bluuebunny/crossref_metadata_2025_split huggingface dataset:
In Silico Assessment of the Influence of Talus Osteochondral Lesion Size and Location on Ankle Joint Stability using Tilted Talar Dome Plane Orientations
Authors: Aslan Lercan , Subasi Omer , Karaismailoglu Bedri , Gedik Cihad C. , Yuruk Batuhan , Ashkani-Esfahani Soheil , Eren Ilker 
Published: December 2024

Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: Osteochondral lesions of the Talus (OLTs) are among the most common injuries that occur in the ankle joint and can be detrimental to the overall function. The size of the lesion is critical in determining the surgical treatment; for smaller lesion sizes, microfracture can be considered but for larger lesions joint level restoring surgical intervention might be required. In this study, talus OLTs with different areas and locations are modeled to biomechanically evaluate the ankle joint stability. Our study aims to evaluate the stress distribution and joint stiffness effect of OLTs on all the 9-cell partition zones of the talar dome in three different ankle positions during gait. Methods: A simplified ankle geometry of an adult female was computationally modeled with 1 mm of cartilage at both sides of the tibiotalar contact. Lesion geometries were created on the talar dome with 4.5, 6.4-, and 9-mm lesion diameters, at each grid partition location on the talus sectioned 1 (anterior) to 9 (posterior). To enhance lesion area fidelity, tilted talar planes were utilized to consider the curvature of the talar dome. The modified models were then transferred to finite element analysis software. The maximum and average von Mises stresses, and stiffness were the biomechanical parameters investigated. Results: Utilizing the design parameters designated for this study, 81 different OLTs are modeled and computationally simulated. It is revealed that the stress parameters are highly misleading and do not predict ankle stability. However, stiffness is found to be a more reliable parameter that has an inverse correlation with the lesion diameter. Zones 8 (posteromedial) and 7 (Figure) on the posterior, and zone 3 on the anterolateral, were observed to be the most critical zones with lesser stiffness which meant decreased ankle joint stability in neutral, dorsiflexion, and plantarflexion, respectively. Zone 9 (posteromedial) was found to be the least critical zone in regard to stiffness. Conclusion: In our Finite Element study, we have found that during the walking gait, lesions in zones 8, 7, and 3 significantly impact joint stability compared to other zones of the same lesion size. This suggests that certain areas have a more pronounced effect on joint stability than others. Our findings challenge the commonly accepted threshold of 150mm² for transitioning from microfracture to other cartilage-restoring surgeries, as it may not be universally valid for all zones.
Interim Analysis of a Prospective Multicenter Study Assessing Radiographic and Patient Outcomes Following a Mini-Open Triplanar Tarsometatarsal Arthrodesis with Early Weightbearing
Authors: Daigre Justin L. , Santrock Robert D. , Chhabra Avneesh , McAlister Jeffrey , Taylor Robert , Farber Daniel C. , Raissi Abdi , Steinke Paul , Allen Marque , Shane Amber , Kile Deidre , McAleer Jody P. 
Published: December 2024

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: The majority of hallux valgus (HV) corrections have been historically performed via a two-dimensional, transverse plane-focused approach, which has demonstrated high rates of recurrence. Recently there has been a trend towards less-invasive approaches and an instrumented 1st TMT system was developed to perform a triplanar 1st TMT arthrodesis through a mini-open incision. Therefore, the purpose of this study is to assess the radiographic and patient-reported outcomes for HV correction performed with this system through a mini-open approach (≤4cm) with early return to weightbearing. Methods: This is an interim analysis of a prospective multicenter study on patients with symptomatic HV and no prior history of HV surgery on the operative foot. Patients were treated with an instrumented 1st TMT procedure through a mini-open (≤4cm) dorsal incision (which is approximately 50% smaller than the system’s prior-generation open incision) utilizing a biplanar locking plate construct with protected early weightbearing. The primary endpoint of this study is radiographic recurrence of HV, with recurrence reported using two different thresholds commonly utilized in the literature: post-operative HVA >15° and HVA >20°. Changes in radiographic measurements, return to weightbearing and activities, Manchester-Oxford Foot Questionnaire (MOxFQ), patient-reported pain (VAS), and forefoot circumference were also evaluated for statistically significant post-operative improvements through 12-month follow-up. Results: 105 patients (mean [range] age: 41.0 [14-57] years) underwent a mini-open TMTA, with 92 and 70 patients completing 6- and 12-month visits, respectively. Mean (SD) incision length was 3.5cm (0.27). Mean (95% CI) time to protected weightbearing and unrestricted activity were 7.9 (6.7, 9.1) days and 3.6 (3.4, 3.8) months, respectively. Significant improvements in HVA, IMA, and TSP were maintained through 12 months (Table 1). Applying recurrence definitions of HVA >15° and >20°, 12-month recurrence rates were 4.8% (3/62) and 0% (0/62), respectively. Significant improvements in VAS and MOxFQ were observed through 12 months (N =65). Twelve-month mean (95% CI) change in forefoot circumference was -0.8cm (-1.2, -0.5), N =64. One (1.0%) of 105 patients required reoperation (HWR due to pain) and no patients experienced symptomatic nonunion. Conclusion: The interim results of this prospective, multicenter study on a mini-open 1st TMT system with early weightbearing demonstrated statistically significant improvements in radiographic alignment and patient-reported outcomes, and minimal forefoot swelling. This study will follow the patients for a total of 24 months postoperatively.
Intermediate-Term Clinical Outcomes of Novel Distal Tibial Rotational Osteotomy for Varus Ankle Osteoarthritis
Authors: Murahashi Yasutaka , Mori Yuta , Takahashi Katsunori , Watanabe Kota , Teramoto Atsushi 
Published: December 2024

Category: Ankle Arthritis; Ankle Introduction/Purpose: Distal tibial oblique osteotomy for ankle osteoarthritis is an effective procedure with joint preserving. However, there is the risk of nonunion due to open wedge osteotomy and complication associated with autogenous bone harvesting. We performed distal tibial rotational osteotomy (DTRO) for ankle osteoarthritis, which modified osteotomy design is expected to reduce the risk of nonunion without autologous bone grafting and soft tissue complications. We evaluated the clinical and radiographical outcome of DTRO. Methods: A total of 23 feet (4 males and 19 females) who underwent DTRO for ankle osteoarthritis in our institutions between 2016 and 2022 was included. All patients required a minimum of one year follow-up. As a surgical procedure, tri-plane osteotomy was performed using anteromedial approach. Then, the distal tibial fragment was rotated distally in the 3D plane until ankle stability was achieved, and the prominence of the medial tibia was resection after the correction. A medial tibial locking plate was applied for stabilization after filling opening gap with synthetic bone blocks. We evaluated demographic data, radiographical measurements, classification of arthritis severity, and the rate of nonunion, wound complications and reoperation. In addition, JSSF scale (Japanese Society for Surgery of the Foot ankle) and SAFE- Q (Self-Administered Foot Evaluation Questionnaire) were assessed preoperatively and at the latest follow-up. Results: Subjects had an average age of 64 years, an average follow-up period of 42 months, and were classified as stage 2/3a/3b in 1/19/2 feet preoperatively. The average of tibial anterior surface angle changed from 83.7° to 93.5°, and the tibial lateral surface angle changed from 81.0° to 81.9° in pre- and postoperative radiography. The JSSF scale significantly improved from 49.1 to 88.2 (p< 0.01) and the SAFE-Q showed significant improvement in all subscales at the latest follow-up. Bone union was obtained within 3 months in all cases, and no nonunion was observed. Delayed wound healing was observed in 1 case (4.4%). Ankle arthrodesis was needed in 1 case of deep infection and in 1 case of arthritis progression stage 3b to 4. Conclusion: In general, the distal tibia has poor soft tissue and blood flow that may lead the nonunion and soft tissue complications for distal tibial osteotomy. The advantage of DTRO was to maintain tibial bone contact after the osteotomy which may be favorable for bone stability and union, and to resect the medial bone prominence which reduce the tension of soft tissue. In this study, bone union was obtained in all cases without harvesting autogenous bone, and wound complications were low at 4.4%. Good intermediate-term outcomes were obtained, and DTRO can be a favorable surgical procedure for ankle osteoarthritis.
Low Rates of Return to Sport and Reduction in Performance Following Acute Achilles Tendon Ruptures in Athletes Participating in Major League Soccer
Authors: Butler James J. , Nasir Bader , Lin Charles , Robertson Djani , Samsonov Alan P. , Kennedy John G. 
Published: December 2024

Category: Sports; Other Introduction/Purpose: The purpose of this study was to assess outcomes following acute Achilles tendon ruptures (AATR) sustained by athletes participating in the Major League Soccer (MLS). Methods: Athletes participating in the MLS who sustained an AATR were identified using a publicly available database, match reports and injury reports. The years of inclusion was from 2008-2022. Data collected and analysed: player demographics, player position, if surgical intervention was warranted, rates of return to play (RTP), time to return to play, games missed. Pre-injury and post-injury performance outcomes collected and analysed: games played, assists, goals, passes, pass %, crosses, shots, shots on target and shot %. Results: Twenty-six athletes sustained an AATR in the MLS (0.008564 per 10,000 athlete-exposures). The mean age was 25.8±8.4 years and the mean BMI was 22.5±6.6kg/m2. There were 15 (57.7%) AATRs sustained by defensive players, 5 (19.2%) AATRs sustained by midfield players, 3 (11.6%) AATR sustained by forwards and 3 (11.6%) AATR sustained by goalkeepers. All athletes (100%) underwent surgical intervention. The mean number of games played prior to injury was 164.7±154.9. The RTP rate to the MLS was 73.1% at mean time of 11.1±5.5 months. The mean number of games missed due to injury was with 30.1±11.7 games. There was a statistically significant decrease in the mean number of games played, goals scored and shots taken following RTP. Conclusion: This current study found that AATRs were an uncommon injury in the MLS with an incidence of 0.008564 per 10,000 athlete-exposures. Sustaining an AATR was associated with a 73.1% return to play rate to the MLS at a mean time of 11.1 ± 5.5 months. There was a statistically significant deterioration in key performance metrics such as mean games played, goals scored and shots taken. This study reinforces the potentially devastating sequelae following AATR in the elite athletic population.
Low Rates of Return to Sport and Reduction in Performance Following Acute Achilles Tendon Ruptures in Elite Rugby Union Players
Authors: Butler James J. , Aratikala Adarsh , Samsonov Alan P. , Wingo Taylor , Calder James , Kennedy John G. 
Published: December 2024

Category: Sports; Other Introduction/Purpose: The purpose of this study was to assess outcomes following acute Achilles tendon ruptures (AATR) sustained by elite rugby union players. Methods: Elite rugby union players who sustained an AATR were identified using a publicly available database, match reports and injury reports. "Elite rugby union" was defined as a player who played professional rugby in the following competitions: United Rugby Championship, Top 14, English Premiership, Super Rugby and international rugby for a top 20 ranked team. The years of inclusion was from 2015-2022. Data collected and analysed: player demographics, player position, if surgical intervention was warranted, rates of return to play (RTP), time to return to play, games missed. Pre-injury and post-injury performance outcomes collected and analysed: games played, tries scored, points scored. Results: Nintety-three elite rugby union players sustained an AATR between 2015-2022 (0.0146 per 10,000 athlete-exposures). The mean age was 27.8±10.1 years and the mean BMI was 30.5±7.6kg/m2. There were 61 (65.5%) AATRs sustained by forwards and 32 (34.5%) AATRs sustained by backs. Forty-five (48.3%) of AATRS occurred during the in-season and 48 (51.7%) AATRs occurred during training. All athletes (100%) underwent surgical intervention. The most common mechanism of injury was a non-contact injury (86.4%). The RTP rate was 68.9% at mean time of 8.9±3.9 months. There was a statistically significant decrease in the mean number of games played, tries scored and points scored following RTP. Conclusion: This current study found that AATRs were an uncommon injury in elite rugby union players with an incidence of 0.0146 per 10,000 athlete-exposures. Sustaining an AATR was associated with a 68.9% return to play rate at a mean time of 8.9±3.9 months. There was a statistically significant deterioration in key performance metrics such as mean games played, tries scored and points scored This study reinforces the potentially devastating sequelae following AATR in the elite athletic population.
Minimally Invasive (MIS) TTC Fusions: A 52 Patient Case Series with High Rate of Limb Salvage
Authors: Miller Christopher P. , MacDonald Tom , Ndu Anthony , Abicht Brad , Raza Marium , Ranganathan Noopur 
Published: December 2024

Category: Ankle Arthritis; Hindfoot Introduction/Purpose: TTC fusion is a common procedures to address complex hindfoot and ankle pathologies. It is a versatile procedure and can be used in many situations as either a primary procedure or limb salvage. Additionally, TTC is often used in the setting of neuropathy, Charcot deformities and failed ankle fracture ORIF. Given the medical and surgical complexity of the patient population, minimally invasive surgery (MIS) procedures may offer a option to more safely address these complicated problems, but only if the procedure can address all aspects of the deformity correction as well as successful fusion. We present the results of the largest case series of all MIS TTC fusions. We hypothesize that the surgical outcomes will be on par if not superior to traditional technique. Methods: This retrospective case series presents all patients MIS TTC fusion between January 1, 2019, and June 1, 2023 as part of a multi-center retrospective review of cases. Patients were identified through the operating room (OR) schedule, and their data was collected from medical charts stored in the institution's EHR. We report on demographics, complications, and fusion outcomes of TTC fusions for this population. Of the 52 cases, 27 cases (52%) also required osteotomies of the malleoli or midfoot for deformity correction which was also performed with an MIS technique when needed. Results: There were 52 patients included in the study. The primary diagnosis was Charcot ankle deformity in 11/52 (21%), Neuropathic ankle fracture in 15/52 (29%), Acute trauma in medical frail patient was 9/52 (17%), arthritis in 13/52 (25%) and other in 4/52 (8%). 26/52 (50%) had severe peripheral neuropathy. 40/52 (76%) patients had some combination of ESRD, poorly controlled diabetes, severe peripheral vascular disease, extremely poor soft tissue coverage. 45/52 (86%) patients achieved successful radiographic fusion. 2/52 (4%) achieved a stiff, asymptomatic pseudo arthrodesis. There were 9/52 (17%) complications: 2 patient deaths, 1 infection, 2 periprosthetic fractures, 1 nail subsidence, 2 delayed healing, 1 wound complications requiring flap closure. limb salvage was achieved in 47 of the 50 (94%) patients who survived to a surgical endpoint. Conclusion: MIS TTC fusion minimizes wound healing complications and infection. Deformity correction was performed with osteotomies when needed. The prevelence of medical comorbidities in this population is underscored by the 2 of patients who died within the early postoperative period (< 1 month). However, the high rate of limb salvage (94% of living patients, 90% of all patients) demonstrates the value of this technique to achieve deformity correction and bony union even in such a compromised patient population. The authors believe that MIS TTC fusion is a critical skill that will assist in treating many of our sickest and most complex patients.
Minimally Invasive Three-Column Fixation for Displaced Intra-Articular Calcaneal Fractures
Authors: Yan Alan Y. , Drazick Anthony , Wei Baofu , Lou Shulei , Li Zhenyu 
Published: December 2024

Category: Trauma; Hindfoot Introduction/Purpose: Calcaneus can be morphologically and biomechanically constructed of medial column, lateral column and a connecting beam acting as transverse column. The fracture of the three columns of intra-calcaneal depression fracture divides the calcaneus into four major fracture fragments, namely the anterior tuberosity fragment, the sustentaculum fracture fragment, the posterior articular fracture fragment, and the posterior tuberosity fracture fragment. Minimally invasive three column fixation with screws was designed to manage the displaced intraarticular calcaneal fractures without extensile exposure. The timely use of the external distraction is key to restore the morphological index of the calcaneus. Frequently, the posterior articular fragment was reduced and fixed through a tarsal sinus approach. Methods: Thirty-five patients with 37 feet (33 xSanders type II, 4 x type III) of acute displaced intraarticular calcaneal fractures were managed with minimally invasive three column fixation. Böhler’s angle, Gissane angle and calcaneal varus angle (CVA) were measured preoperatively and postoperatively. Functional outcomes were assessed based on American Orthopedic Foot and Ankle Society (AOFAS) ankle/hindfoot score. Results: Thirty-five patients with average follow-up time of 8 (range 6–12) months were included. All incisions healed primarily with no incision-related complications. The radiographs demonstrated successful corrections of the Böhler’s angle, Gissane angle and CVA from preoperative status to postoperative status. At average 8-month follow-up, the mean AOFAS score was 90.2 + 17.7 (range 70–98) and considered as the good and excellent rate of 89.7%. Conclusion: Minimally invasive three-column fixation of calcaneal fracture is a three-dimensional fixation, which can effectively obtain and maintain the anatomical reduction of calcaneal alignment, length, height, width and posterior articular surface reduction. Timely use of the medial or lateral based external distraction and direct tarsal sinus incision approach can achieve full or near anatomical reduction of calcaneal fractures. Meanwhile the minimally invasive approach effectively avoided complications associated with lateral extensile incisions. There was no need for prolonged wait period before skin condition to improve which may complicate the reduction and fixation due to early malunion.
Minimally Invasive Ultrasound Guided Percutaneous Fasciotomy for the Treatment of Chronic Plantar Fasciitis
Authors: Encinas Rodrigo , Gauthier Chase , Cantrell Anthony C. , Zhang Yuqing , Jackson J. Benjamin , Gross Christopher E. , Gonzalez Tyler , Scott Daniel J. 
Published: December 2024

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Plantar fasciitis is one of the most common causes of foot pain among the United States’ population. There are several treatment options including both nonoperative and operative approaches. Recently, minimally invasive (MIS) percutaneous plantar fasciotomy has come on the market with anecdotally good patient outcomes but limited published literature. This study aimed to review the patient outcomes, complications, and revision rates in patients undergoing MIS ultrasound-guided percutaneous plantar fasciotomy for the treatment of chronic plantar fasciitis. Methods: A multicenter retrospective chart review of patients undergoing MIS ultrasound-guided percutaneous fasciotomy using the Tenex device (Trice Medical, Lake Forest California) from January 2020 to December 2022 was performed. The main data points collected were patient-reported outcomes, follow-up times, revision surgery, and complications. Continuous variables were defined as a mean and were compared using Paired Student’s T-Test. Multivariable linear regression analysis was utilized to determine specific factors that influenced outcomes when controlling for confounding variables. All P< 0.05 were considered significant. Results: There were 56 (42 female/14 male) patients that underwent 60 procedures. The average age and BMI were 48.6 years (range 19–80), and 33.2 kg/m2 (range 19.7–58.6), respectively. There were two (3.3%) complications of wound-healing delays and one (1.7%) complication of nerve damage noted. There were two (3.3%) revisions. The average follow-up was 27 months (range 13.3–48.6). The average improvement in pain, physical function, and mobility Patient-Reported Outcomes Measurement Information System (PROMIS) scores were 5.2 (range: -5.1–25.8), P< 0.01), 3.6 (range -7–30.7, P=0.01), and 3.1 (range -6–25, P=0.01). Overall, over 90% of patients had no to minimal pain at the final follow-up. No specific demographic factors were significantly associated with an improvement in PROMIS scores or overall pain at final follow-up. Conclusion: MIS ultrasound-guided plantar fasciotomy appears to be a reliable surgical treatment option for chronic plantar fasciitis with high patient satisfaction, minimal complications, and low revision rates.