bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maintenance of Correction of the First Tarsometatarsal Joint Arthodesis Procedure with a First Metatarsal to Second Metatarsal Screw Technique: A Preliminary Report
Authors: Brandão Roberto A. , Greschner Joseph M. , Langan Travis M. , Goss David A. , Hyer Christopher F. 
Published: October 2019

Category: Bunion Introduction/Purpose: Fusion of the first tarsometatarsal joint is common for the treatment of moderate to severe hallux abductovalgus deformity. Despite arthrodesis of the first tarsometatarsal joint, recurrence of the deformity remains a concern. The addition of a screw from the 1st metatarsal base to the 2nd metatarsal base allows for increased stability and can help create a “spot weld” between the metatarsal bases to prevent loss of deformity correction. The additional screw construct is termed the intermetatarsal screw in this study. The purpose of the current study is to determine the long-term maintenance of angular correction of the 1st and 2nd intermetatarsal angle, hallux abductus angle, and tibial sesamoid position after undergoing a 1st tarsometatarsal joint arthrodesis with the addition of the intermetatarsal screw. Methods: A retrospective, single-center chart and radiographic review was performed of 17 consecutive patients who underwent primary hallux abductovalgus correction with a 1st tarsometatarsal joint arthrodesis using the intermetatarsal screw fixation by the senior author. The study period was from January 1, 2017 to May 14, 2018. Three observers independently reviewed radiographic data including preoperative weight bearing, 1st weight bearing, and final weight bearing plain film radiographs. Preoperative films were used if they were within 3 months of the surgery and the radiographic time line for the post-operative intervals were at 12 ± 2 weeks, 18 ± 4 weeks, 26 ± 4 weeks, 52 ± 12 weeks, and the final follow-up visit. Radiographic data evaluated were initial improvement and long-term maintenance of intermetatarsal angle, hallux abductus angle, and tibial sesamoid position. Results: 17 consecutive patients were identified for review that met inclusion criterea. Mean follow up time was 8.12 months (SD ± 3.68). Bony union was achieved in all patients. There was 1 symptomatic recurrent bunion, 1 case of symptomatic hardware, and 1 case of transient neuritis. Average preoperative IMA was 16.05º (±2.34), HAA was 33.05º (±6.24), and tibial sesamoid position was 5.77 (±0.9). Average IMA improvement was 8.38º (±2.21), HAA improvement was 17.25º (±8.21), and TSP improvement was 3.29 (±1.36) positions. Average loss of IMA was 1.03º (±1.24), HAA was 4.14º (±5.34), and tibial sesamoid position was 0.65 (±0.86) positions. Wilcoxon signed rank test showed statistical significance in all radiographic parameters; both in initial improvements and loss of correction (p<0.005). Conclusion: The current study shows the addition of an intermetatarsal screw for 1st tarsometatarsal joint arthrodesis has good union rates, a low complication rate, and maintains correction. Further clinical and comparative studies with a larger patient cohort may yield additional useful information.
Endoscopically Assisted Percutaneous Achilles Tendon Repair: A Biomechanical and Clinical Pilot
Authors: Carpenter Daniel , Dederer Katherine , Weinhold Paul , Tennant Joshua N 
Published: October 2019

Category: Arthroscopy, Sports, Trauma Introduction/Purpose: Achilles tendon rupture treatment includes non-operative, minimally invasive, and open repair techniques. Clinical outcomes of a cohort of patients undergoing a percutaneous endoscopically assisted technique (PEAT) were compared to those of a cohort of non-operatively treated Achilles tendon ruptures. The PEAT repair technique described is a novel method which avoids a proximal lateral incision. We sought to determine clinical outcomes from a cohort undergoing this procedure as well as its basic biomechanical properties. Methods: Clinical: With IRB approval a cohort of operatively treated patients was assessed with the following PROs: Return to sport, VAS pain score, Satisfaction Likert, patient reported complications, single heel lift, patient reported medical & smoking history, ATRS (Achilles Tendon Rupture Score). Chart review of diagnostic modality, injury mechanism, time to surgery, tourniquet times, and surgeon reported complications were also collected. Biomechanical: 6 pairs (12) of age and sex matched fresh frozen lower extremity specimens (mid tibia to toes) with average age 71.5 (48-89) (8 F specimens, 4 M specimens) underwent either open (Kessler) repair or percutaneous repair. Specimens were cycled 10N-43 N for 100 cycles, and 20N-86 N for 200 cycles, measuring displacement and ultimate load to failure. Results: Clinical: 30 patients operatively treated with the PEAT procedure, 22 contacted by phone. Avg. follow up 2.5 years (1.2- 3.8); Avg ATRS 94.1 (81-100, SD 4.8); “very satisfied” 19/20; Avg VAS 0.3. We had a re-rupture rate of 3.33% (1/30). Biomechanical data: At 10-43 N for 100 cycles, all 12 specimens survived for duration of testing with biomechanical equivalence. At 20-86 N for 200 cycles, percutaneous repairs with greater cyclical displacement (1.7 cm vs 1.0 cm); 1/6 percutaneous with early failure; 11/12 specimens survived. Conclusion: The PEAT repair of Achilles tendon rupture showed excellent clinical outcomes with low complications and with biomechanical testing suggesting equivalent strength at low loads.
Epidemiology of Achilles Tendon Injuries in Collegiate Level Athletes in the United States
Authors: Chan Jimmy J. , Chen Kevin K. , Guzman Javier Z. , Vulcano Ettore 
Published: October 2019

Category: Hindfoot, Sports, Trauma Introduction/Purpose: Achilles tendon rupture is a potentially devastating injury particularly for National Collegiate Athletic Association (NCAA) athletes. Little has been studied regarding the incidence and implications of Achilles tendon ruptures in this patient population. Better characterization of the factors commonly found in athletes who rupture their Achilles may provide clues to aid in their prevention. Methods: Achilles injuries across 16 sports among NCAA men and women during the 2004-05 to 2013-14 academic years were analyzed using the NCAA Injury Surveillance Program (NCAA-ISP). Achilles tendon rupture rates per 100,000 athlete-exposures (IR), operative rate, annual injury rate trends, re-injury rates, mechanism of injury, in-season status (pre/in/post-season) and time loss distributions were compiled and calculated. A sub-analysis of contact sports and sports played by both genders (C-BG) was performed to determine if there were significant differences in risks in patients who played in contact sports. Results: N=255 Achilles tendon injuries were identified over 10 academic years (IR: 2.17). The injury rate was higher in males compared to females (IR=2.33 vs. 1.89 respectively). Achilles injuries were most common in Men’s Basketball (IR=4.26), Soccer (IR=3.06), and Football (IR=2.69). The top three women’s sports with Achilles injury were Gymnastics (IR=16.73), Basketball (IR=3.32), and Soccer (IR=1.81). Thirty-three injuries were operative (13.1%) and 14.9% (N=38) were season-ending injuries. The average time loss was 10.65 days when excluding patients who had season/career ending injuries. Reinjury rate was 11.0% (N=28). 61.2% of all injuries occurred during the regular season (N=156) with 36.0% (N=92) and 2.7% (N=7) occurring in pre- and post- season, respectively. There was a significantly greater number of injuries in contact (N=198) versus non-contact sports (N=50) (p<0.001). Conclusion: Achilles tendon ruptures can be devastating injuries in professional and collegiate athletes. In our study, nearly 15% of all NCAA Achilles tendon ruptures resulted in season ending injuries or significant time loss and over 13% of injuries required operative management with a majority of injuries occurring during practice. In addition, a significantly higher proportion of athletes who played a contact sport had Achilles injuries. Better understanding of what circumstances more often tend to result in Achilles injuries can help establish prevention strategies.
Outcomes Following a Modified Broström Procedure and Arthroscopic Debridement of Medial Gutter Osteoarthritis Combined With Chronic Lateral Ankle Instability
Authors: Cho Byung-Ki , Choi Seung-myung 
Published: October 2019

Category: Ankle Arthritis Introduction/Purpose: There is limited information regarding the outcomes of operative treatment for ankle instability with coexisting arthritic changes in the medial gutter. This study was performed to evaluate the intermediate-term clinical and radiological outcomes following a modified Broström procedure and arthroscopic debridement in middle-aged patients with combined medial gutter osteoarthritis and chronic lateral ankle instability. Methods: Twenty-four patients with medial gutter osteoarthritis related to chronic lateral ankle instability were followed for more than 3 years after operative treatment. All patients showed medial joint space narrowing of Takakura stage II at the time of surgery. The clinical evaluation consisted of the American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS) for medial ankle pain during walking, and Foot and Ankle Ability Measure (FAAM). Results: Mean AOFAS and FAAM scores significantly improved from 51.2 and 45.7 points preoperatively to 80.3 and 78.4 points at final follow-up, respectively (P < .001). Although mean pain-VAS significantly improved from 6.8 points to 3.1 points (P < .001), 5 patients (20.8%) complained of gait discomfort with considerable pain of 4 or more points. There was only 1 patient (4.2%) with recurrent ankle instability, while 6 patients (25%) showed a progression of arthritis stage. Conclusion: Modified Broström procedure combined with arthroscopic debridement appears to be an effective operative option for medial gutter osteoarthritis secondary to chronic ankle instability. Despite the onset of arthritis, most patients were able to achieve significant improvement in reducing pain while eliminating instability.
Experiences of Living with Bilateral Total Ankle Replacement and Ankle Arthrodesis: A Qualitative Study from a Patient Perspective
Authors: Conlin Catherine , Pinsker Ellie , Khan Ryan , Daniels Timothy R. 
Published: October 2019

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) and ankle arthrodesis are both effective treatments for end-stage ankle arthritis, however differences in treatment outcomes may be better understood using a qualitative inquiry among individuals who have undergone both procedures. The purpose of this study was to investigate patients’ experiences and impressions of living with bilateral TAR and ankle arthrodesis. Methods: The sample consisted of 10 patients, selected purposively from a larger cohort, who could speak English and had a TAR on one side and ankle arthrodesis on the contralateral side. All procedures were completed by a single experienced surgeon. Semi-structured interviews were conducted at least one year after completion of the most recent procedure (TAR or arthrodesis). Qualitative data analysis was performed in accordance with a descriptive phenomenological theoretical approach, from which codes and themes were derived. Results: Interviews revealed advantages and disadvantages associated with both TAR and ankle arthrodesis from the patients’ perspective. Two overarching domains in which differences between their TARs and ankle fusions emerged: psychological and musculoskeletal. Within these domains, concepts of vigilance (as previously described by Pinsker) and strategizing the use of one ankle over the other emerged as themes that unified nearly all patients. Specific differences between the two procedures with respect to stability versus flexibility were commonly identified. Overall, patients preferred their TAR. Conclusion: This study provides insight into the lived experiences of a unique group of patients who have both an ankle arthrodesis and TAR. Patients evaluated the impact of TAR and ankle arthrodesis on their lives and overwhelmingly favoured TAR. The findings of this study can help clinicians to better counsel patients on expectations after TAR and ankle arthrodesis, and may aid researchers improve patient-report measurement instruments to better capture the outcomes that are important to patients.
Postoperative Medial Cuneiform Position is Correlated with Patient-Reported Outcomes Following Cotton Osteotomy for Reconstruction of the Stage II Adult Acquired Flatfoot Deformity
Authors: Conti Matthew S. , Garfinkel Jonathan H. , Kunas Grace C. , Deland Jonathan T. , Ellis Scott J. 
Published: October 2019

Category: Hindfoot, Midfoot/Forefoot Introduction/Purpose: During reconstruction of the stage II adult acquired flatfoot deformity (AAFD), residual supination of the midfoot is often addressed with an opening wedge medial cuneiform (Cotton) osteotomy after adequate correction of the hindfoot valgus deformity. The purpose of this study was to determine if there was a correlation between postoperative alignment of the medial cuneiform using the previously described cuneiform articular angle (CAA) on lateral radiographs and postoperative patient-reported outcomes using the Foot and Ankle Outcome Score (FAOS). Methods: Sixty-three feet in 61 patients with stage II AAFD who underwent a Cotton osteotomy as part of a flatfoot reconstruction were included the study. The CAA, medial arch sag angle (MASA), and lateral talo-first metatarsal (Meary’s) angles were measured on postoperative weightbearing lateral radiographs at a minimum of 40 weeks postoperatively. Pearson’s correlation analysis was used to determine if there was an association between postoperative radiographic angles and FAOS at a minimum of 24 months postoperatively. Patients were also divided into mild plantarflexion (CAA> or =-2 degrees) and moderate plantarflexion (CAA<-2 degrees) groups, and Wilcoxon rank-sum tests were used to identify whether there were differences in clinical outcomes between the two medial cuneiform positions. A postoperative CAA of -2 degrees was chosen because it is two standard deviations from the average postoperative CAA following a flatfoot reconstruction (Castaneda et al. FAI 2012). Results: Postoperative CAA was significantly positively correlated with the postoperative FAOS symptoms (r=.27, P=.03), daily activities (r=.29, P=.02), sports activities (r=.26, P=.048), and quality of life (r=.28, P=.02) subscales. A positive correlation indicates that higher postoperative FAOS scores are associated with a decreased amount of plantarflexion of the medial cuneiform (i.e. a more positive CAA). Patients in the mild plantarflexion group had statistically and clinically better outcomes compared with the moderate plantarflexion group in the FAOS symptoms (P=.04), daily activities (P =.04), and sports activities (P=.01) subscales (Figure 1). Graft size was correlated with postoperative CAA (r =-.30, P = .02) but not correlated with any postoperative FAOS subscale (all P values > .40). Conclusion: Our study suggests that the surgeon should avoid excessive plantarflexion of the medial cuneiform and use the Cotton osteotomy judiciously as part of a flatfoot reconstruction for stage II AAFD.
Sinus Tarsi Approach for Open Treatment and Internal Fixation of Displaced Intra-articular Calcaneal Fractures in High-Risk Patients: The New Gold Standard?
Authors: Davies James P. , Smith W. Bret , Steinlauf Steven , Millikin Mary 
Published: October 2019

Category: Ankle, Diabetes, Hindfoot, Trauma Introduction/Purpose: Intra-articular calcaneal fractures offer unique challenges. Wound problems and infection are significant complications in the surgical treatment of calcaneal fractures which in turn can be debilitating to patients and outcomes. The literature suggests varying wound complication rates but 21% up to 33% using the traditional extensile lateral approach in some studies. The extensile lateral approach has historically been accepted as the gold standard for fixation and treatment of these fractures. Recently there has been resurgent interest in alternative approaches to the fixation of intra-articular calcaneal fractures. Of interest is the potential of the sinus tarsi approach to decrease wound complications while having comparable reduction quality to the higher wound risk extensile lateral approach. Methods: A multi-center retrospective chart review study was implemented. The study objective was to review wound complication of the sinus tarsi approach compared with outcomes from the traditional extensile approach for fixation of displaced intra-articular calcaneal fractures. Specifically; examining a population of patients considered at high risk for wound issues, comparing radiographic and clinical outcomes. Results: In the high-risk group, only one primary complications resulted, including one patient with a history of an open fracture. All fractures healed with adequate maintenance of alignment. Chi- squared analysis resulted in a statistically significant difference in complication rates between sinus tarsi and the traditional extensile lateral approach at the 95% confidence level. Conclusion: In both high-risk and lower-risk cohorts of patients, a low rate of infection and wound problems was encountered. A limited approach through a sinus tarsi incision provides a viable option to treat displaced intra-articular calcaneus fracture patients with risk factors for wound issues. The patients all healed both their soft tissue wounds and fractures. Functional return was consistent with other study populations. Our study adds another cohort of patient data demonstrating the advantage of the sinus tarsi approach when compared to the extensile lateral in terms of decreased wound complications while maintaining quality of reductions and clinical outcomes.
Clinical Outcomes of Distraction Arthroplasty with Arthroscopic Microfracture for Advanced Stage Ankle Osteoarthritis
Authors: Ikuta Yasunari , Nakasa Tomoyuki , Tsuyuguchi Yusuke , Ota Yuki , Kanemitsu Munekazu , Adachi Nobuo 
Published: October 2019

Category: Ankle Arthritis, Arthroscopy Introduction/Purpose: Ankle trauma is highly implicated in the etiology of osteoarthritis (OA) of the ankle, and posttraumatic ankle OA is often observed in younger patients. In advanced stages, ankle arthrodesis has been considered as a gold standard treatment, and total ankle arthroplasty is also developed over the past decade for older patients. However, the surgical treatment of severe ankle OA for younger, active patients remains challenging. Ankle distraction arthroplasty is an alternative option for treatment of severe ankle OA in younger patients. The distraction device enables joint distraction with ankle motion that induces cartilage repair of the ankle. This study aimed to clarify the clinical outcome of the ankle distraction arthroplasty with arthroscopic microfracture for ankle OA in younger patients. Methods: This retrospective analysis included 7 ankle OA patients who underwent distraction arthroplasty with arthroscopic microfracture, in 5 men and 2 women, with a mean age of 45.9 years (range, 39-62). Range of motion (ROM) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score were evaluated as the clinical outcomes. The talotibial joint space was identified as anterior, center and posterior segment on lateral view. The width of joint space in each segment was measured on pre- and post-operative weight-bearing radiographs. The distraction device was removed at 3 months after initial surgery, and second look arthroscopy was also performed at the same time. The arthroscopic findings were assessed retrospectively. Results: All 7 patients were followed with a mean follow-up period of 4.2 years. One patient who had the worst preoperative AOFAS score of 19 converted to arthroscopic ankle arthrodesis at 2 years after the initial surgery. The mean total ROM and AOFAS score improved from 29.3 to 37.1 (p = 0.028), from 41.7 to 76.1 (p = 0.018), respectively. Weight-bearing radiographs showed a width of ankle joint space with anterior, center and posterior of 1.9 mm, 1.8 mm, 2.0 mm at preoperative status and 2.9 mm, 2.8 mm, 2.9 mm at final follow-up status. Second look arthroscopy revealed that the fibrous cartilage like tissue covered the cartilage defect area at the talotibial joint in all patients. Conclusion: Our findings suggest that the distraction arthroplasty with arthroscopic microfracture could be a useful option for active patients with advanced stage of ankle OA. Good clinical status and the width of joint space had been preserved for a maximum of seven years. Further follow-up was required to elucidate the long-term clinical results.
Associations in the Sagittal Plane: No Evidence that Foot Radiographs Predict Sagittal Alignment or Degeneration of the Spine
Authors: Khan Jannat M. , Idarraga Alex , Skipor Joseph , Kalish Chaim , Berkowitz Mark , Louie Philip K. , Bohl Daniel D. , Lee Simon , An Howard S. , Hamid Kamran S. 
Published: October 2019

Category: Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: The interaction between hip pathology and spinopelvic alignment is a current subject of interest in orthopedics with a number of recently performed studies. However, little is known regarding the interaction between foot & ankle (F&A) pathology and spinopelvic alignment, despite common complaints from patients such as back pain potentially caused by an outturning foot. The purpose of this study is to test for associations between F&A pathology and spinopelvic alignment and degeneration. Methods: A retrospective cohort study was conducted involving consecutive patients who presented to both F&A and spine surgeons within the same practice. Inclusion criteria required that each patient have the following radiographic views while in a weight bearing, standing position: lateral of lumbar spine; anteroposterior (AP), lateral, and mortise of ankle; AP, lateral, and oblique of foot. Patients were excluded from analysis if there was radiographic evidence of previous surgical instrumentation in the spine, ankle, or foot. Bonferroni correction was performed to account multiple statistical analyses, which resulted in the level of significance set to p<0.001. Results: A total of 55 patients met inclusion criteria. There were no associations found between F&A pathology and spinopelvic alignment/degeneration (p>0.001 for each; Table 1). Conclusion: A common patient concern is that a foot condition may be contributing to low back pain through altered gait and postural dynamics. With the numbers available, we were unable to demonstrate statistical associations between F&A radiographic findings and spinopelvic alignment or degeneration. Orthopaedic surgeons can address patients’ concerns about the relationship