bluuebunny/crossref_metadata_2025_split huggingface dataset:
Revolutionizing Achilles Tendon Repair: A Comprehensive Proposal Integrating the WALANT Technique for Percutaneous Achilles Tenorrhaphy
Authors: Felipe Albarrán Carlos , Letelier Hugo , Ignacio Escudero Mario , Birman Eddie , Nuñez Alfredo , Pino Felipe , Jose Pellegrini Manuel 
Published: December 2024

Category: Sports Introduction/Purpose: Achilles tenorrhaphy is one of the most common procedures performed in foot and ankle surgery, and percutaneous techniques are safe and achieve good outcomes. Over the past 20 years, the WALANT technique (Wide-awake local anesthesia no-tourniquet) has gained popularity due to its advantages: it does not depend on the availability of complex operating rooms or anesthetists, allows for intraoperative functional evaluation, presents lower costs, and few complications have been reported. However, there is scarce literature regarding the complications associated with the WALANT technique in foot and ankle surgery, especially in percutaneous Achilles tenorrhaphy. Methods: A retrospective cohort study included patients over 18 who underwent percutaneous Achilles tenorrhaphy using the Dresden technique, with a minimum follow-up of 6 months. The WALANT group was treated on an outpatient basis in a minor surgery theater, while the standard treatment (ST) group underwent surgery in the main theater with spinal anesthesia. Categorical data were analyzed using the Chi-square test, with statistical significance set at p = 0.05. Results: A total of 51 patients were included (19 WALANT and 32 ST), all male, with an average age of 43.1 years. There was one case of surgical wound infection (SWI) in the WALANT group (5.26%); there were no cases of SWI in the ST group, with no statistically significant differences (p=0.18). In the WALANT group, there were no cases of re-rupture, and in the ST group, there was 1 (6.3%) re-rupture that did not require reintervention; no statistically significant difference was found (p=0.19). Additionally, 15.79% of the WALANT group presented with transient hypoesthesia (up to 6 months) of the sural nerve, compared to 3.13% in the ST group, with no statistically significant differences (p=0.10). No cases of deep venous thrombosis were found in either group. Conclusion: The WALANT technique demonstrates no differences in complications between the two groups, indicating it is considered a safe technique regarding associated complications. It's worth mentioning that the WALANT technique is considered a more cost-effective option due to the lower use of resources.
Second-Look Needle Arthroscopy after Prior Surgical Treatment for Cartilage Lesions of the Ankle: The Amsterdam and New York City Perspectives
Authors: Walinga Alex , Butler James J. , Dahmen Jari , Stufkens Sjoerd , Robert Guillaume , Kennedy John G. , Kerkhoffs Gino M M. M.J. 
Published: December 2024

Category: Ankle; Sports Introduction/Purpose: The purpose of this prospective study was to evaluate the quality of the reparative cartilage during second-look needle arthroscopy following talar osteoperiostic grafting from the iliac crest (TOPIC) and autologous osteochondral transplantation (AOT) procedures for the management of large osteochondral lesions (OCLs) of the talus. Methods: Patients who underwent second-look needle arthroscopy following either TOPIC or AOT procedure were prospectively recruited. The primary outcome was the assessment of the quality of the reparative cartilage via second-look needle arthroscopy scored by the International Cartilage Repair Society (ICRS) score. The secondary outcomes were the number and nature of ad-hoc needle arthroscopy interventions and complications associated with these interventions. Results: Five patients underwent second-look needle arthroscopy following TOPIC procedure and 11 patients underwent second-look in-office needle arthroscopy following AOT. The mean ICRS in the TOPIC cohort was 9.4 ± 1.0 at a mean time of 24.4 months following the index procedure. The mean ICRS in the AOT cohort was 10.6 ± 1.3 at a mean time of 58.8 months following the index procedure. No complications were observed in either cohort. Conclusion: This study demonstrated that AOT and TOPIC lead to high-quality reparative cartilage at short-term to mid-term follow-ups, but further studies with larger patient cohorts and longer follow-ups are warranted. Furthermore, second-look needle arthroscopy is a safe and viable minimally invasive procedure that can effectively evaluate the quality of reparative cartilage following surgical intervention for OCLs of the talus. In addition to arthroscopic evaluation of the reparative cartilage, this procedure has therapeutic capabilities and can resect bony and soft tissue sources of anterior ankle impingement.
Sex-Specific Analysis in Patients Undergoing Talar OsteoPeriostic Grafting from the Iliac Crest (TOPIC) for Large Osteochondral Lesions of the Talus
Authors: Dahmen Jari , Gianakos Arianna , Hollander Julian , Rikken Quinten , Stufkens Sjoerd , Kerkhoffs Gino M M.M.J. 
Published: December 2024

Category: Sports; Ankle Introduction/Purpose: Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) is a novel technique for the treatment of large osteochondral lesions of the talus. It is the purpose of the present study to assess the gender-specific differences in the presentation and outcomes following TOPIC between male and female patients. Methods: A prospective comparative analysis was performed comparing consecutive female and male patients having been treated by the press-fit TOPIC procedure. Clinical comparative assessment pre-operatively and at 12 months of follow-up included determination of the Numeric Rating Scale (NRS) scores for pain during walking (primary outcome), at rest, and during stair-climbing. The Foot and Ankle Outcome Score (FAOS) was also assessed. A computed tomography (CT) scan was performed for lesion size, morphology and localization determination pre-operatively as well as 10-12 weeks postoperatively to assess union of the distal tibial osteotomy site and at 1 years postoperatively to assess consolidation of the graft as well as cyst development in the graft. Results: A total of 48 patients (30 women, 18 men) were eligible for inclusion. Both men and women demonstrated significant functional improvements post-operatively concerning the clinical outcomes with no significant differences between men and women (n.s.) except for a significantly greater improvement in postoperative FAOS pain scores in women. Men presented with OLTs significantly larger in both surface area (208 mm2 for males versus 155 mm2 for females, p< 0,05) as well as lesion volume (3.0 cm3 for males versus 1.8 cm3 for females, p< 0.05). At 1-year post-operatively, all patients with a CT scan (n=47) showed graft consolidation. Cyst formation was present in 11 females (37% of the group) and 10 males (59% of the group), respectively (p=0.24). There were no statistical differences in complication rates following the TOPIC procedure. Conclusion: Both male and female patients showed clinically relevant improvements in the clinical outcomes after undergoing the TOPIC procedure, with significant differences in pre-operative size. There were no statistical differences in complication rates following the TOPIC procedure, although a higher proportion of women did require hardware removal. TOPIC procedure is a good treatment strategy for large OLTs in both men and women.
Striding Towards Balance: Exploring Gender Representation and Regional Patterns in Orthopaedic Foot and Ankle Specialists
Authors: Jimenez Mosquea Thelma R. , Ubillus Hugo A. , Walls Raymond J. 
Published: December 2024

Category: Other Introduction/Purpose: Women have historically been underrepresented across all tiers of orthopedic surgery training. While it's widely acknowledged that a greater presence of women in faculty roles within foot and ankle fellowship programs correlates positively with the number of fellowship trainees, there remains a paucity of quantitative data on the representation of women at the foot and ankle subspecialty level. Although there may be a growing number of women participating in foot and ankle fellowship programs, this alone does not necessarily indicate improved gender representation, as statistical trends may be influenced by shifts in specialty preferences among applicants over recent decades. This study aims to address this gap by examining gender diversity among members of the American Orthopaedic Foot & Ankle Society. Methods: This cross-sectional study examined members of the American Orthopaedic Foot & Ankle Society (AOFAS) using the publicly accessible "Find a Doctor" page as of January 2024. Baseline data on gender, state, region, and year of graduation were collected. Specifically, the years of graduation were categorized into two periods: before and after 2013, enabling an evaluation of gender trends over the past decade. Gender information for each fellow was obtained from Healthgrades, while graduation year data were sourced from databases like AOFAS and professional profiles. Descriptive statistics were utilized to analyze baseline fellow data. This approach aimed to provide insights into the gender dynamics and temporal trends within the AOFAS membership, shedding light on potential shifts in the composition of orthopaedic foot and ankle specialists over time. Results: As of January 2024, our analysis revealed a total of 965 foot and ankle surgeons. Among them, 87.7% (847 out of 965) were men, while 12.3% (118 out of 965) were women. Prior to 2013, women accounted for 9.1% of the total, with men comprising 90.9%. Over the past decade, the representation of women nearly doubled to 17.3%, while men still dominated at 82.7%. Regional distribution of women surgeons was as follows: Midwest - 19% (n=22), Northeast - 22% (n=26), South - 36% (n=42), and West - 24% (n=28). Conclusion: While the representation of women in foot and ankle subspecialties is on the rise nationwide, a notable gender disparity persists. Over one-third of women foot and ankle surgeons are located in the South region. We suggest that future efforts focus on enhancing the consistency and quality of publicly accessible information regarding women surgeons in foot and ankle fellowship programs. Presently, there is no centralized, publicly available source of information on the gender distribution of applicants to foot and ankle fellowship programs and the allocation of positions filled.
Strutting in Style, Suffering in Silence: A Biomechanical Study of Hallux Valgus Deformity with High Heeled Shoes
Authors: Casas Erik Jesus Huanuco , Luo Emily Joan , Kutzer Katherine , Talaski Grayson M. , Carvalho Kepler A.M. , Schonhorst Nolan M. , Slivinskis Victor , Valvecchi Tommaso Forin , Kaplan Jonathan , Netto Cesar de Cesar 
Published: December 2024

Category: Midfoot/Forefoot; Other Introduction/Purpose: High heeled shoes (HH) have historically been thought to worsen existing hallux valgus (HV). However, no studies have shown if HH contribute to the pathophysiology of HV development. Weightbearing computed tomography (WBCT), distance mapping (DM), and coverage mapping (CM) allows for three- dimensional analysis of the forefoot and has been previously able to detect subtle differences in joint mechanics. However, no study has used WBCT to study 1st metatarsophalangeal (MTP) joint mechanics in HH. The aim of this study was to describe and compare DM and CM of the 1st MTP at varying HH heights. Methods: 10 non-frequent HH wearing volunteers with no underlying foot/ankle pathology received bilateral WBCT scans at four different HH heights: 0 cm, 3 cm, 6 cm, 9cm. A semi-automatic software was used to segment the 1st MTP. Manual selection of the 1st metatarsal head and proximal phalangeal surface was performed. DM and CM differences were statistically evaluated using One-Way ANOVA test and Wilcoxon rank sum test. P values < 0.05 were considered statistically significant. Results: For both DM and CM, there was a statistically significant difference when comparing all HH height parameters to one another (p < 0.0001). When comparing each HH height individually to the 0 cm condition, all heights demonstrated a statistically significiant difference (p < 0.0001). More specifically, the plantar lateral aspect of the 1st MTP joint space demonstrated the greatest change in both DM and CM compared to the control at all HH heights. Conclusion: This study demonstrates for the first time that HH may contribute to the development of HV in previously healthy feet. Interestingly, the plantar lateral aspect of the 1st MTP was the most affected with increasing HH heights. Further research is needed to elucidate the long term effects of HH shoes on forefoot deformity development.
Surgical Timing for Charcot Foot Reconstruction: Pattern of Paradigm Shift from a Systematic Review of Recent Literature
Authors: Yik Tan Chin , Chua Chen Xi Kasia 
Published: December 2024

Category: Midfoot/Forefoot; Diabetes Introduction/Purpose: The optimal timing to surgically intervene in Charcot foot arthropathy remains controversial. Classical teaching is to avoid intervention in the active stage of Charcot foot, because of the worry of soft tissue and bony complications. However, several authors had advocated the paradigm shift to intervene early in active Charcot foot, to allow deformity correction and stabilization before further deformity develops. This article aims to investigate the current pattern of paradigm shift and the outcomes after intervention in the active and inactive stages of Charcot foot. Methods: This study was done in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis). A literature search was done on Pubmed, Embase, Cochrane Library, and Clinicaltrials.gov. An effort was made to search for all relevant articles in unpublished sources such as conferences as well as the reference list of included studies. All relevant articles published within the last 5 years were included, with the exclusion of case reports. Results: 269 articles were screened, and 17 studies were included. There were 11 studies with surgery in the inactive stage of Charcot foot, 6 studies with surgery in both the active and inactive stages of Charcot foot, and no study was done in the active stage alone. The amputation rate for surgery in the inactive stage was 10.5% while that of active and inactive stages was 12.3%. The re-operation rate for surgery in the inactive stage was 31.2% while that of active and inactive stages was 50.0%. The non-union rate after surgery in the inactive stage was 13.0% while that of active and inactive stages was 32.5%. Conclusion: Most surgeons still prefer to intervene surgically in the inactive stage of Charcot foot. Amputation rate, re-operation rate, and non-union rates were higher in studies that included surgery in both active and inactive stages of Charcot foot. Therefore, surgeons should be cautious in deciding optimal surgical timing for Charcot foot reconstruction and avoid the active stage of the disease if possible.
Survival Comparison Following Below-the-Knee Amputation in Diabetic Patients with and without Hemodialysis
Authors: Lee Jaehyung , Kim Janghyun , Chae Sungkuk , Oh Seung ho , Cha Dongheon 
Published: December 2024

Category: Diabetes; Other Introduction/Purpose: Foot ulcers and subsequent amputations are disabling complications in diabetic patients, and major amputations, including below-knee amputations, leave patients with catastrophic disabilities. Diabetes is the most common cause of causing end-stage renal disease which results in hemodialysis, and patients with diabetes on hemodialysis have a higher prevalence of several co-morbidities compared to those without diabetes. The purpose of this study is to compare survival rates after below knee amputation in patients with diabetes who are on hemodialysis and those who are not. Methods: This retrospective study was conducted on patients with diabetes who underwent below-knee amputation at a single tertiary hospital from 2005 to 2015. Exclusion criteria applied to patients undergoing amputation for reasons not directly related to diabetes, such as trauma or tumor. The survival rate analysis involved categorizing patients into hemodialysis and non-hemodialysis groups at the time of amputation. Within the hemodialysis group, further analysis was performed by subdividing patients into three groups based on the duration of dialysis: Group A (≤5 years), Group B (5-10 years), and Group C (>10 years). Results: A total of 98 patients were enrolled, with 54 in the hemodialysis group and 44 in the non-hemodialysis group. The hemodialysis group exhibited a significantly lower survival rate after below-knee amputation than the non-hemodialysis group (p=0.010 by the log-rank test). The 1-year survival rate was 66.7% in the hemodialysis group, contrasting with the non-hemodialysis group's rate of 90.9%. Similarly, the 5-year survival rate was 20.4% in the hemodialysis group and 52.3% in the non-hemodialysis group. Subgroup analysis revealed no significant differences in survival among the three subgroups based on the duration of dialysis before amputation (A vs. B, p=0.560; A vs. C, p=0.661; B vs. C, p=0.870 by the log-rank test). Conclusion: Among diabetic patients who underwent below-knee amputation, those on hemodialysis at the time of amputation showed lower 1- and 5-year survival rates compared to those without hemodialysis. There was no significant association between the duration of hemodialysis before amputation and survival.
The Impact of the Osteopathic and Allopathic Merger on Foot and Ankle Case Log Volumes: A 2014-2023 ACGME Report Analysis
Authors: Shepard Samuel , Raszewski Jesse A. , Bartholomew Ania , Franko Gerrit , Karvelas Antonios , Brown Jim , Wynn Oakk , Hatic Safet 
Published: December 2024

Category: Other; Ankle Introduction/Purpose: The Accreditation Council for Graduate Medical Education (ACGME) Surgical Review Committee monitors the quantity of experiences through Current Procedural Terminology (CPT) codes logged by residents based on the procedures they perform. The ACGME currently requires a minimum of 20 specific foot and ankle procedures to be completed prior to graduation. These are defined as 15 'ankle fracture' cases and 5 'ankle, hindfoot, or midfoot arthroscopy' cases. The year 2020 marked a milestone change in residency training, as the Allopathic (MD) and Osteopathic (DO) residency accreditation merger resulted in unified graduate medical education training. The purpose of this study was to better understand the effect the merger had on the average number of cases, as well as the defined minimum cases for graduating orthopedic residents. Methods: A retrospective analysis of ACGME case logs examined the max and average number of adult orthopaedic cases related to both Leg/Ankle and Foot/Toes performed by graduating orthopaedic surgery residents from 2014 to 2023, spanning a 10-year period. Trends in case exposure were analyzed by assessing the average number of adult orthopaedic procedures during the study period. All data were sourced directly from the ACGME website.1 Descriptive statistics will be used along with unpaired t-tests to examine if there are statistical differences between pre and post merger averages (Microsoft Corporation, 2018. Microsoft Excel). Results: In 2014, 151 programs graduated 684 residents, compared to 197 programs in 2023 graduating 884 residents. The overall average of leg/ankle procedures prior to the merger was 176.74 (range 151.9-200.8, SD 18.9), which increased to 212.93 post-merger (range 206.5-219.9, SD 6.7; p = 0.006). Similarly, the total number of foot/toes procedures increased from a mean of 72.6 (range 62.5-83, SD 7.3) pre-merger to 82.9 post-merger (range 83.2-83.9, SD 1.1; p = 0.023). The average number of ankle fractures pre-merger was 58.3 (range 53-62.3, SD 3.7), which increased to 68.2 post-merger (range 66.6-69.7, SD 1.5; p < 0.01). Additionally, the average number of ankle arthroscopy procedures increased from 13.8 pre-merger (range 11.4-15.6, SD 1.7) to 15.3 post-merger (range 14.8-15.9, SD 0.5; p = 0.9). Conclusion: The merger between MD and DO residency programs in 2020 has led to a significant increase in the average number of orthopedic surgery procedures related to the foot and ankle performed by graduating residents. This indicates a positive impact on the training and exposure of orthopedic surgery residents in these areas. The findings suggest that the merger has helped to enhance the educational experience and preparedness of orthopedic surgery residents in foot and ankle procedures, meeting the ACGME requirements for graduation.
The Influence of Extraosseous Talar Vascular Luminal Diameter on the Development of Osteochondral Lesions of the Talar Dome
Authors: Aslan Lercan , Ghandour Samir , Gedik Cihad C. , Ashkani-Esfahani Soheil , Guss Daniel , Waryasz Gregory R. , Bejarano-Pineda Lorena , DiGiovanni Christopher W. , Kwon John Y. 
Published: December 2024

Category: Ankle; Trauma Introduction/Purpose: Osteochondral lesions of the talus (OLT) impact both sedentary individuals and athletes, affecting both daily function as well as athletic performance. Purported causations include trauma, genetics, and hypovascularity. Although it is known that the talar dome’s vascularity is mainly supplied the posterior tibialis artery (PTA) and to a lesser degree the sinus tarsi artery (STA), the pathophysiological impact of talar dome hypovascularity on OLT remains poorly studied. Our first hypothesis was that the patients with OLT have a lower diameter of PTA (dPTA) and STA (dSTA), and the second hypothesis was that among the group of the patients with OLT, the patients that require surgery have a lower d PTA and dSTA. Methods: This was a retrospective study that included 77 patients with OLT, and for the control group 77 patients with peroneal tendinitis. To mitigate the effect of comorbidities the patients between 30 to 40 years of age were included and the ones with a history of smoking, diabetes, rheumatologic, and peripheral artery diseases were excluded. The dPTA measurements were done in three different levels for all groups: at the level of 1 cm above plafond, at the level of plafond and at the level of medial malleolar tip (MMT). dSTA was measured at the level of talar neck. Area, volume, depth, and localization of OLT were recorded, as well. Results: The study group had significantly lower dPTA at three levels (1.05±0.22mm, 0.99±0.18mm, 0.98±0.31mm, proximal to distal) compared to the control group (1.25±0.23mm, 1.20±0.22mm, 1.14±0.18mm, proximal to distal) (P< 0.001). The dSTA was also lower in study group as compared to control group (0.5±0.11mm vs. 0.57±0.08mm, respectively P=0.001). ROC Curve analysis revealed the cutoff values for OLT occurrence after ankle injury as; 1.115 mm for the level of 1 cm above plafond, 1.075 mm for the level of plafond,1.055 mm for the level of MMT, 1.085 mm for mean dTPA and 0.5665mm for dSTA (Table-1). A significant negative correlation was observed between OLT size area (mean: 42.24±24.76 mm2) and arterial diameters (P< 0.01, P< 0.01, and P=0.014 for three different levels of dPTA and P< 0.001 for dSTA). Conclusion: Smaller dPTA and dSTA appear to be associated with the occurrence of OLT, with the defect size inversely correlated to arterial diameters. The determined cutoff values for dPTA may help clinicians identify high risk patients to develop OLT after an acute ankle injury. Further elucidation of these vascular abnormalities, particularly dPTA, could hold significant prognostic potential and be used to predict disease progression as well as the likelihood of surgical success in OLT treatment.