bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perspectives on Ligament Augmentation Techniques: A Survey of the American Orthopaedic Foot & Ankle Society
Authors: Alexeev Sergei , Zona Nathaniel , Stark Samuel D. , Buckley Sara E. , Hunt Kenneth 
Published: December 2024

Category: Ankle; Midfoot/Forefoot Introduction/Purpose: Ligament augmentation techniques (LATs) are surgical procedures in which anatomical ligaments are repaired or reconstructed with utilization of a synthetic ligament which spans from bone to bone and is fixated intra- or trans-osseously. There is an extensive, and growing, body of literature reporting LAT use in the foot and ankle. The prevalence of LAT use in the clinical practice of foot and ankle surgery is not well reported. Furthermore, indications for LAT use, such as patient characteristics, are not clearly defined. Surgical decision-making regarding LAT use is not characterized, and the influence of surgeon characteristics on use of LATs has also not been studied. This survey of the AOFAS membership aimed to understand foot and ankle surgeon preferences and practices in utilizing LATs. Methods: Survey questions were generated by a committee of experienced researchers and foot and ankle surgeons. Survey invitations were sent to the membership of the AOFAS, and only attending-level physicians were polled. There were 55 possible questions, which were gated by branching logic pertinent to the respondent’s characteristics and practices. Results were analyzed with descriptive statistics. Analysis of significance between groups was generated using the chi-squared test. A p-value of < 0.05 was considered statistically significant. Results: In total, 204 of 205 surveys received were completed (99.5%). 78.4% of surgeons practice in North America, across a diverse geographic span. Most physician have a primarily foot and ankle practice (88.1%), and 92.1% treat college or professional level athletes. 88.1% of surgeons utilize LATs in the foot and ankle. The most common indication for LAT use reported was quicker return-to-play (67.1%). The patient characteristics most influential of LAT use were elite athlete (67.2%), obesity (47.4%), manual laborer (46.9%), and cavovarus alignment (46.3%) (Figure 1). Significant diversity exists in level of surgeon concern for LAT device costs (p < 0.01), as well as in setting in which surgeons learned their LAT skills (p < .01). 97.7% of respondents who use LATs augment the ATFL. Conclusion: LATs are widely used by the membership of the AOFAS. Surgeon characteristics have a large effect on their use of LATs, and rate of utilization. Many surgeons’ motivations for LAT use are centered around athletic participation, patient employment, and patient anatomy. Concern for safety and efficacy of LAT use is the primary detractor in the use of this technique. Vast diversity exists in the ligaments which are repaired with ligament augmentation. A multitude of novel constructs were self-reported, and techniques which are not reported in the literature were described. We can expect further progress in clinical use of LATs.
Polymethylmethacrylate (PMMA) Augmentation Increases the Strength of Midfoot Beam Constructs in Charcot Neuroarthropathy Model: A Biomechanical Study
Authors: Pattisapu Naveen , Huang Dave , Porter Giselle M. , Owhonda Rebisi , Charlton Timothy , Gross Christopher E. , Thordarson David , Metzger Melodie 
Published: December 2024

Category: Basic Sciences/Biologics; Diabetes Introduction/Purpose: Even with the best conservative care, patients with Charcot Neuroarthropathy (CN) of the foot and ankle often ulcerate, increasing their risk of infection, amputation, and death. Surgical fixation has a 30% risk of recurrent ulceration, likely due to poor host bone quality which is prone to deformity recurrence and subsequent ulceration. We propose midfoot beam reconstruction with PMMA augmentation as a novel means of improving fixation. Methods: A protocol was developed to create the characteristic CN midfoot fragmentation both visually and fluoroscopically in each of tweleve matched-pair cadaveric feet. Afterward, the pairs were divided into two groups (1) Midfoot beam fusion alone, and (2) Midfoot beam fusion augmented with PMMA. In both groups, a solid 7.0 mm beam was placed into the medial column and a solid, 5.5 mm beam was placed across the lateral column. In the PMMA group, 8-10 mL of PMMA was inserted into the medial column. The hindfoot of each specimen was potted and the metatarsal heads were cyclically loaded for 1800 cycles, followed by load to failure while load and displacement were continually recorded. Results: One specimen in the beam only group failed before reaching the 1800th cycle and therefore was not included in the failure analysis. The midfoot beam only group demonstrated greater mean displacement during cycle testing compared to the PMMA group, p< 0.05. The maximum force (N), stiffness (N/mm) and toughness (Nmm) were all significantly greater in group augmented with PMMA, p< 0.05. Conclusion: In a CN cadaveric model, PMMA augmentation significantly decreased gapping during cyclic loading and nearly doubled the load to failure compared to midfoot beams alone. Clinical Relevance: The results of this biomechanical study demonstrate that augmentation of midfoot beams with PMMA increases the strength and stiffness of the fusion construct, which may reduce the risk of nonunion and infection in patients with neuropathic midfoot collapse.
Preoperative Incongruent Subtalar Joint Predicts Less Favorable Clinical Outcome in Total Ankle Arthroplasty
Authors: Kyung Min Gyu , Kim Jahyung , Kim Joonhee , Lee Hye Ran , Kim Ji Hye , Yoon A Ro , Kim Min Ju , Lee Dong Yeon 
Published: December 2024

Category: Ankle Arthritis; Hindfoot Introduction/Purpose: The clinical role of incongruent subtalar joints on ankle arthritis as well as that on the clinical outcome of surgical treatment such as total ankle arthroplasty (TAA) has not yet been fully understood. The mobile subtalar joint may compensate for malalignment of the arthritic ankle as well as counteract the effect of realigning surgeries. We aimed to determine the clinical effect of incongruent subtalar joint space on TAA. Methods: We retrospectively reviewed 34 patients who underwent TAA, which were grouped according to the status of subtalar joint incongruency. For clinical parameters, American Orthopaedic Foot & Ankle Society (AOFAS) score and pain visual analog scale (VAS) were collected. For radiographic parameters, preoperative talar tilt angle, medial distal tibial angle, and anterior distal tibial angle were measured. A comparison of clinical and radiographic parameters between groups as well as multiple regression analysis was performed to identify contributing factors to the final functional outcome. Results: Interobserver and intraobserver reliabilities of subtalar joint congruency demonstrated substantial agreement. At the final follow-up, the AOFAS score was significantly higher in the congruent group (n=13) compared to that of the incongruent group (n=21), (90.38 vs. 79.57, p=0.007). However, there was no significant difference in pain VAS between the groups at the final follow-up (p=0.181). For measured radiographic parameters, there were no significant differences between the two groups in talar tilt angle, medial distal tibial angle, and anterior distal tibial angle. In multiple regression analysis, the female sex (p=0.006) and incongruency of the subtalar joint (p=0.013) were found to be significant contributing factors to the final AOFAS score. Conclusion: Patients in which the preoperative subtalar joint is incongruent showed less favorable AOFAS scores after undergoing TAA. A thorough preoperative investigation should be taken into the state of the subtalar joint for TAA.
Preserving Paratenon in Acute Achilles Tendon Repair: A 5-Year Follow-Up
Authors: Kord Mohammad Hossein Chegini , Ebrahimi Alireza , Waryasz Gregory R. , Ashkani-Esfahani Soheil , Razi Mohammad 
Published: December 2024

Category: Sports; Trauma Introduction/Purpose: Achilles Tendon (AT) rupture is one of the most prevalent adult tendon injuries, with the incidence rate estimated to range between 7 to 40 in 100000 person-years. Although some surgical approaches involve incising or removing the Paratenon when repairing injured or degenerative tendons, an alternative perspective suggests preserving the paratenon during AT repair could potentially benefit healing through two proposed mechanisms: retaining the hematoma, which may contain factors with stem cell-like properties and reducing mechanical stress on the skin incision site. The aim of this study was to investigate the potential influence of Paratenon preservation on the outcomes of AT repair in a 5-year follow up study. Methods: After receiving IRB approval, we conducted a single-center study in Tehran, Iran, involving a consecutive series of 52 patients who sustained acute AT ruptures (less than 2 weeks from injury) and underwent a modified surgical technique performed by surgeons affiliated with the local institution. The technique involved careful skin incision while preserving the Paratenon intact and performing the tendon repair over the retained Paratenon (Figure 1). Patients were prospectively evaluated with a mean follow-up duration of 5 years (between 48 to 72 months). Functional outcomes were assessed using the Achilles Tendon Rupture Score (ATRS) and the American Orthopedic Foot and Ankle Society (AOFAS) rating scales in all patients at 6, 9, 18, and 36 months postoperatively. Two complementary follow-up visits at 12 and 24 months after the last visit were scheduled. Results: The mean AOFAS and ATRS scores were 83±4 and 85.7±3.1, respectively, by the 36-month follow-up visit. Approximately 90.1% of patients regained preinjury activity levels during the complementary follow-up visits, including 71.3% of professional athletes returning to prior recreation. Isokinetic testing revealed plantar flexion and dorsiflexion strength deficits of 83.7±5.1% and 87.8±3.6% compared to the uninjured sides at 3 months after the surgery. Calf muscle atrophy was minimal. While 19 patients reported initial activity-related pain, these symptoms resolved within 12 months. No wound complications, nerve injuries, or footwear issues occurred during the study period. Conclusion: Preserving the Paratenon during AT repair showed satisfactory functional and clinical outcomes without any case of the wound complications that are common after open repairs. These findings support the hypothesis that an intact Paratenon aids tendon healing and reduces complication rates. Retaining the Paratenon may also help mitigate the "bowstring" effect on the repaired Achilles tendon. This surgical technique warrants further investigation as a potential strategy for enhancing outcomes following AT ruptures.
PROMIS Ability to Predict Outcomes and Time to Surgery for Patients Treated with Bunion Surgery for Hallux Valgus
Authors: Gauthier Chase , Kumar Padam , Paradis Austin , Dias Travis , Ecker Thomas , Gonzalez Tyler , Jackson J. Benjamin 
Published: December 2024

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Patient-reported outcome metrics are useful in determining a patient’s clinical response to a given intervention. Despite their usefulness, few studies have identified the potential prognostic value of patient-reported outcome metrics. This study looks to evaluate whether preoperative PROMIS scores can predict time to surgery and improvement in postoperative PROMIS scores in those undergoing hallux valgus correction surgery. Methods: A retrospective review was conducted of patients undergoing surgical intervention for hallux valgus at a single academic institution between June 2020 and June 2023. Demographic information, time to surgery, PROMIS scores, and preoperative radiographic measurements were collected. The minimal clinically important difference (MCID) in PROMIS scores was defined as half of the standard deviation of the change in PROMIS scores. A total of 209 patients were included in the study. Categorical and continuous data were compared using the Chi-squared test and Student’s T-test, respectively. Multivariable logistic regression analysis was utilized to control for confounding variables. All p< 0.05 were considered statistically significant. Results: Higher preoperative pain interference (PI) (OR=1.3, p< 0.001), mobility (OR=1.22, p=0.003), and global health-physical (OR=1.14, p=0.043) scores were independent predictors for increased odds of achieving an MCID in PI score. Lower preoperative physical function (PF) (OR=1.18, p=0.007) scores and higher preoperative PI (OF=1.16, p=0.005) and global health-physical (OR=1.22, p=0.001) scores were independent predictors for increased odds of achieving an MCID in PF scores. No factors were independently associated with achieving an MCID in mobility scores. Finally, being seen first by an MD (OR=3.7, p=0.034) and being unmarried (OR=34.3, p=0.032) were both independent predictors for having surgery within 6 months of presentation. Hallux valgus and Intermetatarsal angles at presentation did not significantly influence either the ability to achieve an MCID in PROMIS scores or time to surgery. Conclusion: Worse preoperative PI and PF scores were independently associated with an increased likelihood of achieving an MCID in those respective scores when controlling for confounding variables. Additionally, the severity of a patient’s hallux valgus, based upon their radiographic measurements at presentation, did not significantly influence a patient’s postoperative outcomes or time to surgery. These results suggest that patients with more severe hallux valgus symptoms, but not necessarily more severe hallux valgus radiographic findings, are most likely to clinically improve following surgical intervention.
Results of Autograft vs Allograft with Bone Marrow Aspirate Concentrate in Lateral Column Lengthening for Reconstruction of Progressive Collapsing Flatfoot Deformity
Authors: Huang Daran , Cher Eric Wei Liang , Png Wenxian , Singh Inderjeet Rikhraj 
Published: December 2024

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Although Evan’s lateral column lengthening (LCL) calcaneal osteotomy is the standard joint-sparing surgical option to correct the forefoot abduction in Johnson and Strom Grade IIB progressive collapsing flatfoot deformity (PCFD), studies evaluating the choice of filling (autograft or allograft) for the osteotomy site on outcomes reveal heterogeneous results. The purpose of this study is to compare the results of graft choice on bony union, subsequent clinical outcomes and complication rates after LCL osteotomy. Methods: This was a retrospective study of 34 patients who underwent Evan’s LCL divided into 2 cohorts dependent on the type of graft used for the opening osteotomy (Group A used tricortical autograft harvested from the iliac crest, n = 24; Group B used tricortical allograft soaked in the patient’s own bone marrow aspirate concentrate, n = 10). Patient demographics, time to union, postoperative complications, and patient-reported outcome measures were compared among groups using univariable analyses. Minimum follow-up was 24 months. Results: Both groups demonstrated significant improvement in Visual Analogue Scale (VAS) of the midfoot and hindfoot, American Orthopaedic Foot & Ankle Society (AOFAS)-Mid and AOFAS-Hind scores at 6 months (P < 0.05) and continued experiencing improvement at 24 months postoperatively (P < 0.05). Nevertheless, there was no statistically significant difference in clinical outcomes or time to union between autograft and allograft when performing Evan’s LCL. In terms of complications, neither group experienced any non-union, though all who experienced surgical complications were from group A - 3 patients suffered peroneal tendinopathy, 1 patient experienced Achilles tendinopathy, 2 patients underwent removal of implants and 1 patient had chronic pain due to irritation to the plantar nerve. Conclusion: Significant and early improvement in clinical outcomes were observed in both groups with 100% union rates. Though Group A (iliac crest autograft) had higher rates of complications, it did not fare worse on patient-reported outcome measures when performing Evan’s LCL. Future studies involving larger sample sizes with standardized definitions for radiographic union will be critical to further elucidate graft-related impacts on outcomes after LCL.
Data Resource Profile: Heart Valve Society Aortic Valve Database (HVS AV Database)
Authors: van der Ven Carlijn C.E.M. , Kluin Jolanda , Takkenberg Johanna J.M. , El-Hamamsy Ismail , Meuris Bart , Pibarot Philippe , Youssefi Pouya , Lansac Emmanuel , Verbrugghe Peter , Veen Kevin M. ,   on behalf of the Aortic Valve Research Network Investigators
Published: December 2024

Background Multicenter, standardized, long-term data are essential for assessing outcomes of patients following aortic (valve) treatment. To facilitate this, the international Heart Valve Society (HVS) Aortic Valve (AV) Database was established. This paper provides an overview of the HVS AV Database. Methods The HVS AV Database includes adult patients with aortic valve disease (regurgitation and/or stenosis), with or without ascending aorta aneurysm, undergoing surgical or transcatheter intervention. It has an ambispective design, and centers interested in interventional outcomes following aortic (valve) intervention can participate free of charge. Results The variables collected in the database are harmonized with the International Consortium for Health Outcomes Measurement (ICHOM) standard Set of Patient-Centered Outcome Measures for Heart Valve Disease (HVD). In total, 33 outcome variables, including 12 clinical and 21 echocardiographic, and 286 case-mix variables are collected. Currently, the database includes 10,893 patients from 78 participating centers worldwide, with 7910 patients having undergone aortic valve repair and 1968 aortic valve replacement. Participating centers can extract their own data at any time, and multicenter research proposals are encouraged. The database is compliant with GCP, FDA, GDPR and HIPAA regulations, supporting data transfer across continents. Conclusions The HVS AV Database is aimed at improving outcomes for patients requiring intervention for aortic (valve) disease. Through uniform scientific reporting, it contributes to global efforts to standardize data capture, improve patient outcomes and shift the focus from device to global patient outcomes.
Development of an orthotopic pulmonary valve replacement porcine model for mechanical heart valve thrombosis
Authors: Langenaeken Tom , Van Hecke Manon , De Meester Pieter , Roets Jean , Meuris Arthur , Verbrugghe Peter , Rega Filip , Meuris Bart 
Published: December 2024

Objective Animal models are indispensable for the development of valve prostheses like we currently know them. Recent developments have questioned the validity of sheep as the model of choice for the evaluation of mechanical heart valves. The pig has been raised as a better alternative due to a more comparable coagulation system. We therefore compared the thrombogenicity of the sheep compared to the pig in a model of pulmonary valve replacement. Methods Pigs (n = 12) and sheep (n = 5) underwent pulmonary valve replacement with a mechanical valve in orthotopic position. No antithrombotic medication of any kind was given. Follow-up period was 5 months or until established valve thrombosis. Valve performance was assessed by monthly cardiac ultrasounds combined with post-mortem macro- and microscopical analysis of the valve and downstream organs. Results In the pig cohort, valve thrombosis was established after less than a month in all but one animal. Post-mortem valve examination showed terminal valve thrombosis with immobilized hinges. In the sheep cohort, all animals completed the follow-up period of 5 months. At post-mortem examination, all valves were free from any thrombi or deposits with both leaflets mobile. Conclusion The sheep model appears not thrombogenic enough to elicit mechanical valve thrombosis in the highly thrombogenic pulmonary position. Contrarily, the porcine model elicits massive thrombosis at a fast rate in an identical position. These findings confirm that we should shift to the pig as a standard for (mechanical valve) thrombosis research.
Bioinformatics based exploration of the anti-NAFLD mechanism of Wang’s empirical formula via TLR4/NF-κB/COX2 pathway
Authors: Chen Suhong , Zhou Chuanjie , Huang Jiahui , Qiao Yunlong , Wang Ning , Huang Yuzhen , Li Bo , Xu Wanfeng , He Xinglishang , Wang Kungen , Zhi Yihui , Lv Guiyuan , Shen Shuhua 
Published: December 2024

Abstract
Background
Nonalcoholic fatty liver disease (NAFLD) has developed as a leading public wellness challenge as a result of changes in dietary patterns. Unfortunately, there is still a lack of effective pharmacotherapy methods for NAFLD. Wang’s empirical formula (WSF) has demonstrated considerable clinical efficacy in treating metabolic disorders for years. Nevertheless, the protective effect of WSF against NAFLD and its underlying mechanism remains poorly understood.

Methods
The NAFLD model was established using a 17-week high-sucrose and high-fat (HSHF) diet with 32 ICR mice. In assessing the therapeutic efficacy of WSF on NAFLD, we detected changes in body weight, viscera weight, biomarkers of glycolipid metabolism in serum and liver, transaminase levels and histopathology of liver with H&E and Oil Red O staining after oral administration. The chemical components in WSF were extensively identified and gathered utilizing the HPLC-Q-TOF/MS system, database mining from HMDB, MassBank, and TCMSP databases, alongside literature searches from CNKI, Wanfang and VIP databases. The forecast of network pharmacology approach was then utilized to investigate the probable mechanisms by which WSF improves NAFLD based on the performance of prospective target identification and pathway enrichment analysis. Besides, molecular docking was also conducted for the verification of combination activities between active components of WSF and core proteins related to NAFLD. In final, validation experiments of obtained pathways were conducted through ELISA, immunohistochemistry (IHC), and western blot (WB) analysis.

Results
Pharmacodynamic outcomes indicated that WSF intervention effectively mitigated obesity, fat accumulation in organs, lipid metabolism disorders, abnormal transaminase levels and liver pathology injury in NAFLD mice (P < 0.05, 0.01). A total of 72 existent ingredients of WSF were acquired by HPLC-Q-TOF/MS and database, and 254 common targets (11.6% in total targets) of NAFLD and WSF were identified. Network pharmacology revealed that WSF presses NAFLD via modulating TNF, IL6, AKT1, IL1B, PTGS2 (COX2), and other targets, and the probable pathways were primarily inflammatory signaling pathways, as confirmed by molecular docking. Molecular biology experiments further conformed that WSF could decrease levels of inflammatory factors like IL-1β, IL-6 and TNF-α (P < 0.01) and expression of TLR4, NF-κB and COX-2 (P < 0.05, 0.01) in the liver.

Conclusion
WSF treatment effectively protects against lipid metabolism disorders and liver inflammation injury in HSHF diet-induced NAFLD mice, and its molecular mechanism might be via suppressing the TLR4/NF-κB/COX-2 inflammatory pathway to reduce the release of inflammatory cytokines in the liver.

Graphical abstract