bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bone Anchor Suture Tape Fixation Technique for the Treatment of Calcaneal Avulsion Fractures
Authors: Miskiel Sandra A. , Pagliaro Andre J. 
Published: October 2019

Category: Hindfoot, Trauma Introduction/Purpose: Surgical treatment of avulsion fractures of the calcaneus has a reported fixation failure rate as high as 23%, and there is much controversy surrounding the best method of treatment for these fractures. We present a technique for fixation of calcaneal avulsion fractures utilizing a bone anchor suture tape fixation technique that can be utilized with or without additional standard internal fixation. Methods: Five patients (2 male, 3 female), with an average age of 73 years old, presenting with a closed extraarticular avulsion fracture of the calcaneus, are included in this case series. Patients underwent bone anchor and suture tape fixation of fracture by a single foot and ankle-fellowship trained orthopaedic surgeon. Patients were additionally assessed pre-operatively, using the contralateral uninjured limb, for gastrocnemius equinus; and if present, patients underwent a gastrocnemius recession. If appropriate, a single compression lag screw and washer inserted perpendicular to fracture line was utilized for additional fixation. Outcomes observed were time to radiographic consolidation, failure of fixation, reoperation rate, presence of post-operative infection, and return to previous function. Results: Of the included patient cohort, all fractures went on to union, and there were no failures of fixation. There was one removal of a compression screw and washer due to hardware pain, and one superficial infection, which resolved with local wound care. All patients went on to weight-bearing as tolerated within 8 weeks post-operatively. Radiographic consolidation was observed at approximately 12 weeks. 4 out of 5 patients returned to previous function, with 1 patient expiring due to unrelated causes prior to determination of final function. Conclusion: Use of a bone anchor suture tape fixation technique appears to hold promise and warrants further investigation for its potential utilization as a reliable technique for fixation for avulsion fractures of the calcaneus. Our technique increases the distribution of surface area forces over the cortical bone while incorporating multiple points of fixation, including through the Achilles tendon insertion, neutralizing the distraction forces of the tendon directly.
Bi-Radial Curvature Morphology of the Healthy Talus
Authors: Myerson Mark , Clancy James , Paxson Bob , Obert Richard , Anderle Mathew , Brinker Laura , Daniel Lee Eng M. 
Published: October 2019

Category: Ankle Introduction/Purpose: In order to design an implant for the ankle joint that mimics normal joint motion, the condylar geometry of the talus must be anatomically accurate. Previous attempts to describe the curvature of the talus have typically involved fitting single-radius arcs to the medial and lateral facets. The purpose of this investigation was to determine if the curvature of the medial and lateral sides of the talus can be more accurately described by dividing the condyles into anterior and posterior regions, thus creating bi-radial curves for both the medial and lateral sides of the talus. Methods: After IRB approval, 18 subjects (9 male, 9 female; mean age 34.5 years) underwent weight-bearing CT scans at mid- stance of simulated gait. All subjects were deemed to have a healthy right ankle by the surgeon investigator. CT images were used to generate 3D models of each talus. A coordinate system was defined and the articular surface of the talus was separated into four sections: medial-anterior (MA), medial-posterior (MP), lateral-anterior (LA) and lateral-posterior (LP). The curvature of each section was defined by selecting points on the articular surface at 10° intervals. The extent of each radius was 30° of arc and the magnitude of each radius was selected to minimize the gaps between the radii and the spline curve to define a best-fit bi-radial approximation to the spline curve using geometry that could be easily used to define the articular surface of the talus. Ratios of the aforementioned radii were calculated. Results: The average MA, MP, LA and LP radii were 18.3 mm, 26.6 mm, 21.5 mm and 25.1 mm, respectively. The medial (A/P), lateral (A/P), anterior (M/L) and posterior (M/L) radii ratios were 0.70, 0.87, 0.88 and 1.07, respectively. The anterior and posterior ratios were compared using a paired t-test and found to be statistically different (P=.019). Further, the data were compared against a hypothesized value of 1 using a one-tailed one-sample t-test. The anterior ratio was significantly lower than 1 (P=.014) while the posterior ratio was significantly greater (P=.037). On the lateral side, 83.3% of the subjects exhibited a larger posterior radius than anterior radius. Only one subject (5.6%) had a larger anterior radius than posterior radius on the medial side. Conclusion: This study shows that the radius increases in the sagittal plane from the anterior portion to the posterior portion of both the medial and lateral sides of the talus. Furthermore, the MA radius is smaller than the LA radius. Conversely, the MP radius is larger than the LP radius. These results substantiate the validity of an implant design that incorporates a condylar radius ratio that is smaller for the anterior dorsiflexion surface and greater for the posterior plantar flexion surface. Implants with more accurate anatomical geometry may allow for more normal kinematics and potentially prolong the life of the implant.
Location and Morphology of Acute Lateral Ligament Injury of the Ankle
Authors: Noguchi Hideo 
Published: October 2019

Category: Ankle, Sports, Trauma Introduction/Purpose: Acute ankle ligament injuries are usually treated non-operatively, even if the injury is severe. However, when chronic ankle instability is symptomatic, operative treatment is required. When planning local repair, the condition of the remaining ligament is important. We surgically treated acute severe lateral ligament injuries in 103 ankles and investigated the locations of the injuries in the anterior talofibular (ATF) and calcaneofibular (CF) ligaments, subdividing each into three parts. This paper should facilitate more precise planning of the surgical reconstruction procedure. Methods: From 2006 to 2014, 1,042 patients visited our outpatient clinic with a diagnosis of acute lateral ligament injury of the ankle. In total, 103 feet underwent surgical treatment and the locations of the ATF and CF ligament ruptures were investigated. The rupture location in the ATF ligament was subclassified as fibular side, body, or talar side, while for the CF ligament it was classified as fibular side, body, or calcaneal side. Results: The ATF ligament was ruptured on the fibular side in 38 feet (36.9%), body in 30 feet (29.1%), and talar side in 35 feet (34.0%). The CF ligament was ruptured on the fibular side in 15 feet (14.6%), body in 26 feet (25.2%), and calcaneal side in 62 feet (60.2%). Conclusion: Almost all surgical reports on lateral ligament reconstruction procedures (Brostrom et al.) describe ATF ligament repair and advancement on the fibular side, although only one-third of the ligaments were injured on the fibular side in our series. About two-thirds of the CF ligaments had damage to the calcaneal side structure of the entheses. When CF ligament repair is needed, surgeons should be aware of our finding that this ligament was ruptured at the fibular attachment in only 15% of cases, and on the calcaneal side in 60%. This knowledge should lead to better results of surgical reconstruction.
Preoperative PROMIS Scores as a Predictive Method for Postoperative Success in Posterior Tibial Tendon Dysfunction Surgery
Authors: Nayak Rusheel , Patel Milap , Kadakia Anish 
Published: October 2019

Category: Hindfoot Introduction/Purpose: Patient Reported Outcomes Instrumentation System (PROMIS) pain interference (PI) and physical function (PF) scales were recently validated for foot & ankle surgery. Few studies have explored PROMIS in advanced posterior tibial tendon dysfunction (PTTD) surgery. We examined the change in PROMIS scores after PTTD reconstruction surgery and aimed to determine whether preoperative PROMIS scores, radiographic data, and demographic data can model and predict surgical improvement. Methods: PF and PI scores were prospectively obtained on 215 patients between November 2013 and May 2017. Of the 34 patients who had PTTD surgery, 25 patients were included with a minimum follow-up of 7-months (mean 21.8). Paired t-tests and multivariable linear regression models tested the difference in PROMIS scores pre- to postoperatively. Minimal clinically important differences (MCID) and receiver operator curve (ROC) analysis determined the accuracy of using preoperative scores in predicting postoperative change. The MCID for PROMIS PI and PF was defined as half of its respective standard deviation. Multivariable linear regressions with preoperative PROMIS scores, changes in radiographic imaging, and BMI were created to model change in PROMIS scores. Results: There was a significant difference in pre- to postoperative mean PI PROMIS scores (p = 0.0016, average change = -7.16). Mean PF scores improved postoperatively, but not significantly (p = .0595, average change = +4.17). Improvement in PI remained significant (p= 0.02) after adjusting for significant predictors (education level and diabetes status). Multivariable regression models utilizing preoperative PROMIS scores, radiographic variables, and BMI were unable to predict changes in PF and PI scores (p > 0.05). Using pre-determined MCID criteria, 68% achieved surgical success for PI (defined as change of at least -3.45) and 52% achieved surgical success for PF (defined as change of at least +3.00). However, preoperative PI (p=0.310) and PF (p=0.054) scores were unable to significantly predict MCID surgical success or failure. Conclusion: After major PTTD reconstruction, PI scores improve to significance but PF scores may not. After PTTD reaches an advanced stage, surgery may provide significant pain relief and improvement in physical function and radiographic parameters, but it may be difficult to predict clinical improvement based solely on preoperative PROMIS scores. Realistic expectations of improvements in pain and functionality should be maintained postoperatively in advanced PTTD surgery.
Outcomes of Revision Total Ankle Replacement: A Minimum of 2 Year Follow-up
Authors: Nicolas Andrea Pujol , Ramaskandhan Jayasree Ramas , Nurm Triin , Siddique Malik 
Published: October 2019

Category: Ankle, Ankle Arthritis Introduction/Purpose: Total ankle replacement as a valid treatment for end stage ankle arthritis, is gaining popularity and every year there is an increasing number of procedures. With revision rates as high as 21% at 5 years and 43% at 10 years there is a need for understanding and reporting the outcome of revision ankle replacement. Our aim was to study the patient reported outcomes following revision TAR with a minimum of 2 year follow up. Methods: All patients that underwent a revision total ankle replacement between 2012 and 2016 were included in the study. All patients received a post-operative questionnaire comprising of MOX-FQ score, EQ-5D (UK) and Foot and Ankle outcomes scores (FAOS) and patients satisfaction questionnaire with a minimum of 2 years follow up. Results: 32 patients had a revision total ankle replacement between 2012 and 2016. 2 patients were deceased therefore 30 patients were included in the study. 5 patients declined participation for completing questionnaires. We received 21 (66%) completed questionnaires. The mean MOX-FQ average domain score for pain was 58.8, walking/standing 65.8 and social function was 48.2. The mean FAOS scores were 50.7 for pain, 50.6 for symptoms, 54.9 for ADL and 28.2 for quality of life. The mean overall health score today for EQ-5D was 67.8/100. 45% of patients were satisfied with the pain relief and return to sports and recreation obtained following the operation, 48% were satisfied with the improved in daily activities. 52% were overall satisfied with the results from surgery. Conclusion: Revision total ankle replacement gives overall satisfactory results demonstrated from patients reported outcomes at a minimum of 2 years following surgery.
Patient Knowledge of Provider Training Background and Preferences for Treatment of Foot and Ankle Conditions
Authors: Nielsen Alex W. , Law Brian C. , Shi Glenn G. , Kraus Jonathan C. 
Published: October 2019

Category: Professional, Patient Care Introduction/Purpose: Differences exist in the training backgrounds of medical providers who treat foot and ankle disorders. Considerable overlap and similarities also exist between podiatric and orthopaedic surgeons, though patients may be unaware of the differences. It is not known to what extent professional training influences how patients seek care. The purpose of this study is to understand patients’ knowledge of the differences in professional training background between podiatry and orthopedic surgery and to determine which factors are important to patients when selecting a provider. Methods: Patient survey data was gathered from Froedtert Memorial Lutheran Hospital and the Mayo Clinic. A 27-question survey was administered to new patients who were referred to the foot and ankle service in an orthopedic department at both institutions. Survey questions included data on patient demographics, patient opinion, and knowledge of differences between podiatry, orthopedics, and other foot and ankle providers. Patients were grouped by provider preference. Univariate and multivariate regressions were used to characterize the study population and determine provider preference. Significance was determined through t-tests, Fisher’s Exact test, and chi-square tests. Results: Of the 169 patients who completed the entire survey, 99 chose “orthopedic surgeon” as their provider of preference for any foot or ankle injury. Between the groups, there was no significant difference in age, healthcare affiliation, previous podiatric visits, level of education, and perceived knowledge about the differences between the two specialties (Table 1). For patients who listed podiatry as their preference, they were less likely to expect their doctor to have completed residency (76.2% vs. 90.7-94.9%, p=0.03). Patients preferred an orthopedic surgeon over a podiatrist for ankle (63.3% vs. 9.5%, p<0.001) and knee injuries (82.8% vs. 5.8%, p<0.001), while they preferred a podiatrist for toe pain (42.6% vs. 27.8%, p<0.001). 76.3% of patients thought orthopaedic surgeons and podiatrist undergo the same professional training. Conclusion: Foot and ankle patients have poor understanding of the different medical and surgical training backgrounds between a podiatrist and orthopedic surgeon. The majority of patients believe podiatrist and orthopaedic surgeons have the same professional training. However, patients also believed orthopaedic surgeons have a longer training period, though it was still underestimated by three years. Patients preferred care for podiatrist with conditions affecting the toes and orthopaedic surgeons for all other conditions.
Absence of ATFL Remnant Does not Affect the Clinical Outcomes of the Modified Broström Operation for Chronic Ankle Instability
Authors: Park Sunghoon , Kim Taehun , Park Younguk 
Published: October 2019

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: The modified Broström operation (MBO) for chronic ankle instability (CAI) has demonstrated good clinical results. Absence of ligamentous tissue was known as a risk factor for recurrence of ankle instability after the sugery. The aim of this study was to evaluate the effect of quality of ligament tissue (anterior talofibular ligament, ATFL) on prognosis in a cohort of patients with CAI after the MBO. Methods: This study was a retrospective case series. A total of 60 patients underwent the MBO for CAI with a mean follow-up of 30.1 months (range, 24-47 months). Presence of ATFL remnant was assessed on ultrasound (US), magnetic resonance imaging (MRI), and arthroscopy in all patients. The foot and ankle outcome score (FAOS) was used to evaluate functional outcomes. Clinical outcomes were compared according to the condition of the ligament remnant. Association with other risk factors was evaluated using multiple linear regression analysis. Results: ATFL was visible in 51/60 cases on US. Thirty patients had thin or absent ATFL on MRI; 22 patients, normal thickness ATFL; and 8 patients, thick ATFL. ATFL was visible in 15 patients on arthroscopy and nonvisible or not clear in 45 cases. Significant differences in FAOS were not noted according to the presence of ATFL remnant on US, arthroscopy, and the grade of ATFL thickness on MRI. No correlation was found between FAOS and the thickness of ATFL. Conclusion: The results suggest that the MBO for patients with CAI had good results, regardless of the presence or absence of ATFL remnant.
Platelet Rich Plasma Therapy and Understanding the Risk Factors of Heel Pain Syndrome
Authors: Pitarini Astuti , Tham Wilson , Hong See Kwok , Prabhakaran Abinaya , Han Chee Yu 
Published: October 2019

Category: Basic Sciences/Biologics, Hindfoot, Sports Introduction/Purpose: Heel pain syndrome is a complex condition causing morbidity and decreases the quality of life in our adult population. It is known that individuals with a body mass index (BMI) of more than >30 kg/m2 have increased risk of plantar fasciitis. However, heel pain consists of larger entities not merely to plantar fasciitis alone. Limited study mentioned the association between hypertension and musculoskeletal pain. Platelet rich plasma (PRP) therapy is an emerging treatment option for its regenerative properties in the treatment of degenerative enthesopathic conditions as in plantar fasciitis and lateral elbow epicondylitis. We hypothesize that obesity (BMI>30 kg/m2) and hypertension do influence the poorer outcome after PRP injection in individuals with heel pain. Methods: We analysed 154 heel pain cases from orthopaedic outpatient clinic that were treated with PRP injection. BMI and BP were taken as preadmission measurements with at least three readings for blood pressure. PRP was harvested from the antecubital vein, and spun in a centrifuge machine. Follow-up was conducted with AOFAS Ankle Hindfoot system before injection, 6 weeks and up to 2 years after injection. Results: Mean age was 49.96 (range 20-81 years old) with 52.60% female and 47.4% male. Plantar fasciitis was the majority source of heel pain (71.43%) followed by achilles tendinopathy (26.62%), posterior tibial tendon disorder (1.3%), and peroneal tendinopathy (0.65%). One hundred and twenty-eight (83.1%) patients achieved resolution of heel pain and related symptoms after injection. Statistical analysis was performed using one sample student t-test. No statistical significant result was found in both overweight (p =0.29) and obesity grade 1 (p = 0.40). Statistical significant result found in the prehypertension group (p<0.04). Conclusion: Based on this preliminary data, we recommend weight loss with trials of lifestyle modification in individuals with obesity, and better control of our patients’ blood pressure in order to achieve comparable outcome with normal BMI population.
Dorsiflexory Wedge First Metatarsal Osteotomy: Does an Oblique Cut Increase Surface Area?
Authors: Prissel Mark , Van Dyke Bryan , Brandao Roberto , Halverson Adam , McGann Maria , Hyer Christopher 
Published: October 2019

Category: Ankle Introduction/Purpose: A plantarflexed first metatarsal can contribute to a forefoot driven cavus foot deformity or result in plantar ulcerations from forefoot pressure overload in a neuropathic patient. Often, this deformity is managed via a dorsiflexon first metatarsal base osteotomy. This osteotomy is often described as a vertical wedge, with a dorsal base, in the proximal metatarsal. Alternatively we propose an oblique wedge, which may also allow for increased surface area for osseous healing to occur, in addition to being more theoretically stable to weightbearing with greater fixation options. Methods: Ten cadaveric below-knee specimens were randomized into an oblique wedge (5 specimens) and vertical wedge (5 specimens) groups. The osteotomies were performed by a single surgeon on the same date. Digital calipers were utilized to obtain measurements to calculate surface area for each osteotomy. Demographic data including patient age at death, height, weight, BMI, sex, and laterality were obtained. Results: The mean surface area of the proximal metatarsal for the vertical group was 298.2±76.5 mm2, whereas the oblique group was significantly larger at 538.6 ± 200.4 mm2 (CI 95%, p=0.0255). Similarily, but not to significance the distal side of the osteotomy demonstrated increased surface area for the oblique group with 397.8±191.4 mm2 compared to the vertical group with 265.8±75.3 mm2 (CI 95%, p=0.13. The groups were demographically similar, including height (CI 95%, p=0.62) and BMI (CI 95%, p=0.19). Conclusion: Our results demonstrate significantly greater surface area for the oblique dorsiflexory wedge first metatarsal osteotomy, compared to the vertical dorsiflexory wedge first metatarsal osteotomy. Further analysis is recommended for large cohort head-to-head clinical comparison of these techniques with consideration for cost effectiveness of fixation constructs, procedural complications and patient reported clinical outcome measures.
Mid-term (4-7 years) Results of Matrix-Associated Stem Cell Transplantation (MAST) in Chondral Defects of the First Metatarsophalangeal Joint
Authors: Richter Martinus , Zech Stefan , Meissner Stefan , Naef Issam 
Published: October 2019

Category: Midfoot/Forefoot Introduction/Purpose: Matrix-associated stem cell transplantation (MAST) has shown good short-term results for treatment of chondral defects at first metatarsophalangeal joint (MTP1). The aim of the study was to assess mid-term results (=4-year-follow- up). Methods: In a prospective consecutive non-controlled clinical follow-up study, 61 patients with 81 chondral defects at MTP1 that were treated with MAST from October 1, 2011 to October 31, 2014 were analysed. Degree of osteoarthritis, range of motion (ROM), size and location of the chondral defects, pedographic parameters, and the Visual Analogue Scale Foot and Ankle (VAS FA) before treatment and at follow-up were registered and analysed. Bone marrow aspirate was harvested from the ipsilateral pelvic bone marrow and centrifuged (10 minutes, 1,500 RPM). The supernatant was used to impregnate a collagen I/III matrix (Chondro-Guide). The matrix was fixed into the chondral defect with fibrin glue. Results: Following mean (range) values were registered at time of surgery: age 44 (35-72) years, VAS FA 49.4 (12.3-82.3), ROM 20.4/0/8.4° (dorsiflexion/plantarflexion), degree of osteoarthritis 1.9 (1-3). The 81 chondral defects were located as follows, dorsal metatarsal head, n=28 (35%), plantar metatarsal head, n=12 (15%); dorsal & plantar, n=21 (26%); medial sesamoid, n=14 (17%); lateral sesamoid, n=6 (7%)(two defects, n=14, three defects, n=3). The defect size was 0.9 (.5 - 3.0) cm2. Fifty-six patients (92%) completed follow-up at 62 (48-84) months. VAS FA increased to 82.5 (45.6-100; t-test, p<.01). ROM increased to 30.2/0/15.4 (p=.05). Degree of osteoarthritis decreased to 1.1 (0-3, p=.04) Conclusion: The surgical treatment of chondral defects at MTP1 including MAST led to improved clinical scores, ROM and degree of osteoarthritis after 4-7 years. No adverse effects of MAST were registered. Even though a control group is missing, we conclude that MAST is an effective method for the treatment of chondral defects at MTP1.