bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ground Reaction Force on the Frontal Plane Directs to the Center of Mass During Gait: Analysis from Gait Database
Authors: Takeda Ryutaro , Kobayashi Yoshiyuki , Kobayashi Etsuko , Matsumoto Takumi 
Published: December 2024

Category: Other; Basic Sciences/Biologics Introduction/Purpose: In recent years, a paradigm shift has emerged in the preoperative planning for lower extremity osteotomies or arthroplasty. The focus has shifted from the loading axis during static standing known as Mikulicz line, to the loading axis during gait. These methods assumed that ground reaction force (GRF) vector directed toward the center of mass (CoM) on the frontal plane in the stance phase of gait. However, no study has clarified the relationship between the CoM and GRF vector. Furthermore, it is unknown to what extent the GRF vector turns inward from the Mikulicz line. The aim of the study is to reveal the geometrical relation on the frontal plane between the GRF vector and the anatomical landmarks including joint centers and the CoM during gait. Methods: The analysis was performed using the AIST (National Institute of Advanced Industrial Science and Technology) gait database 2019 which includes the data of 10 m walk on barefoot with comfortable speed obtained using motion-capture-system and force plates. The stance phase data of right feet for 162 participants (Male/Female = 78/84) under 50 years old was extracted. On the frontal plane, the distance from the GRF vector to the right hip center (D_hip) and to the CoM (D_CoM) were evaluated in the time period between the first and the last peak of the vertical GRF because this period could be considered as a single stance phase. The angle between GRF vector and the line passing center of pressures and hip centers (Mikulicz-GRF_Angle) was also calculated. Results: The analysis focused on the time period corresponding to 22 - 79 % of the stance phase, representing a single stance phase. Throughout this phase, the GRF vector on the frontal plane consistently directed medially to the hip center. The average D_hip during the single stance phase was 7.6 ± 1.0 cm, with a range of 6.6-9.2 cm. D_CoM was 1.3 ± 0.2 cm, and its range was 0.9 - 1.6 cm. Mikulicz-GRF_Angle was 5.6 ± 0.7 degrees, with a range of 4.8 - 6.7 degrees. Conclusion: During the single stance phase of gait in healthy young adults, the GRF vector consistently directs toward their CoM rather than their hip center on the frontal plane. The loading axis during gait was oriented 4.8 - 6.7 degrees medially to the hip center. These findings should be considered during surgery aimed at kinematic alignment reconstruction of the lower extremity.
Improving Detection of Underlying Neurologic Etiology for Pediatric Cavovarus Foot Deformity: We Can Do Better
Authors: O'Sullivan Michael , Christie Michelle , Hartman Rusty , Riccio Anthony I. 
Published: December 2024

Category: Other; Midfoot/Forefoot Introduction/Purpose: While evaluation of an underlying neurologic disorder in children with cavovarus foot deformity (CVD) is of great importance, no standardized method of neurologic assessment exists. Moreover, the yield of commonly employed diagnostic measures remains unstudied. This study aims to compare the diagnostic yield of traditional methods of neurologic assessment for patients CVD of unknown etiology to a more advanced diagnostic algorithm. Methods: An IRB-approved retrospective review of patients presenting to a single pediatric tertiary care center for bilateral or unilateral CVD was performed over a 19-year period. Patients with a known etiology for their deformity or preexisting neurologic or syndromic diagnoses were excluded. Neurologic evaluation of all remaining patients was conducted by a pediatric neurologist using one of two diagnostic algorithms. The traditional diagnostic algorithm (TDA) consisted of clinical examination, MRI of the brain and spinal cord and/or EMG/NCV. The advanced diagnostic algorithm (ADA) Included all components of the TDA in addition to genetic testing, and/or muscle/nerve biopsy and/or repeat EMG/NCV testing when initial workup remained negative. These diagnostic algorithms were compared regarding determination of an underlying etiology for CVD. Results: 108 patients (average age 9.7 years) were included. 96 were assessed via the TDA which detected an underlying neurologic diagnosis in 56 (58%). 15 had central neurologic disease, 35 had peripheral neuropathies and 6 had combined central/peripheral neuropathology. Of the 40 patients in whom no diagnosis was made using the TDA, 21 were further assessed using the ADA revealing a diagnosis in 15 (71%), thereby increasing the diagnostic yield to 71/77 patients (92%) when the ADA was incorporated and 71/96 (74%) overall. Moreover, 23 of 41 patients (56%) diagnosed with an unspecified polyneuropathy by TDA received a more specific diagnosis via the ADA. Definitive diagnosis was achieved solely by genetic testing without the TDA in 12 patients, 75% of whom had variants of Charcot-Marie-Tooth disease. Conclusion: Neurologic etiology remains undetected in 42% of children with CVD using solely neuroaxis imaging and electrodiagnostic testing. Determination of an underlying neurologic cause for deformity can be increased by over 30% through the incorporation of genetic testing and other components of the ADA.
Indications and Limitations of Resection and Ligaments Repair for Os Subfibulare Based on the Hasegawa Classification
Authors: Hio Naohiro , Taki Masanori , Hasegawa Atsushi 
Published: December 2024

Category: Ankle; Arthroscopy Introduction/Purpose: Os subfibulare (OS) is present in 10-38.5% of chronic ankle instability cases, increasing the risk of talus osteochondral lesions. Despite the lack of consensus on surgical indications and methods for symptomatic, treatment-resistant OS, surgery is often performed. Hasegawa et al. proposed a classification detailing the condition of the os subfibulare and its ligament attachments, indicating effective excision and possible additional surgeries. However, the relationship between classification items, surgical methods, and outcomes remains unclear, with no further studies based on this classification reported. This paper examines the indications and limitations of ligament repair surgery following OS excision, based on the Hasegawa classification. Methods: This study analyzed 18 joints treated surgically for os subfibulare (OS) from December 2015 to December 2022, with at least one year of follow-up. Participants included 6 males and 11 females, averaging 21.6 years old, ranging from 12 to 62. The surgical approach involved arthroscopic examination, direct OS removal, and lateral ligament repair. For ligament repairs with potential fibula gaps, dissected extensor retinaculum strips were used for bridging. Additionally, suture tape augmentation was applied in two cases exhibiting overall laxity. Outcome measures assessed were pain via the Visual Analog Scale (VAS), functional status using the Japanese Society for Surgery of the Foot ankle/hindfoot scale (JSSF scale), subjective instability, talar tilting angle (TTA), and anterior drawer stress distance (ADSD), both derived from stress radiographs. Results: In a study applying the Hasegawa classification to 17 joints, significant post-surgical improvements were noted in pain (VAS improved from 38.5±26.2 to 6.7±16.4), function (JSSF scale increased from 75.6±9.4 to 94.8±8.4), and subjective instability (reduced from 58.8% to 17.6%). TTA and ADSD showed no significant difference before and after the surgery. However, a detailed analysis of the Hasegawa classification subitems (size, grade, type) revealed that TTA, ADSD, and subjective instability tended to worsen with increased severity in each category, indicating a correlation between the severity of the classification subitems and the degree of postoperative instability or radiographic findings, despite overall significant clinical improvement. Conclusion: Surgical outcomes for ligament repair following os subfibulare (OS) excision are generally favorable. However, according to the Hasegawa classification, an increase in the severity of each category tends to result in a rise in both subjective and objective instability postoperatively. Treatment for OS necessitates not only an assessment of the remaining ligament and the size of the OS but also a direct and indirect evaluation of the lateral soft tissue. It is considered that this surgical method is well-suited for cases with mild conditions.
Influence of First Ray Positioning on Ankle Contact Stresses in the Setting of a Subtalar Arthrodesis
Authors: Maly Connor , Sakyi Maxwell , Goetz Jessica , de Cesar Netto Cesar , Chrea Bopha 
Published: December 2024

Category: Ankle; Hindfoot Introduction/Purpose: Subtalar arthrodesis is a commonly performed procedure for primary and post-traumatic subtalar arthritis and in the setting of deformity correction. Following arthrodesis, loss of motion at the subtalar joint alters loads experienced at the ankle joint. The influence of the first ray, an essential aspect of the foot tripod, in protecting or overloading the ankle joint in the setting of a fused subtalar joint is unknown. The purpose of this study was to assess the influence of first ray positioning on cartilage contact mechanics in the ankle joint in a native subtalar joint and following subtalar arthrodesis. Methods: Twelve below-knee cadaveric specimens (6 L/6 R) were mechanically loaded in neutral ankle flexion with an MTS-applied axial load of 600N and a pneumatically applied 45N of Achilles tendon tension to simulate 2-legged standing. A calibrated piezoresistive pressure sensor placed within the ankle joint measured cartilage contact pressure on the talar dome under load for 10 frames at 2Hz. In each specimen, contact pressure was measured pre- and post-subtalar fusion and after the application of two progressively larger dorsal opening wedges (4mm and 8mm Cotton osteotomy) in both the fused/unfused conditions. Computed tomography scans of specimens were segmented to generate 3D talus surfaces on which to overlay measured contact pressures. Peak and mean contact pressure, contact area, and center of pressure were compared between fused and unfused conditions with each first-ray correction. Results: Fusion of the subtalar joint increased contact pressures and shifted the contact patch laterally on the talar dome. First ray plantarflexion increased contact pressure and medialized the contact patch in both the fused and unfused conditions. (Figure 1). Joint contact area significantly decreased (by an average 18±9.3%) in all fused conditions compared to the unfused baseline (p < 0.001). Peak pressure in the unfused conditions increased over baseline by an average of 4±11.5% with the 4mm wedge and by 11±17.9% with the 8mm wedge, however neither increase was significant. Compared to the unfused baseline, subtalar fusion significantly increased peak contact pressures (32±21.7%, 38±23.4% and 49±30.5%) and mean contact pressures (23±22.2%, 23±19.8%, 21±19.1%) for the fused baseline, fused 4mm, and fused 8mm, respectively. Conclusion: This cadaveric biomechanical study found that subtalar fusion has a much stronger effect on ankle cartilage contact stress than changes in first-ray position. Alterations of the first ray position in specimens with subtalar fusion resulted in an increase in peak and mean contact pressure relative to the native ankle joint. Plantarflexion of the first ray modestly shifted the location of peak cartilage pressure in both the subtalar-fused and unfused foot but did not significantly increase contact pressure over the non-dorsiflexed condition.
In-Office Posterior Tibial Needle Tendoscopy Is An Effective Treatment Strategy for Patients with Stage 1 Posterior Tibial Tendon Dysfunction: A Retrospective Review
Authors: Butler James J. , Randall Grace W. , Rynecki Lauren , Mercer Nathaniel , Kennedy John G. 
Published: December 2024

Category: Arthroscopy; Other Introduction/Purpose: Posterior Tibial Tendon Insufficiency (PTTI) is a common pathology of the foot and ankle and the leading cause for adult-aquired flatfoot deformity. PTTI typically presents with loss of medial arch of the foot which may progress to hindfoot valgus, forefoot abduction, and development of midfoot osteoarthritis. Following failure of conservative management, tenosynovectomy is indicated in early stage PTTI. However, current tendoscopy techniques lead to significant soft tissue damage. Minimally invasive approaches to these arthroscopic procedures minimize damage to soft-tissue and allow for a much faster recovery. The purpose of this retrospective review is to evaluate the therapeutic and diagnostic potential of In-Office Posterior Tibial Needle Tendoscopy for PTTI. Methods: Chart review was conducted to identify patients who underwent In-Office Posterior Tibial Needle Tendoscopy with a minimum of 1-year follow-up. Data collected and assessed included: patient demographics, pathological characteristics, treatment characteristics, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score, visual analog scale (VAS) scores, return to sport (RTS), and failures. Results: Eleven patients were included at a mean follow-up of 17.4 ± 9.0 months and a mean age of 40.8 ± 14.64 years. Five patients (45.5%) were stage 1 PTTI, 5 patients were stage 2a PTTI and 1 patient was stage 2b PTTI. The mean AOFAS score improved from 45 ± 5.4 preoperatively to 70 ± 18.5 at final follow-up (p< 0.01). The mean VAS improved from 6 ± 0.7 preoperatively to 3.7 ± 1.6 at final follow-up (p< 0.01). The failure rate was 36.3%. All patients with stage 1 PTTI were asymptomatic at final follow-up. Four of the 6 patients (66.7%) with stage 2 PTTI warranted further surgical intervention. Conclusion: This retrospective study demonstrated there is therapeutic and diagnostic potential for In-Office Posterior Tibial Needle Tendoscopy. Patients with early stage PTTI had improved subjective clinical outcomes and rapid return to sport. For moderate to severe PTTI, in-office needle tendoscopy may be less beneficial. Further high quality studies are necessary to determine the optimal role of In-Office Posterior Tibial Needle Tendoscopy in the management of Posterior Tibial Tendon injury.
Intermediate Clinical and Radiographic Outcomes of the Inbone II: for Patients with Five Years Minimum Follow-up
Authors: Kothari Parin , Phillips Alexander , Potter Ramsey , Albert Drew , Padley Michelle A. , Anderson John G. , Bohay Donald R. , Maskill John D. , Boose Marshall A. , Behrend Lindsey A. 
Published: December 2024

Category: Ankle Arthritis; Ankle Introduction/Purpose: The TAA was originally introduced in the 1970s and each subsequent generation of implant has been improved upon. Innovative solutions led to second and third generation arthroplasties, which addressed the initial failures and incorporated new designs to improve patients’ lives through significant improvements in pain and function. The Inbone II Total Ankle System was made available in 2009. The successor to the Inbone I, it features pivotal changes to both the tibial stem and talar components. The purpose of this study is to gather intermediate (five or more year follow-up) data on the Inbone II Total Ankle Systems since it's approval in 2009. Methods: The study is retrospective, single-site cohort of patients who have undergone one or multiple surgeries involving the Inbone II Total Ankle System by the senior authors with at least 5 years of follow-up. For patients that are able to be reached, and choose to consent, a prospective clinical visit was conducted. This visit included physical and radiographic assessments, as well as patient-reported outcome measures. Results: Initially, 168 potential patients (77 females and 72 males) and were identified. The average patient was 62.5 years (range: 25 - 88) at surgery. Following retrospective data collection, these post-operative dispositions were noted: (19 (11.3%) declined prospective follow-up, 29 (15.5%) were lost to follow-up, 5 (3%) underwent amputations, 7 (4.2%) were explanted, and 2 (1.2%) expired). Of these, 59 (35%) patients (63 implants) have returned to the office for prospective assessments. Of these, 28 were female, and 31 were male. The mean time from surgery was 7.2 years (6.4 to 10.6). 15 reported complications following the procedure, most commonly noted as residual post-operative swelling (7 patients). Patient satisfaction was noted to be 93% overall, with an average AOFAS score of 84.2% (52 - 100). Conclusion: Preliminary data demonstrates that ankle replacement with the Inbone II device has the equivalent survival rate as that reported in the literature at 5 years post surgery.
Is Race Associated with Referral Disparities for Patients with Diabetic Foot Ulcers?
Authors: Schweser Kyle M. , Khaleel Mubinah , Garlapaty Ashwin , Hawkins Sam , Cook James , Rucinski Kylee 
Published: December 2024

Category: Diabetes; Other Introduction/Purpose: Racial minorities, including African Americans, Indigenous Americans, Asian Americans, Hispanic/Latinos, and Pacific Islanders are more likely to develop Type II diabetes and experience associated microvascular complications. Amputation rates related to diabetes and/or peripheral arterial disease are three times higher for African Americans, suggesting that race, access, and/or mistrust of the medical community may contribute to adverse outcomes for certain minority groups. Determining where the breakdown along the care continuum occurs is fundamental for achieving equitable outcomes among minority groups. This retrospective study was designed to determine 1) the associations of race and living status with rates of referral to specialists for DFU treatment, and 2) the severity of DFU at time of initial presentation. Methods: Patients were identified from the medical record based on a diagnosis related to diabetic foot ulcers made between January 01, 2018, and June 01, 2023, in the family medicine clinic, endocrinology clinic, or emergency department at a Midwest Level 1 Academic Hospital. Referral incidence to specialty orthopaedic foot clinic, severity at onset based on the Wagner ulcer scale, patient demographics, and National Area Deprivation Index (ADI) were analyzed. Results: 597 patients were eligible for inclusion. Patients seen in the Orthopaedic Specialty Clinic (n=98, 16.4%) were significantly younger (56.5 ± 10.9 years vs.61.1 ± 12.5, p< 0.001). Race was not associated with lower referral rates (p = 1) or source of referral (p = 0.68) to specialty clinic. Ulcer severity upon initial presentation did not differ based on race (p=0.318), however, all patients who initially presented to the emergency department (ED) had more severe ulcers (p = 0.016). Patients referred from the ED had lower National ADI scores (p=0.03). No significant differences in referral source or ulcer severity at presentation were seen for sex, rural status, or marital status, suggesting minority patients with diabetic foot ulcers are referred to specialists equally compared to non-minority patients. Conclusion: Patient race was not associated with decreased referral rate to specialty clinic for diabetic foot complications and ulcer severity at initial presentation. Patients with lower socioeconomic status relied on referrals from the ED, as opposed to their Primary Care Providers. Ubiquitous application of these findings may be limited given the breakdown of ethnic groups in the Midwest, and including other regions in a multicenter study would provide further incite.
Isolated Subtalar Repositional Arthrodesis Compared with Triple Arthrodesis for the Treatment of Progressive Collapsing Foot Deformity
Authors: Kim Sunghoo , Lee HoSeong 
Published: December 2024

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: The optimal extent of arthrodesis for severe and rigid progressive collapsing foot deformity is controversial. Traditionally, triple arthrodesis has been recommended; however, good results have been reported using subtalar arthrodesis only. We compared the results of triple arthrodesis and isolated subtalar repositional arthrodesis. Methods: A total of 22 symptomatic feet were evaluated retrospectively. Isolated subtalar repositional arthrodesis was performed in 13 cases (the subtalar group) and double or triple arthrodesis in 9 cases (the triple group). Various radiographic variables for assessing flatfoot and osteoarthritic changes in ankle and tarsal joints were measured and compared between the 2 groups at 3 time points: preoperatively, 3 months postoperatively, and 4 years postoperatively. Additionally, we analyzed various factors that affect postoperative valgus talar tilt in the ankle joint, which has been associated with poor prognosis. Results: There were no differences in preoperative demographic data and the severity of the disease between the 2 groups; both groups showed improvement in radiographic parameters postoperatively compared with preoperative results. With the numbers available, no significant differences could be detected in postoperative radiographic measurements between the 2 groups. Of all the variables analyzed, postoperative hindfoot alignment angle was associated with postoperative talar tilt development. Additionally, postoperative talar tilt was observed more in triple group than in subtalar group. Conclusion: Isolated subtalar repositional arthrodesis is an effective and sustainable method of correcting advanced PCFD, with comparable outcomes to triple or double arthrodesis. In addition, patients with residual hindfoot valgus deformity are at risk of developing valgus talar tilt and therefore care should be taken to correct this deformity as completely as possible.