bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age Is a Risk Factor for Contralateral Tendon Rupture in Patients with Acute Achilles Tendon Rupture
Authors: Park Young Hwan , Kim Jae Young , Choi Gi Won , Kim Hak Jun 
Published: October 2019

Category: Ankle Introduction/Purpose: Rupture of the contralateral Achilles tendon following Achilles tendon rupture can lead to devastating outcomes. However, despite the clinical importance, the risk factors and incidence of contralateral Achilles tendon rupture have not been well-studied. This study aimed to determine the incidence of contralateral tendon rupture after Achilles tendon rupture and to identify associated patient characteristics. Methods: Medical records for 226 consecutive patients with Achilles tendon rupture were retrospectively reviewed. The occurrence of contralateral Achilles tendon rupture and patient characteristics were determined through review of medical records and telephone surveys. Results: The cumulative incidences of contralateral Achilles tendon rupture at one, three, five, and seven years after Achilles tendon rupture were 0.4%, 1.8%, 3.4%, and 5.1%, respectively. The only statistically significant risk factor was age between 30 and 39 years at the time of initial Achilles tendon rupture (hazard ratio = 4.9). Conclusion: Patients who sustain Achilles tendon rupture in their 30 s have significantly increased risk for contralateral tendon rupture.
An MRI Analysis of the Site of Acute Achilles Tendon Rupture: Is the Most Common Site 2–6 Cm from the Calcaneal Insertion?
Authors: Park Young Hwan , Chang An Seong , Choi Gi Won , Kim Hak Jun 
Published: October 2019

Category: Sports, Ankle Introduction/Purpose: No previous study has performed a quantitative analysis of the site of acute Achilles tendon rupture. The purpose of this study was to investigate the site of acute Achilles tendon rupture via magnetic resonance imaging (MRI). Methods: The medical records and MRIs of 201 patients with acute Achilles tendon rupture were retrospectively reviewed. The rupture site was measured as the distance from the calcaneal insertion of the Achilles tendon to the proximal end of the distal stump. The relationship between the site of the rupture and patient demographics was analyzed, and the intra- and interobserver reliability scores of the measurements were assessed using intraclass correlation coefficients. Results: The rupture site had a mean size of 6.1 cm with a standard deviation of 1.6. The median was 6.3 cm, and the range of the 10th–90th percentile was 5.0–8.1 cm. There was no significant difference in rupture site according to patient demographics. All of the intra- and interobserver reliability scores of the measurements of the rupture site were excellent. Conclusion: Most acute Achilles tendon ruptures that were visible on MRI occurred 5–8 cm above the calcaneal insertion, which is greater than the previously reported 2–6 cm location.
Understanding “Recovery” Following Ankle Reconstruction: A Qualitative Study
Authors: Pinsker Ellie , Gignac Monique A.M. , Sale Joanna E.M. , Daniels Timothy R. , Beaton Dorcas E. 
Published: October 2019

Category: Ankle, Ankle Arthritis, Outcomes research Introduction/Purpose: Patients’ perception of a good outcome (‘feeling recovered’) is not fully understood. A clear understanding of the benefits and harm of a surgery is necessary for clinical decision-making. Qualitative work exploring the nature of patient recovery would improve our ability to understand and measure these outcomes. The purpose of the study is to examine patients’ perceptions of post-surgical outcome following ankle reconstruction for treatment of end-stage ankle arthritis. Methods: Twenty-five English-speaking individuals were asked to participate following a routine clinic visit. They were recruited from an existing cohort of persons who had undergone total ankle replacement or ankle fusion at least one year prior. A qualitative researcher conducted semi-structured, face-to-face interviews with participants in a private hospital room. Results: Twenty-five adults (12 women, 13 men) ages 25–82 years were interviewed for 1-2 hours. Participants varied in their socioeconomic status and education levels. Patients did not view their recovery simply as physiological change. Most participants reported ongoing challenges or difficulties, yet considered themselves better. Participants described a broader concept of recovery with multiple contributing factors, including appraisal of the importance of ongoing issues and coping efforts. When participants experienced ongoing difficulty with valued activities, they gained a sense of recovery using coping efforts. Many ‘readjusted’ behaviorally to continue with their valued goals and activity preferences. Others cognitively redefined their goals or preferences to accommodate their ongoing issues. Participants who could not cope with their difficulties or disliked their coping effort perceived their recovery negatively. Conclusion: Perception of recovery and experience of outcome rarely involved resolution of all symptoms and functional limitations. The manner in which patients described their recovery was typically more nuanced than a simple change in magnitude of symptoms or functional limitations. This research expands our understanding of the experience of ankle reconstruction and draws attention to different meanings of recovery that has implications for outcome evaluation and measurement. Improved measures for evaluating the recovery outcome states will enable clinicians to identify facilitators and barriers to recovery.
MALDI-TOF Analysis of K-wire Biofilms: A Pilot Study
Authors: Rex James , Durante Elizabeth , Barcel Anthony , Gross Christopher 
Published: October 2019

Category: Basic Sciences/Biologics Introduction/Purpose: In orthopedic foot and ankle surgery, temporary fixation utilizing percutaneous Kirschner wires (K- wires) is required for a variety of procedures. Reported infection rates at the pin site are highly variable, and may be as high as 20%. Currently, there is a paucity of literature regarding the microbiology of K-wires used in foot and ankle surgery, as most wires are typically disposed of once removed. The purpose of this pilot study was to determine the specific pathogens which take advantage of K-wires, in order to further elucidate the etiology of pin tract infection, as well as inform antibiotic prophylaxis decisions with wire fixation. Methods: In this study K-wires were removed from patients in a sterile environment, and divided into external and internal segments. Each segment was cultured separately, and the dominant pathogen was isolated in a subculture. Matrix Assisted Laser Desorption/Ionization-Time of Flight (MALDI-TOF) was employed for analysis, allowing for speciation of the dominant pathogen growing on the wire. Results from internal and external samples were then compared. Results: At this time a total of 10 samples have been analyzed: internal and external segments from 5 individual wires. Biofilm growth was exhibited on 60% of both the external (3/5) and internal samples (3/5). In one sample, growth occurred in the internal segment only, while the external segment was found to be sterile. Of the 5 wires tested, only one was found to be sterile (20%). All cultures were identified as Staph. Epidermidis by MALDI-TOF analysis. Conclusion: More attention should be given to microbial growth on these wires, especially in patients predisposed to infection. It is concerning that S. Epidermidis, with its propensity to form biofilms, was the dominant pathogen on our samples, especially internally. We are currently collecting further samples in order to determine which other pathogens may be taking advantage of K-wires, such that more informed decisions about antibiotic prophylaxis can be made, and to elucidate further the etiology of pin tract infections, etiology of pin tract infections.
EFAS Score – Multilingual Development and Validation of a Patient-Reported Outcome Measure (PROM) by the Score Committee of the European Foot and Ankle Society (EFAS)
Authors: Richter Martinus , Agren Per-Henrik , Besse Jean-Luc , Cöster Maria , Kofoed Hakon , Maffulli Nicola , Rosenbaum Dieter , Steultjens Martijn , Alvarez Fernando , Boszczyk Andrzej , Buedts Kristian , Guelfi Marco , Liszka Henryk , Louwerens Jan-Willem , Repo Jussi P. , Samaila Elena , Stephens Michael , Witteveen Angelique G. H. 
Published: October 2019

Category: Basic Sciences/Biologics Introduction/Purpose: A scientifically sound validated foot and ankle specific outcome measure for different European languages is still missing. Indeed, language-specific cross cultural validation in other languages than English is largely absent. Some outcome measures were validated for specific pathologies such as hallux valgus, ankle arthritis or flatfoot. The European Foot and Ankle Society (EFAS) established in 2013 a Score Committee to develop, validate, and publish a new score, the “EFAS Score”, which is not specific for single pathologies for different European languages. The principal aim of this project was to develop and validate the EFAS Score simultaneously for different European languages. Methods: The EFAS Score was developed and validated in three stages: 1) item (question) identification, 2) item reduction and scale exploration, 3) confirmatory analyses and responsiveness. The following score specifications were chosen: scale/subscale (Likert 0-4), questionnaire based, outcome measure, patient related outcome measurement. For stage 3, data were collected pre- operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using analyses from classical test theory and item response theory. Results: Stage 1 resulted in 31 general and 7 sports related questions. In Stage 2, a 6-item general EFAS Score was constructed using English, German, French and Swedish language data. In Stage 3, internal consistency of the scale was confirmed in seven languages: the original four languages, plus Dutch, Italian and Polish (Cronbach’s Alpha >0.86 in all language versions). Responsiveness was good, with moderate to large effect sizes in all languages, and significant positive association between the EFAS Score and patient-reported improvement. No sound EFAS Sports Score could be constructed. Conclusion: The multi-language EFAS Score has been successfully validated for orthopaedic foot and ankle surgery populations incorporating a wide variety of foot and ankle pathologies, including language-specific validation in seven languages so far (English, German, French, Swedish, Dutch, Italian, Polish). Validation for other languages (Danish, Finnish, Norwegian, Portuguese, Spanish, Turkish) is in progress. All validated score versions are freely available at www.efas.co .
Medial Femoral Condyle Periosteal Free Flap: A Novel Technique for the Treatment of Avascular Necrosis of the Talus
Authors: Saad Adam , Jimenez Megan L. , Rogero Ryan , Saad Sherif , Winters Brian S. 
Published: October 2019

Category: Hindfoot Introduction/Purpose: Avascular necrosis (AVN) of the talus is commonly caused by trauma and often requires surgical management. It is recommended that healthy patients, in pre-collapse stages, undergo joint preservation procedures. Good results have been published in patients in pre-collapse stages who undergo vascularized bone grafting. Although many graft options exist, more recently the medial femoral condyle (MFC) free vascularized graft has been introduced. This graft typically utilizes vascularized corticoperiosteal bone but can be modified to the use of solely periosteum, which theoretically decreases morbidity and operative time. There is limited research on the periosteal-only MFC flap to treat AVN of the talus. We present a case series and surgical technique utilizing a periosteal vascularized pedicle graft to teat AVN of the talus. Methods: A surgical technique is presented, in addition to a retrospective review of AVN of the talus of 6 lower extremities. Treatment included talus core decompression along with an ipsilateral medial femoral condyle free vascularized periosteal graft. All patients included were in the pre-collapse stage. Short-term clinical outcome measures of Foot & Ankle Ability Measure- Activities of Daily Living (FAAM-ADL) subscale, Short Form-12 (SF-12), and Visual Analog Scale (VAS) for pain were recorded for all patients post-operatively. Paired T-tests were used to compare pre- and post-operative functional scores. Post-operative MRIs were reviewed by a musculoskeletal radiologist. Results: The causes of AVN included trauma (2/6, 33%), sepsis (2/6, 33%), and idiopathic (2/6, 33%). Post-operative FAAM-ADL (P=0.004) and VAS (P=0.003) scores showed statistically significant improvement from pre-operative values at an average of 16.0 months (range, 6-28 months) after surgery. Additionally, all patients (100%) reported being “very satisfied” with their surgical outcome. There was 1 minor complication, with one patient reporting minimal paresthesias following surgery. Post-operative MRIs, taken at a mean of 12.7 months, demonstrated both resolution of marrow edema and soft tissue inflammation surrounding the areas of AVN and a lack of AVN progression in 100% of lower extremities, when compared to pre-operative MRIs. Conclusion: Medial femoral condyle free vascularized periosteal graft is a complex procedure which requires a team comprised of a foot & ankle surgeon and a plastic/hand surgeon familiar with microvascular surgery. This study shows promising initial results for the treatment of an extremely challenging diagnosis: AVN of the talus. Long-term, prospective studies are needed to confirm the findings presented in the current study.
Isolated Fibular Stress Fractures: Demographic and Radiographic Factors
Authors: Sarpong Nana O. , Levitsky Matthew , Held Michael , Greisberg Justin K. , Vosseller J. Turner 
Published: October 2019

Category: Ankle, Trauma Introduction/Purpose: Fibular stress fractures are rare injuries that are incompletely understood in terms of pathogenesis and predisposing factors. While stress fractures all involve relative stress concentration in a finite area leading to local mechanical failure, the risk factors for this injury have not been assessed. Their relative rarity has made understanding of these risk factors difficult. In a retrospective case series, we sought to define demographic and radiographic risk factors for isolated fibular stress fractures. Methods: We retrospectively reviewed the records of 13 patients with isolated fibular stress fractures at our institution between January 2010 and November 2018. We collected and analyzed baseline demographic data and radiographic parameters including prior history of fracture, location of stress fracture, bone quality, and heel alignment. Results: The cohort consisted of 6 men and 7 women with a mean age of 41.8 years at the time of diagnosis of the fibular stress fracture. The average BMI in the cohort was 28.5 kg/m2. The location of the stress fracture was in the distal third of the fibula in 69.2% (9/13), proximal third in 23.1% (3/13), and middle third in 7.7% (1/13). There was no evidence of osteopenia on radiographic analysis in any patients, by assessment of the senior author and attending radiologist at our institution. Isolated stress fractures in the distal third of the fibula were observed more commonly in women. Distal fibula stress fractures were associated with physiologic hindfoot valgus, while proximal fractures were seen with a varus hindfoot. Conclusion: In this retrospective case series of a rare injury, isolated stress fractures in the distal third of the fibula were the most common fibular stress fracture. Proximal fibular stress fractures were associated with a varus hindfoot. All fractures in this case series healed with immobilization in a walking boot with or without a short period of nonweightbearing.
Surgical Treatments of Talar Osteochondral Lesion: A Long-term Follow-up of Return to Sport and Patient-Reported Outcome Measures
Authors: Schwartz Andrew , Niu Shuo , Mirza Faris , Thomas Ashley , Labib Sameh 
Published: October 2019

Category: Ankle, Arthroscopy, Sports, Trauma Introduction/Purpose: Talar osteochondral lesion (TOCL) is a common problem in the young athletic population, mostly related to trauma. TOCL surgical treatment algorithm remains controversial, though results are improving as we gain experience. The results of TOCL surgical treatment on function and return to sport are promising, but quantified return to sport metrics remain largely unknown. Methods: A total of 156 consecutive patients following TOCL chondroplasty (10/1/2000-5/31/2018) by a single practice were retrospectively reviewed and included in this study. There were 54.5% female with a mean age 38.2 years, and mean follow-up 40.2 months following the index surgery. Patients were divided into four groups according to the type of chondroplasty performed: Antegrade arthroscopic drilling and/or microfracture (antegrade, 83 patients), retrograde arthroscopic drilling (retrograde, 35 patients), osteochondral autograft transfer (OATS, 26 patients), and allograft cartilage implantation (allograft, 12 patients). VAS scores for pain and function at the final clinic visit were collected. Patient-reported outcome measures including the short form-12 (SF-12), The Foot and Ankle Disability Index Sports Module (FADI-sports), Tegner score, Marx scale, Naal’s Sports inventory are also actively being collected. Results: Nearly 75% of patients are satisfied with surgical intervention of TOCLs. Allograft transplant was the least satisfying (71.4%), while OATS was the most satisfying (90%). Each surgical intervention yielded significantly decreased pain and increased function postoperatively (all p<0.001). Currently, 57 patients (36%) provided patient-reported outcome measures, with an average follow up of 79.8 months (Table 1). All surgical interventions trended toward decreased Tegner score, though only antegrade drilling showed a significant decrease (p<0.001). Based on Naal’s sports inventory, 85.7% of surgically treated patients reported participating in sport activities, on average 3 times/week and 50.6 minutes/session. Conclusion: Traditionally, TOCLs presented a difficult problem that is marred by unsatisfactory surgical outcomes in typically active patients. As our surgical understanding has evolved, we’ve continued to improve on outcomes. Our patients demonstrated a 74.5% satisfaction rate, a statistically significant improvement in pain and function, and a high rate of return to sport with little difference between surgical interventions at a long-term follow-up.
Lateral Flexor Digitorum Longus Transfer for Peroneal Tendinopathy
Authors: Sherman Thomas I. , Koury Kimberly , Orapin Jakrapong , Schon Lew C. 
Published: October 2019

Category: Sports Introduction/Purpose: Flexor digitorum longus (FDL) transfer to the lateral foot for concomitant irreparable rupture of the peroneal tendons has been reported in few clinical series. The purpose of this study is to provide midterm outcomes including subjective outcome scores, clinical examination data, and objective power after single-stage FDL tendon transfer. Methods: Twenty-five consecutive patients over a 7 year period (2008-2015) underwent FDL to fifth metatarsal transfer for irreparable peroneal tendon tears. Fifteen patients with a mean follow-up of 53.7 months completed the pain visual analog score (VAS), Foot Function Index (FFI), Short Musculoskeletal Functional Assessment (SMFA), and Foot and Ankle Ability Measure (FAAM) scores and participated in range of motion, peak force, and peak power testing. Results: All 15 patients were satisfied with their surgery and reported a reduction in their pain level with the average decrease in VAS of 5.59 +/- 2.5 (range: 1 - 9). The mean FAAM was 86.4 +/- 9.7 (range: 52.4 - 100). The mean FFI was 12.8 +/- 9.2 (range: 0 - 21.4). The mean SMFA Function index was 12.4 +/- 8 and the mean SMFA Bothersome Index was 11.5 +/- 11. Patients had on average 58% less eversion and 28% less inversion compared to the nonoperative side. Both isometric peak torque and isotonic peak velocity were decreased by 38.4% and 28.8%, respectively. On average, power in the operative limb was diminished by 56% compared to the nonoperative limb. Conclusion: FDL transfer to the lateral foot for significant, non-reconstructable peroneal tendinopathy is an effective, and durable treatment option.
Arthroscopic Debridement and Micronized Adipose Tissue Injection for End-Stage Ankle Arthritis
Authors: Shimozono Yoshiharu , Kennedy John G. 
Published: October 2019

Category: Ankle, Ankle Arthritis Introduction/Purpose: Joint arthritis is one of the leading musculoskeletal disorders in the adult population. The surgical treatment for end-stage ankle arthritis generally includes arthrodesis, distraction arthroplasty and total replacement. Recently, new therapeutic approaches, including the use of biologics, have been developed. Among the many sources, the adipose tissue is considered a greater chondrogenic potential and thus a lot of attention is being placed on it in the treatment of arthritis. Although several studies reported good clinical outcomes of adipose-based therapies for knee arthritis, there is a paucity of studies reporting the effects of adipose-based therapies for ankle arthritis. The purpose of this study is to evaluate the effect of intra- articular injection of autologous micronized adipose tissue in patients with end-stage ankle arthritis. Methods: A retrospective cohort study investigating consecutive patients treated with arthroscopic debridement and micronized adipose tissue injection for end-stage ankle arthritis was performed. Micronized adipose tissue was obtained from abdomen using a minimal manipulation technique in a closed system (Lipogems) without the addition of enzymes or any other additives. Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS), Short-Form 12 (SF-12), and visual analog scale (VAS) scores preoperatively and at final follow-up. Results: Total of 12 patients were included. The mean age was 57.5 years and mean follow-up time was 13.1 months. Mean symptoms, pain, daily activities and quality of life scores in FAOS significantly improved from 44.5, 41.3, 58.9, and 20.6 preoperatively to 76.2, 70.1, 80.9, and 60.7 postoperatively, respectively at final follow-up (p<0.001). The mean SF-12 and VAS score significantly improved (33.8 to 63.4, 7.2 to 2.9, respectively, p<0.001). One patient did not receive any benefits. In 4 patients, although they had symptomatic relief in early stage, FAOS and VAS scores deteriorated to baseline by 6 months after procedure. Total 4 patients were not satisfied with the procedures. No adverse events or relevant complications were reported. Conclusion: The current study demonstrates that arthroscopic debridement and micronized adipose tissue injection is a safe and beneficial procedure in the treatment of end-stage ankle arthritis. However, in 4 of 12 patients in this small cohort, the deterioration of clinical outcomes to the baseline was observed by 6 months after procedures. All of these patients had mechanical malalignment of hindfoot, suggesting that mechanical alignment may be one of the prognostic factors of this procedure. Further studies investigating longer-term effects in larger cohort should be warranted to confirm the benefit of micronized adipose tissue injection for end-stage ankle arthritis.