bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arthroscopic Repair of Lateral Ankle Ligament for Chronic Lateral Ankle Instability: A Systematic Review and Meta-Analysis
Authors: Shimozono Yoshiharu , Brown Alexandra J , Hurley Eoghan T , Kennedy John G 
Published: October 2019

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Open modified Broström-Gould procedure is generally accepted as the gold-standard treatment for chronic lateral ankle instability. Recently an arthroscopic lateral ankle ligament repair technique has become increasingly popular in an effort to reduce post-operative pain and facilitate early recovery. The purpose of the current systematic review was to evaluate the current evidence on arthroscopic lateral ankle ligament repair techniques and to compare the clinical outcomes of arthroscopic and open techniques for chronic lateral ankle instability with meta-analysis. Methods: A systematic search of MEDLINE and EMBASE databases was performed during August 2017. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Variable reporting outcome data, clinical outcomes, and percentage of patients who returned to sport at previous level were also evaluated. Comparative studies were compared using RevMan version 5.3, and a p-value of < 0.05 was considered statistically significant. Results: Twelve studies for a total of 421 ankles were included; 92% of studies were LOE III or IV and the QOE in all studies was of poor or fair quality. There were three comparative studies of open and arthroscopic repair procedures, with two Level III studies and one Level I study. There was a significant difference in favor of arthroscopic repair at final follow-up for the Karlsson- Peterson score (MD; 2.59, 95%CI, -0.19 to 2.36, I2=0%, p=0.10) and the AOFAS score (MD; 1.50, 95%CI, 0.41 to 2.59, I2=0%, p=0.007) in the comparative studies. The overall complication rate was 13.4% in the included studies but in the comparative studies there was no statistically significant difference between open and arthroscopic repair (12.1% vs 11.4%, p=0.90). Conclusion: The current systematic review demonstrated that arthroscopic lateral ankle ligament repair may yield favorable clinical outcomes and may be superior to open procedure in the short-term, but there is no clinical evidence to support the advantages of the arthroscopic procedure over the open procedure in the mid- long-term follow-up. There was a relatively high complication rate associated with the arthroscopic procedures, with a 13.4% complication rate, although recent comparative studies demonstrated similar complication rates.
Mid-Term Outcomes of Bone Marrow Stimulation for Primary Osteochondral Lesions of the Talus: A Systematic Review
Authors: Shimozono Yoshiharu , Toale James , Mulvin Conor , Dahmen Jari , Kerkhoffs Gino MMJ , Kennedy John G 
Published: October 2019

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Arthroscopic bone marrow stimulation (BMS) is the most common reparative surgical intervention in the treatment of small osteochondral lesions of the talus (OLT). BMS has shown favorable short term clinical outcomes but several recent studies have shown less satisfactory results in the mid- to long-term due to fibrocartilagenous repair tissue deterioration over time following BMS. However, conflicting results with good mid- to long-term outcomes following BMS have been reported. There is still a lack of evidence on the success rates of BMS at mid-term and longer-term follow-up. The purpose of this systematic review was to evaluate the clinical evidence of mid- to long-term outcomes following BMS for the treatment of OLT. 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. Methodological quality of evidence was decifered using the Modified Coleman methodology score (MCMS). Studies reporting outcomes of BMS for primary ostechndral lesions at a minimum 4-year follow-up were included. Clinical outcomes, radiological outcomes, and reported data were evaluated. Results: Fifteen studies containing 853 patients (858 ankles) were included at a weighted-mean follow-up time of 71.9 (48-141) months. The mean age was 35.3 (24.7-41.9) and the mean lesion size was 110.5mm2 (87-140). Nine studies (60%) used the AOFAS ankle hindfoot score with a weighted-mean postoperative score of 89.9 (78.4-91.8). Six studies showed both pre and post-operative AOFAS scores and showed a weighted-mean improvement of 24.5 (16-38.5). Four studies utilised the VAS score. The weighted-mean postoperative VAS scores were 2.4 (1.8-2.6). Three studies (20%) measured post-opeartive MRI at mid-term using the MOCART score and showed 48% complete filling, 74% complete integration, 76% surface damage, and 78% inhomogeneous repair tissue. Complication rate was 3.2% and reoperation rate was 6% following BMS at mid-term. Conclusion: This systematic review found good clinical outcomes following BMS for primary OLT at mid-term follow-up based on the AOFAS score. The complication rates were relatively low and the data showed a reoperation rate of 6% at mid-term. However, the radiological and MRI outcomes did not show similarly positive results, which may lead to recurrence and reoperation at long-term. Data were variable and numerous aspects largely under-reported in the literature relevant to the systematic review. Further high quality studies, a validated outcome scoring system and further MRI reports are required to accurately assess the success of BMS at mid-term.
Risk Factors for Periprosthetic Joint Infection Following Total Ankle Replacement
Authors: Smyth Niall A. , Kennedy John G. , Schon Lew C. , Parvizi Javad , Aiyer Amiethab A. 
Published: October 2019

Category: Ankle, Ankle Arthritis Introduction/Purpose: A major complication of total ankle replacement (TAR) is a periprosthetic joint infection (PJI). The reported rate of this complication ranges between 2.4 – 8.9%. Identifying preoperative patient characteristics that correlate with an increased risk of PJI is of great interest to orthopaedic surgeons, as this may assist with appropriate patient selection. The purpose of this study is to systematically review the literature to identify risk factors that are associated with PJI following TAR. Methods: Utilizing the terms “(risk factor OR risk OR risks) AND (infection OR infected) AND (ankle replacement OR ankle arthroplasty)” we searched the PubMed/MEDLINE electronic databases. Using the PRISMA guidelines, studies were selected for inclusion if they assessed clinical risk factors for developing a PJI following TAR. In addition, the reference lists of included studies were also reviewed and compared to the collected studies to ensure that no pertinent papers were omitted. The quality of the included studies was then assessed using the American Academy of Orthopaedic Surgeons Clinical Practice Guideline and Systematic Review Methodology. Recommendations were made using the overall strength of evidence. Results: Eight studies met the inclusion criteria, totaling 12,704 patients who underwent a TAR. A limited strength of recommendation can be made that the following preoperative patient characteristics correlate with an increased risk of PJI following TAR: inflammatory arthritis, prior ankle surgery, age greater than 65 years, body mass index less than 19, peripheral vascular disease, chronic lung disease, hypothyroidism, and low preoperative AOFAS hindfoot scores. There is conflicting evidence in the literature regarding the effect of obesity, tobacco use, diabetes, and duration of surgery. Conclusion: Several risk factors were identified as having an association with PJI following TAR. These factors may alert surgeons that a higher rate of PJI is possible. However, because of the low level of evidence of reported studies, only a limited strength of recommendation can be ascribed to regard these as risk factors for PJI at this time.
The Effect of Immobilization Devices on Contact Pressures of the Ankle and Hindfoot
Authors: Smyth Niall A. , Abbasi Pooyan , Netto Cesar de Cesar , Michnick Stuart M. , Casscells Nicholas D. , Parks Brent G. , Schon Lew C. 
Published: October 2019

Category: Ankle, Hindfoot Introduction/Purpose: The tall Controlled Ankle Motion (CAM) boot and the short CAM boot are commonly used devices to immobilize the foot and ankle. These devices are preferably used instead of casts and splints as they are easily removed, allowing possible wound examination, personal hygiene, and therapeutic exercises. However, the effect of these devices on joint contact pressures is unknown. The aim of this study is to assess the effect of the tall CAM boot and short CAM boot on contact pressures of the ankle, subtalar, talonavicular, and calcaneocuboid joints. We hypothesize that both the tall CAM boot and short CAM boot will reduce contact pressures of the ankle and hindfoot joints, with the tall CAM boot having the greatest effect. Methods: Eight lower extremity cadaver specimens were mounted on a servohydraulic test frame. The specimens were loaded to 700 N at a cyclical frequency of 1 Hz with the posterior tibial, peroneus longus, peroneus brevis, flexor hallucis longus, flexor digitorum longus, and Achilles tendon physiologically tensioned. TekScan (TekScan, Boston, MA) pressure sensors were placed in the ankle, subtalar, talonavicular, and calcaneocuboid joints. In the sagittal plane, the specimens were loaded on a neutral surface, followed by 20o of dorsiflexion. Each specimen served as its own control, with contact pressures measured with no immobilization (control), followed by placement in a short CAM boot and tall CAM boot. In addition, contact pressures in the immobilized limbs were measured at muscle loads both equal to and half of the load applied to the control in order to account for decreased muscle activation during immobilization. Results: There was no difference in the average and peak contact pressures of the ankle, subtalar, talonavicular and calcaneocuboid joints when comparing the short CAM boot to no immobilization at equal tendon loads. The tall CAM boot significantly decreased average and peak contact pressures of the ankle, subtalar, and talonavicular joints when compared to no immobilization. The reduction in contact pressures was accentuated when the load applied to the tendons was decreased in accordance with diminished muscle activation during immobilization. Neither immobilization device decreased the contact pressures of the calcaneocuboid joint at equal tendon loads. Conclusion: Immobilization in a tall CAM boot decreases contact pressures of the ankle and hindfoot in both a neutral position and in dorsiflexion. A tall CAM boot should be used clinically if the goal of its use is to maximally reduce contact pressures of the ankle and hindfoot.
Adjacent Joint Arthrodesis Risk After First Metatarsophalangeal Joint Arthrodesis: A 10 Year FollowUp Study
Authors: Teoh Kar , Gonzi Gianluca 
Published: October 2019

Category: Midfoot/Forefoot Introduction/Purpose: Arthrodesis remains the gold standard for end stage symptomatic first metatarsophalangeal (MTP) joint osteoarthritis. Based on several ankle arthrodesis studies, it is well known that adjacent joints are put under more stress leading to secondary osteoarthritis. However, the direct association between first MTPJ arthrodesis and the progression of adjacent joint arthrosis remains unclear. The purpose of this study was to determine the progression of interphalangeal (IPJ) and 1st tarsometarsal joint (1st TMT) degeneration following first MTP joint arthrodesis. Methods: All patients treated with first MTP joint arthrodesis from 2003 to 2008 were identified from our regional centre. Data was obtained from our institution’s electronic clinical workstation which included demographic information, radiographs and clinical letters. A telephone survey with a predetermined written script was carried out in patients as we were not able to obtain ethics to perform repeat radiographs. Results: A total of 166 first MTPJ arthrodesis were included with at least 10 year follow-up. We excluded patients who have moved out of region. There was a 3:1 female to male ratio, with an average age at time of operation being 63 (27- 83). 25% of the patients reported adjacent joint pain (15% at IPJ, 10% at 1st TMTJ) at final follow up. 3 (1.8%) patients required arthrodesis of adjacent joints (1 at IPJ, 2 at 1st TMTJ). Conclusion: This study improves the understanding of biomechanical impact on the foot following 1st MTPJ fusion and is helpful in the consenting process.
Revision Arthrodesis of the Subtalar Joint
Authors: Tracey Joseph , Taghavi Cyrus , Li Shuyuan , Myerson Mark 
Published: October 2019

Category: Hindfoot Introduction/Purpose: Subtalar arthrodesis is an invaluable tool in managing arthritis, deformity, and muscular imbalance of the hindfoot. However, failed arthrodesis is complicated by bone necrosis, sclerosis with loss of bone, less than ideal biologic settings, and the literature reports a high rate of non-union. The aim of this study was to review all subtalar arthrodeses performed within a single institution, and specifically describe the management of non-union. Methods: 492 consecutive subtalar arthrodesis cases were retrospectively analyzed between October 2001 and July 2013. From the primary arthrodesis group 91 (18%) were treated for subtalar coalition (100% arthrodesis), and were excluded to better depict the arthrodesis rate; the remaining 401 patients were treated primarily for post-traumatic arthritis. Pertinent demographics, comorbidities, and clinical notes were all retrieved through the electronic medical record and radiographs were reviewed through a PACS system. Results: 49 patients with a mean age of 49 years (range 23 - 80) presented with subtalar non-union (overall rate 10%, adjusted rate 18%). 41 (84%) underwent revision at a mean of 16.2 months (range 2.8 - 57.1) from the index arthrodesis. The rate of revision arthrodesis was 78%, 21/30 (70%) in situ arthrodeses, 7/7 bone block arthrodesis (p=.028), and 4/4 triple arthrodesis (p=.028). Arthrodesis was present at a mean of 3.4 months (range 1.6 - 7.6). 4/9 (44%) of the recurrent nonunions elected to abstain from surgery. Of the 5 remaining patients, 2/5 had a successful third attempt at arthrodesis, 1/5 had an additional nonunion followed by a successful fourth attempt at arthrodesis, 1/5 had a successful tibiotalocalcaneal arthrodesis, and 1/5 required a below-knee amputation. Conclusion: Risk factors identified for non-union were post-traumatic arthritis, ipsilateral ankle arthrodesis, and individual patient factors (smoking, diabetes, and infection). Different methods of screw fixation were not found to be significantly different between the fused and nonunion groups. Despite directed management to obtain rigid fixation and adequate compression, the rates of subtalar arthrodesis from primary (82%), revision (78%) and secondary revision (60%) cases were very poor with the exception of the group which underwent a bone block arthrodesis (100%, p=.028).
The Impact of Metabolic Syndrome on 30-day Outcomes Following ORIF for Ankle Fractures
Authors: Xie Jack , Malik Azeem Tariq , Quatman Carmen E , Ly Thuan V. , Phieffer Laura , Khan Safdar N 
Published: October 2019

Category: Ankle, Trauma Introduction/Purpose: Metabolic syndrome (MetS) has been shown to be associated with significant post-operative morbidity. Despite an increasing prevalence of MetS in the US population, it’s impact on post-operative outcomes following ankle fractures remains limited. Methods: The 2012-2016 ACS-NSQIP database was used to query for patients undergoing ORIF for ankle fractures using Current Procedural Terminology (CPT) codes – 27766, 27769, 27792, 27814, 27822 and 27823. Patient undergoing surgery for polytrauma were excluded from the analysis. Records were further filtered to remove patients with missing data. The study cohort was divided into two groups – MetS vs. No MetS. MetS was identified using a pre-defined criteria, used previously in other studies, as the co-existence of 1) Diabetes Mellitus, 2) Hypertension and 3) BMI =30 kg/m2. Results: A total of 1,013 (6.7%) MetS underwent ORIF for ankle fractures. Following adjustment for differences in baseline demographic, co-morbidities, pre-operative and operative data, MetS was an independent predictor of experiencing any 30-day complication (OR 1.35 [95% CI 1.05 -1.74]; p=0.020), wound complications (OR 1.67 [95% CI 1.07-2.60]; p=0.024), renal complications (OR 3.54 [95% CI 1.20-10.48]; p=0.022), 30-day readmissions (OR 1.66 [95% CI 1.24-2.22]; p=0.001), 30-day unplanned re-operations (OR 1.69 [95% CI 1.14-2.51]; p=0.009). MetS was significantly associated with decreased odds of home discharge (OR 0.66 [95% CI 0.54-0.79]; p<0.001). Conclusion: Patients with MetS undergoing ORIF for ankle fractures are at an increased risk of experiencing adverse complications, re-admissions and re-operations within 30-days of the surgery. Providers should understand the need of appropriate post-operative surveillance in this high-risk group to minimize the risk of poor outcomes.
Reconstruction of Calcaneal Fracture Malunion with Osteotomy and Subtalar Joint Salvage
Authors: Zhang Mingzhu , Yu Guangrong 
Published: October 2019

Category: Hindfoot Introduction/Purpose: The goal of this study was to discuss the outcomes of treating calcaneal fracture malunion by restoring the subtalar joint with a reconstructive osteotomy. Methods: From May 2005 to November 2016, 85 patients (88 feet) with calcaneal malunions after a displaced intraarticular calcaneal fracture were treated by osteotomy and autogenous bone graft. The subtalar joint was preserved. The mean time from initial injury to reconstructive operation was 8.9 months (95% confidence interval, 4.5-11.6 months). The displaced posterior facet was restored through a reconstructive osteotomy, whereas the bone defect in the calcaneus after reduction was filled with the lateral exostosis that had been removed, iliac bone graft was used if necessary. All patients were evaluated clinically and radiographically at a minimum of 24 months. Sixty two patients (63 feet) were followed for a mean of 45.4 months (29.0-52.3 months). Results: According to American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, the average score was 81.6 points (95% confidence interval, 78.5-90.4 points), which was significantly higher than the preoperative assessment. Radiographs showed that Böhler’s angle, Gissane’s angle, talus declination angle, and width and height of calcaneus were improved to a great extent. Eight patients had wound edge necrosis, and 4 had superficial infection. Two patient required a subtalar fusion for subtalar arthritis at 2 years after surgery. Conclusion: Restoring the subtalar joint with a reconstructive osteotomy and autogenous bone graft was an effective treatment method for selected calcaneal fracture malunions. It reconstructed calcaneal morphology and preserved the subtalar joint.
Doctor YouTube: A Quality Analysis Of Medical Information Videos On The Video Platform YouTube On Ankle Sprain
Authors: Zyskowski Michael , Pesch Sebastian , Greve Frederik , Matthey Francesca von , Wurm Markus , Zapf Julian , Biberthaler Peter , Kirchhoff Chlodwig 
Published: October 2019

Category: Ankle, Sports, Trauma Introduction/Purpose: The video portal YouTube has evolved from pure entertainment to professional and semi-professional video tutorials and medical video channels in the recent past. As a result, YouTube today is a source of information that is widely used by patients and relatives. Ankle sprains are one of the most common musculoskeletal injuries, this study was designed to analyze the quality of informational videos available on YouTube and to identify potential hazards as well as content errors. Methods: In July 2016, YouTube was searched for the terms “ankle sprain”, “high ankle sprain”, “ankle pain” and “ankle pain distortion”. The analysis was limited to the first 5 result pages for each search term. Only English and German videos were included. The videos were found by 2 independent evaluators (MZ, SP) using a multi-dimensional score checklist for the sections anatomy, risk factors and symptoms (max 8 pts), biomechanics (max 3 pts), imaging (max 2 pts), clinical examination (max 6 pts), treatment (max 5 pts), rehabilitation measures (max 2 pts) and prevention (max 2 pts) with a maximum scores per contribution of 31 pts evaluated. Results: The mean score of the video quality was 11.5 ± 4.5 pts. Distribution of points by subgroup: anatomy, risk factors and symptoms 3.7 ± 1.4, biomechanics 1,8 ± 1.2, imaging 0.9 ± 0.8, clinical examination 1.3 ± 1.2, treatment 2 ± 1.3, rehabilitation 1.1 ± 0.9, prevention 0.6 ± 1. No evaluated contribution achieved “very good” Quality Assessment Score of 25-31 pts, one video was rated ”good” with 21-26 pts, 2 videos were “satisfactory” (20-16 pts), 14 videos ”sufficient” (15-10 pts.). 7 videos were rated as “insufficient” (9-4 pts). One clip (2.5 pts) was rated as a promotional video. A slight correlation between views by videos and score (r = 0.11) and a small correlation between the total score and Likes occured (r = 0.15). Conclusion: Patients watching online video tutorials on ankle injuries are seeking valid information. YouTube gives an extensive video footage of low quality. The defective and incorrect information analyzed by us must be corrected by medical advice. Furthermore, the presented investigation shows an average to bad quality so that the introduction of a seal of approval by the AOFAS for digital content, based on an evidence-based quality control should be discussed in the future.