bluuebunny/crossref_metadata_2025_split huggingface dataset:
Osteochondral Autograft Transplant as a Potential Salvage Procedure for Articular Cartilage Defects of the Lateral Compartment in Lateral Meniscus–Deficient Knees: Results From a Country With Limited Availability of Meniscal Transplant
Authors: Nishitani Kohei , Nakagawa Yasuaki , Matsuda Shuichi 
Published: November 2020

Background: The treatment of a meniscus-deficient knee is challenging, especially when patients are young and active and are not favorable candidates for prosthetic joint replacement. Hypothesis: We hypothesized that osteochondral autologous transplant (OAT) alone can be considered a salvage treatment for patients with cartilage damage of the lateral compartment of the knee, even with lateral meniscal deficiency, if the knee alignment is close to neutral. Study Design: Case series; Level of evidence, 4. Methods: Patients with lateral meniscal deficiency, whose femorotibial angle was 170° to 180° and who underwent OAT on the lateral compartment of the knee without concomitant realignment osteotomy, were retrospectively included in this study. The International Knee Documentation Committee (IKDC) subjective score and the Japanese Orthopaedic Association score for knee osteoarthritis (JOA knee score) were recorded. The International Cartilage Repair Society (ICRS) cartilage repair assessment was used to evaluate the repaired cartilage at second-look arthroscopy. Results: The study included 10 patients (mean ± SD age, 31.7 ± 19.7 years; 3 men and 7 women) who had ICRS grade 4 cartilage lesions (mean size, 3.5 ± 1.7 cm2); the mean follow-up was 73.8 ± 42.5 months. From preoperative assessment to final follow-up, the mean IKDC subjective score improved significantly from 53.5 ± 10.0 to 85.4 ± 10.1, and the mean JOA knee score improved significantly from 81.0 ± 8.4 to 95.6 ± 5.3 ( P = .004 for both). One patient with a femorotibial angle of 170° underwent revision distal femoral osteotomy owing to prolonged symptoms and progression of the valgus deformity, and 2 other patients with femorotibial angles of 170° and 171° also exhibited progression of valgus malalignment or low clinical scores postoperatively. Patients with a favorable femorotibial angle (174°-178°) exhibited relieved symptoms and preservation of femorotibial angle alignment within 1° of change at follow-up. At second-look arthroscopy (n = 8 patients), 6 patients had an ICRS score of nearly normal or normal. Conclusion: In the study patients, for which a meniscal allograft was unavailable, the OAT procedure was able to relieve the symptoms associated with cartilage lesions, even with lateral meniscal deficiency, when the femorotibial angle alignment was close to neutral.
Development of cardiotoxicity model using ligand-centric and receptor-centric descriptors
Authors: Patel Chirag N , Kumar Sivakumar Prasanth , Rawal Rakesh M , Thaker Manishkumar B , Pandya Himanshu A 
Published: November 2020

Background: Bioinformatics and statistical analysis have been employed to develop a classification model to distinguish toxic and non-toxic molecules. Aims: The primary objective of this study is to enumerate the cut-off values of various physico-chemical (ligand-centric) and target interaction (receptor-centric) descriptors which forms the basis for classifying cardiotoxic and non-toxic molecules. We also sought correlation of molecular docking, absorption, distribution, metabolism, excretion, and toxicology (ADMET) parameters, Lipinski rules, physico-chemical parameters, etc. of human cardiotoxicity drugs. Methods: A training and test set of 91 compounds were applied to linear discriminant analysis (LDA) using 2D and 3D descriptors as discriminating variables representing various molecular modeling parameters to identify which function of descriptor type is responsible for cardiotoxicity. Internal validation was performed using the leave-one-out cross-validation methodology ensuing in good results, assuring the stability of the discriminant function (DF). Results: The values of the statistical parameters Fisher Discriminant Analysis (FDA) and Wilk’s λ for the DF showed reliable statistical significance, as long as the success rate in the prediction for both the training and the test set attained more than 93% accuracy, 87.50% sensitivity and 94.74% specificity. Conclusion: The predictive model was built using a hybrid approach using organ-specific targets for docking and ADMET properties for the FDA (Food and Drug Administration) approved and withdrawn drugs. Classifiers were developed by linear discriminant analysis and the cut-off was enumerated by receiver operating characteristic curve (ROC) analysis to achieve reliable specificity and sensitivity.
Total Ankle Arthroplasty: Risk Factors For Subsequent Flap Coverage
Authors: Cunningham Daniel J. , Ryan Sean , Adams Samuel B. 
Published: November 2020

Category: Ankle Arthritis; Ankle; Diabetes Introduction/Purpose: Total ankle arthroplasty (TAA) results in improved patient outcomes and preserved range of motion for patients with end-stage arthritis. Wound complications following these procedures, while rare, can have a significant impact on patient morbidity, particularly when they require return to the operating room and flap coverage. We sought to determine the risk factors associated with the need for flap coverage over TAA, and hypothesized that intraoperative variables such as additional procedures to provide angular correction would play a more important role than patient-specific variables. Methods: We performed a single center retrospective review of primary total ankle arthroplasties from April 2007 - February 2019. Patients demographics and medical comorbidities were collected in addition to concomitant procedures performed at the time of TAA such as tibial osteotomies, removal of hardware, and subtalar fusion. Multivariable, main effects logistic regression models were performed to evaluate the impact of specific concomitant procedures during primary TAA on the rate of subsequent flap coverage with adjustment for age, sex, and medical comorbidities. Results: 2,124 TAA resulted in 29 flaps after an average of 1.1 (range 0-5) surgeries and 89.7 (range 18-591) days after the index arthroplasty. The most common flap was a radial forearm free flap performed in 15 (51.7%) patients. Patients requiring flap coverage were significantly older (p=0.044), were more likely to be diabetic (p=0.029), and were more likely to present to the ED and be readmitted within 90-days of their surgery (p<0.001). In a multivariable model controlling for age, gender, and diabetes diagnosis, patients with flaps were more likely to have a concomitant osteotomy (OR 3.720, 95% CI 1.693-8.177; p=0.001) at the time of there TAA. Other concomitant procedures did not show a significant association with subsequent need for flap coverage. Conclusion: Simultaneous procedures during TAA may place patients at higher risk of wound breakdown, specifically requiring flap coverage. In particular, osteotomies, namely tibial osteotomies for realignment, carry a special risk for wound healing difficulty. This should be considered as the indications for TAA continue to expand. [Table: see text]
Portable Dynamic Ultrasonography Versus Fluoroscopy for the Evaluation of Syndesmotic Instability: A Cadaveric Study
Authors: Hagemeijer Noortje , Lubberts Bart , Saengsin Jirawat , Bhimani Rohan , Sato Go , Waryasz Gregory R. , Kerkhoffs Gino , DiGiovanni Christopher W. 
Published: November 2020

Category: Ankle; Trauma Introduction/Purpose: Syndesmotic instability, when subtle, is challenging to diagnose and often requires visualization of the syndesmosis during applied stress. The purpose of this study was to determine the association between tibiofibular clear space (TFCS) values measured with 1) a portable ultrasound (US) device and 2) fluoroscopy during applied external roation stress for the evaluation of syndesmotic instability. Methods: Eight fresh lower leg cadaveric specimen amputated above the proximal tibiofibular joint were used in this study. Portable US device (Butterfly iQ, Butterfly Network Inc) images and fluoroscopic images taken by a mini C-arm were used to evaluate the ankle syndesmosis in the intact stage, and after sequentially sectioning of the anterior-inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), and posterior-inferior tibiofibular ligament (PITFL) at 7.5Nm torque. A Pearson’s correlation was performed to investigate the correlation between the TFCS among the two modalities. A paired t-test was used to compare TFCS values measured with US or fluoroscopy. Three cadavers were measured by two independent observers to assess reliability of the measurements for each diagnostic modality and analyzed using intraclass correlation coefficients (ICC). P-values of < 0.05 were considered significant. Results: The mean TFCS (+- SD mm) values measured with the US and fluoroscopy are presented in Table 1. TFCS values obtained with the US and fluoroscopy correlated (rho 0.60). Between the imaging modalities similar TFCS values were found in the intact state (difference 0.81+-1.0, p-value 0.061). Compared with fluoroscopy, the TFCS values measured using US increased significantly after sequential transection of the AITFL (0.039), IOL (p=0.004) and PITFL (p<0.001). The ICC for measuring the TFCS with US was 0.86 and 0.84 with fluoroscopy indicating excellent agreement. Conclusion: During application of an external rotation force to the ankle, US and fluoroscopic TFCS measurements among different stages of syndesmotic ligamentous injury correlate. However, compared with fluoroscopy, a portable US ultrasound device seems to be a more sensitive diagnostic technique to evaluate subtle syndesmotic instability. [Table: see text]
Robotic Arm Assistances in the Foot and Ankle Surgery: A Prospective Study
Authors: Angthong Chayanin 
Published: November 2020

Category: Other; Ankle; Trauma Introduction/Purpose: Little is known about the robotic assistance in the foot and ankle surgery. The present study was to report the robotic arm innovation and its utilization in the foot and ankle surgery. Methods: The robotic arm has been developed to serve for the tasks in foot and ankle surgery. This robot was called as ‘Limb- lifting assistance via robotic arm (LARA)’. It was designed to be a strong base with up and down movement of the trunk using the controller with safe level of electricity to lift its arm to support the ankle or leg during the perioperative period as the surgeon demanded as an attached picture. LARA was prospectively applied in the healthy volunteer and patients with foot and ankle diseases or injuries. The satisfaction levels were collected from the patient and user regarding LARA application. The physical and mental effort levels were also collected from the user during the use of LARA. The related complications were collected in all patients. Results: There were no reported complication from the healthy volunteer. Froma total of 10 patients, there was a scratch at the skin of one patient’s ankle area but it was no need of treatment. Other 9 patients did not report the related complication from the LARA. There was no difference of significant complication between the healthy volunteer and the patients. Based on the data availability, the mean physical and mental effort levels were 5 from 100 (highest level = 100; lowest level = 0). The mean satisfaction level was 100 and 90 from the patient and user perspectives (highest = 100; lowest = 0) respectively. Conclusion: Based on the results of this study, LARA was safe and effective to apply in the perioperative use for the foot and ankle surgeries with low-level of human user effort in both physical and mental aspects.
Outcome of Bunion Correction with First Tarsometatarsal Arthrodesis in Adult Acquired Flatfoot Deformity Correction
Authors: Bemenderfer Thomas B. , Boersma Jacob B. , Pryor Michael J. , Maskill John D. , Bohay Donald R. , Anderson John G. 
Published: November 2020

Category: Bunion; Hindfoot; Midfoot/Forefoot Introduction/Purpose: Arthrodesis of the first tarsometatarsal (TMT-1) joint is a widely accepted procedure for treatment of hallux valgus (HV) with medial column instability secondary to unstable first ray, midfoot arthritis, and severe or recurrent deformities with high intermetatarsal angles (IMA). This study aimed to evaluate clinical and radiographic outcomes in patients with mild-to-severe HV who underwent TMT-1 arthrodesis and proximal hindfoot correction for adult acquired flatfoot deformity (AAFD). Methods: All patients with symptomatic HV and AAFD who failed conservative management underwent TMT-1 fusion and proximal hindfoot correction (medial displacement calcaneal osteotomy, lateral column lengthening, subtalar fusion, or tibiotalocalcaneal fusion) by one of three senior foot and ankle surgeons at a single tertiary center between January 2006 and December 2018 were included in our retrospective case series. Demographics, clinical outcomes, patient comorbidity information, and radiographic outcomes including hallux valgus angle (HVA), IMA 1-2, hallux valgus interphalangeus angle, distal metatarsal articular angle, and sesamoid station were collected. The primary outcome was change in HVA measured as the difference between final postoperative and preoperative weight bearing HVA measurements. Secondary outcomes were reoperation, minor complications (local wound care, use of antibiotics, and skin dehiscence), and change in radiographic measurements. Results: With an average follow up of 26 months, 155 patients (17.4% male, 82.6% female; average age 59.0 years old, range 18 to 84) met inclusion. The average change in HVA was -18.6 degrees (range +15.8 to -81.0). There was a total of 85 reoperations in 35.5% (n=55; 48 hardware removal). Minor complications were present in 18.7% (n=29; 25 local wound care, 23 use of antibiotics, and 10 skin dehiscence). 44.5% (n=69) had no evidence of recurrent HV while mild, moderate, and severe grade bunions were present in 40.0% (n=62), 5.2% (n=8), and 0.6% (n=1). Improvement in overall bunion grade was maintained in 69.7% (n=108) with no change in 19.4% (n=30). Hallux varus was present in 9.7% (n=15; 3 underwent TMT-1 arthrodesis). Conclusion: The present study demonstrates a significant improvement in HVA following TMT-1 arthrodesis and proximal hindfoot correction for AAFD. The majority of patients undergoing TMT-1 arthrodesis and proximal hindfoot correction for AAFD obtain and maintain improvement in the radiographic severity of their bunions. However, patients should be counseled concerning expectations with regards to outcomes associated with complex AAFD reconstructions.
Leg-Length-Evening Device Improves Balance in Patients Wearing a Controlled Ankle Motion Boot: A Multicenter Randomized Controlled Trial
Authors: Bohl Daniel D. , Mehraban Nasima , Idarraga Alexander J. , Wu Kevin J. , Patel Milap , Vora Anand M. , Kadakia Anish R. , Lee Simon , Hamid Kamran S. 
Published: November 2020

Category: Other Introduction/Purpose: Patients are often made weight-bearing as tolerated (WBAT) in a controlled ankle motion (CAM) boot for the management of various foot and ankle conditions. The CAM boot causes a leg-length discrepancy (LLD) between the booted (longer) and contralateral (shorter) lower extremities. This discrepancy can potentially cause balance problems, undue strain on joints, and discomfort in patients. We hypothesized that a leg-length evening orthotic placed on the plantar aspect of the contralateral shoe improves balance among patients who are WBAT in a CAM boot. Methods: Patients made WBAT in a CAM boot were randomized to either the leg-length-evening orthotic intervention group or to a control group in which patients wore a normal shoe of their choice. Patients were followed for two weeks and asked a series of questions pertaining to balance and pain experienced at their knees, hips, and back. Balance was the primary outcome and was scored from 0 (no difficulty with balance) to 10 (great difficulty with balance). Results: Out of 107 subjects enrolled and randomized, 95 (88.8%) completed the study, satisfying the a priori sample size requirement of 94 patients. There were no differences in baseline characteristics between groups (p>0.05 for each). Intervention patients reported less difficulty with balance than control patients (intention-to-treat analysis: 2.0+-1.5 versus 3.2+-1.8, p=0.001; as-treated analysis: 2.1+-1.7 versus 3.0+-1.7, p=0.009). Intervention and control patients did not differ with respect to pain experienced at their knees, hips, or back, or in a composite total pain score (p>0.05 for each). Conclusion: This multicenter randomized controlled trial found that adding a limb-length-evening orthotic to the plantar aspect of the contralateral shoe in a patient that is WBAT in a CAM boot improves balance. The trial was powered to identify a difference in the primary outcome measure of balance and may have been insufficiently powered to identify differences in knee, hip, back, or total pain.
Radiographic Characterization of Midfoot and Transverse Tarsal Joint Osteoarthritis
Authors: Caughman Alexander , Gross Christopher E. 
Published: November 2020

Category: Midfoot/Forefoot Introduction/Purpose: The burden of midfoot arthritis is staggering. Foot osteoarthritis affects over 16% of all adults over the age of 50, interfering with activities of daily living and leisure. Non-operative management often culminates in fluoroscopic guidance injections. Its management is troublesome for surgeons as conservative treatment is maximized because its surgical solution is oftentimes fraught with nonunions and other complications. The purpose of this study was to see how well surgeons are able to predict midfoot and transverse tarsal joint osteoarthritis on x-rays as it compares to CT and MRI scans. Methods: We reviewed the records of 117 patients (146 feet) with a diagnosis code of midfoot osteoarthritis who were treated from 2015 to 2019 at an academic medical center by a single surgeon. The mean age was 63.2 +- 10.7 years. The average BMI was 31.2 +- 6.4. Each of those patients had both plain radiographs and either a CT or MRI scan. Patients had weight-bearing anteroposterior and lateral radiographs according to a standardized protocol. Radiographs and advanced images were graded separately for the presence of joint space narrowing, subchondral cysts, and other signs of arthritis. We then compared how frequently a radiograph predicted an arthritic midfoot or transverse tarsal joint as compared to a CT scan or MRI using a paired t test. Results: The most common joints affected by arthritis were the 2nd TMT (83.5% by X-ray; 88.4% by CT) and 3rd TMT (71.9% by X-ray; 68.4% by CT). Advanced imaging showed a significantly higher rate of arthritis in the 1st, 4th, and 5th TMT as compared to X-rays. Only 20.2% of patients’ radiographs had a direct correlation with their CT scan. A CT scan showed one or two more affected joints by 23.6% and 17.6 % respectively, and rarely showed one or two less joints affected by arthritis, 6.8% and 0.6% respectively. Based on this data, a radiograph’s sensitivity and specificity vary wildly-from 86.0% and 57.8%, respectfully in the 3rd TMT to 43.8% and 96.0%, respectfully in the 1st TMT. Conclusion: Radiographs vary quite drastically in their sensitivities and specificities in diagnosing osteoarthritic joints in the midfoot and transverse tarsal joints. If intending to treat midfoot osteoarthritis with fluoroscopic injections, we recommend not relying on plain radiographs, but advanced imaging.
Anterior Talofibular Ligament Reconstruction could Produce Comparable Functional Outcomes with or without Calcaneofibular Ligament Reconstruction for Chronic Lateral Ankle Instability
Authors: Feng Shi-Ming 
Published: November 2020

Category: Ankle; Arthroscopy; Sports Introduction/Purpose: This study evaluates the effects on functional outcomes of with or without calcaneofibular ligament reconstruction when reconstructing the ATFL for chronic lateral ankle instability Methods: This retrospective cohort study included 48 chronic lateral ankle instability patients with later ligament reconstruction that underwent either with or without a calcaneofibular ligament reconstruction using an ipsilateral free semitendinosus tendon autograft from June 2014 to October 2017. The Visual Analogue Scale score, the American Orthopaedic Foot & Ankle Society score, Karlsson Ankle Functional Score and Anterior Talar Translation in both groups were compared. Results: All patients were followed up for at a mean of 30 months, Visual Analogue Scale score, the American Orthopaedic Foot & Ankle Society score, Karlsson Ankle Functional Score and Anterior Talar Translation between two the groups were not statistically significant different. Conclusion: There are no differences at 2.5 years in postoperative ankle function and stability when an ipsilateral free semitendinosus tendon autograft is used to manage CLAI with anterior talofibular ligament reconstruction with and without reconstructing the calcaneofibular ligament.
Patient Reported Outcomes and Recurrence following 127 Primary Lapidus Surgeries for Hallux Valgus
Authors: Galli Sara H. , Johnson Nick , Davis W. Hodges , Anderson Robert B. , Jones Carroll P. , Cohen Bruce E. 
Published: November 2020

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Treatment for symptomatic hallux valgus encompasses a spectrum of surgical options to appropriately address the degree of deformity. The modified Lapidus has emerged as a powerful surgical option to address moderate to severe deformity as well as hallux valgus with 1st ray hypermobility. Unlike metatarsal osteotomies, the literature is lacking in clinical and radiographic outcomes. Previous retrospective series have reported recurrence rates less than 15%, but our experience found a higher recurrence rate. We aimed to evaluate the effect of radiographic recurrence on patient reported outcome measures and satisfaction. Methods: After obtaining institutional board review approval, patients were identified by procedural billing codes from 2012- 2016. Only primary Lapidus surgeries were included. All patients were contacted and invited to return to obtain patient reported outcome scores (AOFAS, FAAM) and assess satisfaction. HVA>=20 at final follow-up was used to define recurrence. Data was analyzed utilizing statistical analysis software (SAS v9.4).328 surgeries were identified with 255 eligible and contacted for follow-up. 77 surveys were completed in person and 50 were completed over the phone or via email with total response rate of 50%. Results: Average follow-up was 59 months. 38% had radiographic recurrence (48/127), 24% perceived recurrence (30/125), and 9.5% had reoperation for recurrence (12/126). AOFAS scores were lower with radiographic recurrence (p=0.01) and perceived recurrence (p=0.003). FAAM-ADL scores were not different in radiographic recurrence (p=0.79) but were lower in perceived recurrence (p=0.001). Overall, satisfaction was good-excellent in 74% and fair-poor in 26%. For radiographic (p=0.03) and perceived recurrence (p<0.0001), there was lower satisfaction reported. 78% would repeat surgery. Decision to repeat surgery was not different for radiographic recurrence with 81% without vs 74% with recurrence (p=0.37) saying they would have surgery again. However, it was different for perceived recurrence with 84% without vs 59% with recurrence saying they would have surgery again (p=0.01). Conclusion: Despite a high radiographic recurrence rate (38%), only a portion perceived a recurrence (24%) and an even smaller proportion (9.5%) had a reoperation for the recurrence. Nonetheless, these results suggest radiographic and clinical outcomes are not as high as previously reported for the modified Lapidus procedure.