tarsal tunnel volume is affected by position of the foot and the alignment of the ankle. Although medial displacement calcaneal osteotomy (MDCO) significantly alters the alignment of the hindfoot, the change of tarsal tunnel volume after this procedure has not yet been well documented. Therefore, authors investigated the volumetric change of tarsal tunnel after MDCO using Computed Tomography (CT) scan. Methods: This retrospective study involved 101 feet of 91 patients who underwent a MDCO at our institution from March 2016 to December 2018. We compared the tarsal tunnel volume from the preoperative and postoperative CT scan images under following protocols. On a sagittal scout image, the oblique axial plane was drawn parallel to the long axis of the calcaneus using talonavicular joint as a landmark. Serial oblique axial images were displayed using PACS (PathSpeed, GE Healthcare, Chicago, IL, USA) with both the soft tissue and the bone window settings. The volume of tarsal tunnel was evaluated from just distal to the tip of medial malleolus anterior colliculus to distance of 3 cm distal using 10 consecutive images by drawing the border of tarsal tunnel. The volume was calculated by adding 10 cross-sectional areas and then multiplying by 3 mm corresponding to slice thickness. Results: The mean preoperative and postoperative tarsal tunnel volume were 12229 mm3 (SD, 1842 mm3) and 12762 mm3 (SD, 1803 mm3), respectively. There was 4.6% (SD, 3.4%) of volume increase after MDCO (p <0.001). Results indicated high inter- and intraobserver reliability coefficients (r = 0.97, r = 0.98, respectively). Conclusion: MDCO increased the volume of tarsal tunnel. This finding might support clinicians performing MDCO as a conjunctive surgical option in treating patients with tarsal tunnel syndrome.
Result of Short Leg Cast or Short Leg Splint for Chronic Open Wound over Lateral Malleolus
Authors: Kim Ki Chun , Lee Kyung Tai , Young Ki-Won , Sung Hoon , Kim Jin Soo , Lee Young Koo , Park Young Uk , Lee Hong-Seop , Kim Jae Woo , Jegal Hyuk 
Published: October 2019

Category: Ankle Introduction/Purpose: Chronic open wound(COW) over lateral malleolus(LM) is hard to manage for high recurrence rate. Characteristic bone to skin structure of LM is vulnerable to pressure or shear force causing bursitis or ulcer leading to bone exposure in some cases. In resting state, ankle is slightly plantar flexed and varus position, so the skin over LM receives tension. This unfavorable condition for vascularity and pressure endurance could be worse when patients have sensory loss, vascular impairment or paraplegia. We hypothesized short leg cast (SLC) or short leg splint (SLS) keeping ankle in neutral position relieves skin tension and reverse this unfavorable condition leading to wound healing. Methods: Between July, 2014 and November, 2018, fifteen patients with COW over LM were included. Infection was accompanied by twelve. Seven patients were diagnosed diabetic foot. Seven patients could not move their affected limb actively due to paraplegia or weakness. Firstly, Vascular evaluation and management was done for ischemic patients. For all patients, repeated debridement for necrotic and infected tissue was done at intervals of two or three days until the viable wound was present. Negative pressure wound therapy(NPWT) was added in non-viable wound cases. SLC or SLS followed these procedures till wound healing. Removable SLS was kept for the patients who could not control lower limb such as paraplegia or weakness after wound healing. Results: Wound healing was achieved in 14 cases(93.3%). It took average 51.4±40.2 days for wound healing. One patient did not succeed in wound healing resulting in below knee amputation because of infection aggravation. There was no recurrence in all wound healed patients. Conclusion: Repetitive COW over LM could be healed using SLC or SLS and the healed wound kept its state with removable SLS. It is considered that conservative treatment for Repetitive COW over LM with SLC or SLS is another favorable treatment option.