bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sports and physical activity after osteochondral talar reconstruction with arthroscopic autologous matrix-induced chondrogenesis
Authors: Indino Cristian , D’Ambrosi Riccardo , Maccario Camilla , Usuelli Federico Giuseppe 
Published: September 2018

Category: Sports Introduction/Purpose: Osteochondral talar lesions (OLTs) are common entities in active patients who practice sports. Degenerative changes and development of osteoarthritis can occur in up to 50% of non-treated patients, due to poor chondral tissue healing abilities. In recent years, autologous matrix-induced chondrogenesis (AMIC) repair has been introduced for OLTs with satisfactory results through medium-term follow-up. The aim of the study was to evaluate the return to sport and physical activities in patients underwent arthroscopic autologous matrix-induced chondrogenesis (AT-AMIC) 2 years after surgery. Methods: This is an observational cross-sectional study. Informed consent was obtained from all participants, and procedures were conducted according to the Declaration of Helsinki. Twenty-seven consecutive patients, 62.9% (17) male (mean ± SD age: 33.7±11.2 years), that underwent AT-AMIC were included in the study. All patients were assessed with the American Orthopaedic Foot & Ankle Score (AOFAS), physical component score of the 12-Item Short Form Health Survey (PCS-SF-12), HALASI ankle activity score and University of California, Los Angeles (UCLA) activity scale preoperatively and at 24 months after surgery. Results: Overall, 81.48% of the patient group returned to the same preinjury sport. Mean follow-up was 42.7 ±11.1 months. A significant interaction with time (from pre-operative to the final follow-up) for the clinical parameters UCLA, Halasi, AOFAS and SF-12 was found, P<0.001). In addition, there were significant differences between preoperative versus last follow-up (all, P <0.001), Conclusion: A high percentage of patients return to their sport activity after osteochondral talar reconstruction with AT-AMIC technique; furthermore AT-AMIC improve quality of life in young and active patients, allowing return to sport.
New “Freer test” for assessment of syndesmotic diastasis -Cadaveric study
Authors: Kim Jinsu , Park Young-uk , Lee Kyung-tai , Young Kiwon , Lee Sang 
Published: September 2018

Category: Sports Introduction/Purpose: Syndesmotic stability is usually assessed arthroscopically by an arthroscopic probe insertion between the anterolateral tibio-fibular recess. This probe test can predict the syndesmotic instability, however, is difficult to determine syndesmotic fixation. The syndesmosis has dynamic motion and fairly firm structure, 2 mm thin probe cannot make syndesmotic dynamic diastasis. We proposed a new “Freer test” for diagnosis of syndesmosis injury which performed to insert a 2 mm diameter freer elevator between tibio-fibular lateral gutter while keeping the ankle at the plantigrade. The purpose of the present study was to evaluate the diagnostic value of freer test for anterior inferior tibiofibular ligament (AITFL) complete tear, interosseous ligament (IOL) tear and Weber type B fibular fracture. Methods: Ten fresh ankle cadaveric specimens were used. Operative procedures progressed as below; firstly, exposed antero-lateral ankle joint with direct lateral longitudinal incision, incised AITFL, incised IOL, performed Weber type B osteotomy at fibular, fixed the osteomized fibular with 8-hole locking plate and fixed the AITFL with suture anchors. In each procedure, freer tests with ankle dorsiflexion (DF, plantigrade) and plantarflexion (PF) were performed with freer elevator linked 3 kgf compression gauge. A negative test was defined as the freer did not insert with a more than 3 kgf. A positive test was defined lesser than 3 kgf, and measured the force at the insertion. Results: All freer test was negative with DF before procedures. Six ankles with PF were positive with average 1.5 kgf. All freer test positive has shown after AITFL cutting in DF, PF(mean 1.76 kgf, 1.19 kgf). After IOL cutting, all freer tests were positive in DF, PF(mean 1.46, 0.79 kgf). After fibular osteotomy, all freer tests were positive in DF, PF (mean 0.83,0.18 kgf). After fibular fixation with plate, all freer tests were positive in DF, PF (mean 1.26, 0.97 kgf). After syndesmotic fixation with anchors, 8 freer tests were positive in DF. 2 negative in PF, 4 negative in PF and 6 positive in PF. 2 positive in DF had partial breakage on anchor footprint due to weak bone. Conclusion: The “freer test” is useful diagnostic tool which test positive means AITFL rupture.
Comparison of Time-dependent Changes in Syndesmotic Reduction Between Suture-button and Screw Fixation for Ankle Malleolar Fractures with Tibiofibular Diastasis
Authors: Kimura Seiji , Yamaguchi Satoshi 
Published: September 2018

Category: Trauma Introduction/Purpose: Reduction of the tibiofibular syndesmosis is one of the most important factors that affect the clinical outcome after ankle malleolar fractures with syndesmotic diastasis. Recent studies have shown that suture-button fixation can yield better syndesmotic reduction than screw fixation immediately after surgery. However, the time-dependent change in the reduction for each fixation method has not been well studied. The purpose of this study was to compare the postoperative changes in the syndesmotic reduction after surgical treatment of ankle malleolar fractures between suture-button fixation and screw fixation using bilateral computed tomography. Methods: Patients who sustained ankle malleolar fractures with tibiofibular diastasis and underwent tibiofibular fixation were included. Suture-button fixation (Group B; n=14; age, 39 years) was used between 2015 and 2016, and syndesmotic screw fixation (Group S; n=20; age, 35 years) was used between 2012 and 2014. The syndesmotic screws were routinely removed. Patients underwent CT scanning of the bilateral ankles at 2 time points: at 2 weeks and 1 year after fracture fixation. Side-to-side differences in the anterior and posterior tibiofibular distances, and anteroposterior fibular translation were measured. Syndesmotic melreduction was defined as a side-to-side difference?2 mm in either of the measurements. The changes in each measurement and incidence of malreduction for each group were assessed using the Wilcoxon signed-ranks test and McNemar’s test. Differences between the two groups at each time point were also compared. Results: At 2 weeks after fracture fixation, the side-to-side difference in anterior tibiofibular distance was significantly wider in Group B (1.9 mm) than in Group S (0.7 mm) (p=0.03). Additionally, the fibulas were more translated posteriorly in Group B (1.5 mm) than in Group S (0.2 mm). At 1 year, the anterior tibiofibular distance decreased to 0.8 mm in Group B (p=0.09). On the contrary, it significantly increased to 1.9 mm in Group S (p=0.002). In Group B, the incidences of malreduction were 4/14 and 2/14 at 2 weeks and 1 year, respectively (p=0.74). Two ankles, which were malreduced at 2 weeks, changed to a reduced syndesmosis at 1 year. In Group S, the incidences were 8/20 and 9/20 at 2 weeks and 1 year, respectively (p=0.35). Conclusion: Syndesmotic alignment changed over time in both fixation methods, however, the patterns of change were different. Using suture-button fixation, the anterior tibiofibular distance decreased over time. As a result, the widened syndesmoses at 2 weeks changed to reduced syndesmoses at 1 year. On the contrary, using tibiofibular screw fixation, the anterior tibiofibular distance widened after screw removal. Our result suggests that the flexible suture-button fixation allows the fibula to move to the optimal location over time.
Assessment of Variables that Influence Agreement Amongst Reviewers for Foot & Ankle International
Authors: Kwon John , Gonzalez Tyler , Miller Chris , Cook Shera Palmer , Thordarson David 
Published: September 2018

Category: Other Introduction/Purpose: The peer-review process is a rigorous process under which manuscripts are assessed for their overall scientific quality and is generally accepted as the highest standard of scientific scrutiny with regard to medical publishing. A common criticism regards the often disparate nature of reviewer recommendations when a decision is rendered which belies the supposed uniformity of the review process. The purpose of this investigation was to: (1) examine the historic level of agreement amongst reviewers for Foot & Ankle International (FAI) and (2) to assess variables which may influence agreement in order to improve the peer-review process. Methods: Approval to conduct this study was obtained from the Editorial Board of FAI. All manuscripts submitted to FAI during 2015 which underwent peer-review were included in the analysis. For each reviewed manuscript, demographic data was collected regarding specific reviewer and manuscript characteristics in a de-identified manner. Univariate analysis was performed. Results: 442 manuscripts underwent peer-review by 198 reviewers during the study period. During this time period, other papers were reviewed by the Editor-in-Chief and rejected prior to being sent out for review. Of the 884 reviews performed, 339 (38%) recommended rejection, 353 (40%) recommended revision and resubmission and191(22%) recommended accept. Only 199 manuscripts (45%) had a decision rendered in which both reviewers agreed on the initial recommendation.The most common initial decision was rejection (52.7%) followed by revise and resubmit (42.8%). Only 20 manuscripts (4.5%) received an outright acceptance upon initial review. Comparing the agreeing versus disagreeing reviewers, there was no difference in demographic data such as reviewer age or experience. When examining key words (designated by reviewers as a particular area of interest within foot and ankle), there was no association between shared interests and level of reviewer agreement. Overall, for all reviewers, mean acceptance rate was19% (+/- 16%), mean reject rate 37% (+/- 20%) and mean revise 44% (+/- 19%). Conclusion: Regarding initial decision for publication in FAI, there was only 45% agreement amongst reviewers for manuscripts which underwent peer-review in 2015. However, no reviewer-specific variables examined in this investigation were found to correlate with agreement. Despite reviewers having similar interests in various aspects of foot and ankle surgery, this did not lead to an increased likelihood of agreement. Agreement and more uniform assessment of manuscripts by reviewers may be increased by specific education.
Scarf and Weil osteotomy for symptomatic hallux valgus does not fully remove second toe residual metatarsalgia
Authors: Loh Bryan , Koo Kevin , Liow Ming Han Lincoln , Lim Winston Shang Rong , Ng Chong Zheng , Rikhraj Inderjeet 
Published: September 2018

Category: Bunion Introduction/Purpose: Patients with hallux valgus (HV) often experience concurrent second toe metatarsalgia due to altered forefoot biomechanics. Additional second toe Weil osteotomy has been performed to reduce transfer metatarsalgia as some studies have highlighted the presence of second toe pain after isolated HV correction. 1, 2 There is a paucity of literature evaluating residual second toe pain after these procedures . We hypothesize that combined Scarf/Weil osteotomy will result in less residual second toe pain while achieving good functioning outcome. The aim of this study was to evaluate the presence of second toe pain after isolated scarf osteotomy versus combined Scarf/Weil osteotomy. Methods: Between January 2007 and June 2012, 439 patients underwent a scarf osteotomy for symptomatic hallux valgus at a tertiary hospital. Patients who underwent isolated scarf osteotomy were matched 1:1 to patients who had both Scarf and second toe Weil osteotomy. The following functional outcome scores were prospectively collected preoperatively and postoperatively at 6 and 24 months: American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal (MTP-IP) Scale, Visual Analog Scale (VAS), SF36-Physical Component Score (PCS) and Mental Component Score (MCS). Radiological outcomes such as the Hallux Valgus Angle (HVA) and Intermetatarsal Angle (IMA) were measured. Statistical analysis was performed using SPSS® 20.0 and significance was defined as a p-value = 0.05. The Student’s unpaired t-test was used to compare the radiological and functional outcomes between the two groups of patients, while the paired t-test was used to analyze improvement in pre- and postoperative outcomes within each group. Results: 94.4% of the patients were female and no difference in BMI. In the Scarf/Weil group, the HVA and IMA improved by 21.2 ± 10.2 and 8.2 ± 4.7 degrees respectively (both P<0.001). At 2 years, the AOFAS-hallux score improved by 26.6 ± 20.9 (p=0.034), AOFAS-second toe by 29.3 ± 20.9, VAS-hallux by 3.1 ± 3.4 (p<0.001), VAS-second toe by 3.6 ± 3.2 (p<0.001). In the Scarf group, the HVA and IMA improved by 17.1 ± 8.0 and 5.8 ± 4.3 degrees respectively (both p<0.001). At 2 years, the AOFAS-hallux score improved by 32.2 ± 21.2 (p=0.034), AOFAS-second toe by 13.0 ± 16.3 (p <0.001), VAS-hallux by 4.4 ± 3.3 (p<0.001), VAS-second toe by 1.2 ± 2.4 (p<0.001). Conclusion: A significant finding is that at 6 months and 2 years, the VAS-2nd toe score in the isolated Scarf group was 1 ± 0 point lower than the other group (p<0.001). All other functional outcome scores were comparable between the two groups at 6 months. Our findings suggest that shortening second toe Weil osteotomy for large HV deformity may not fully resolve second toe metatarsalgia in the short-term, providing useful information for preoperative counselling.
Prevalence of isolated gastrocnemius tightness in patients with foot and ankle pathology – a population based study
Authors: Malhotra Karan , Chan Oliver , Cullen Nicholas , Welck Matthew , Goldberg Andrew , Singh Dishan 
Published: September 2018

Category: Other Introduction/Purpose: Gastrocnemius tightness (GT) is thought to predispose patients to multiple musculoskeletal pathologies including back pain, plantar fasciitis, and metatarsalgia. It is thought to be especially prevalent in patients with foot and ankle pathology (FAP) and consequently there is an emerging trend to perform lengthening / release procedures in this patient group. However, it is not clear what proportion of the normal population has GT and how this differs in patients with FAP. We set out to investigate what the incidence and degree of GT in the foot and ankle population is compared to the normal population. Methods: This was a prospective study comparing GT in a cohort of patients with FAP with GT in controls matched for age, gender, and ethnicity. The control group consisted of healthy adult volunteers and the FAP group consisted of patients presenting to our Foot & Ankle unit. Patients with previous surgery, tendoachilles tightness, or ankle arthritis were excluded. GT was measured using a digital inclinometer and the lunge test. It was calculated as the difference between maximal ankle dorsiflexion with the knee extended and with the knee flexed. Data on the control group was collected first and a power calculation suggested a FAP cohort size of 91 feet was required to detect a 2° difference in GT (a= 0.05, ß = 0.05, Ratio 3:1). Results: After case-matching 97 FAP cases were paired with 291 controls for analysis. Mean GT was 8.0° ±5.7° (range: 0-21°) in FAP patients versus 6.0° ±3.5° (range: 0-16°) in controls (p<0.001). Regression analysis demonstrated demographics including BMI and activity level were not significant determinants of GT in the FAP group (r=0.141, p=0.599). Subgroup analysis of the FAP group revealed a mean GT of 10.3° ±6.0° in patients with forefoot pathology (FoP) versus 6.9° ±5.3° in the other FAP patients (NFoP) (p=0.008). When comparing the NFoP group to the controls, there was no difference in GT (p=0.188). In total 21 FAP patients (21.6%) and 12 FoP patients (37.5%) had GT greater than 2 standard deviations of the control group (Figure 1). Conclusion: This population based study demonstrates increased GT in the FAP population versus the normal population; however, in patients without forefoot pathology, this difference may not be clinically relevant. Over a third of patients with forefoot pathology have GT which is greater than the normal population range. We conclude that not all patients with foot and ankle pathology have inherently increased GT, compared with the normal population, but it is reasonably common in patients with forefoot pathology. Further work is required to define what degree of GT may be considered significant, to determine which patients will benefit from surgical treatment.
Anatomical Feasibility Study of Flexor Hallucis Longus Transfer in Treatment of Achilles Tendon and Posterior Ankle Arthroscopy
Authors: Mao Haijiao 
Published: September 2018

Category: Hindfoot Introduction/Purpose: The aim of this study was to evaluate the occurrence of anatomical variations of the musculotendinous junction of the flexor hallucis longus (FHL) muscle, the relationship between FHL tendon or muscle and the tibial neurovascular bundle at the level of the posterior ankle joint in human cadavers. Methods: Seventy embalmed feet from 20 male and 15female cadavers, the cadavers’ mean age was 65.4 (range from 14 to 82) years, were dissected and anatomically classified to observe FHL muscle morphology define the relationship between FHL tendon or muscle and the tibial neurovascular bundle . The distance between the musculotendinous junction and thehe relationship between FHL tendon or muscle and the tibial neurovascular bundle was determined. Results: The three morphology types of FHL muscle were identified: a long lateral and shorter medial muscle belly, which was observed in 63 specimens (90%).; equal length medial and lateral muscle bellies, this variant was only observed in 5 specimens (7.1%); a lateral and no medial muscle belly, which was observed in 2 specimens (2.9%). No statistically significant difference was observed according to gender or side (p > 0.05). Two patterns were identified and described between FHL tendon or muscle and the tibial neurovascular bundle. Pattern 1, the distance between the neurovascular bundle and FHL tendon was 3.46 mm (range, 2.34 to 8.84, SD = 2.12) which was observed in 66 specimens (94.3%); Pattern 2, there was no distance which was observed in 4 specimens (5.7%). Conclusion: Knowing FHL muscle morphology variations provide new important insights into secure planning and execution of a FHL transfer for Achilles tendon defect as well as for the interpretation of ultrasound and magnetic resonance images. During posterior arthroscopic, posteriormedial portal may be introduced into the posterior aspect of the ankle without gross injury to the tibial neurovascular structures.
Ultrasound Evaluation of Peroneal Tendon Location Within the Fibular Groove
Authors: Martin Kevin , Wake Jeffrey 
Published: September 2018

Category: Sports Introduction/Purpose: The use of MRI in diagnosing peroneal tendon dysfunction can be difficult due to the anatomic orientation of the tendons and their relationship to the posterior fibula. MRI is also limited in its roll in diagnosing dislocation or intrasubstance subluxation due to the static nature of the examination. Due to these limitations Ultrasound has become increasingly more common. The purpose of this study was to identify the location of the peroneal tendons in relationship to the fibular groove during a dynamic examination in an asymptomatic population of elite United States Military Service members. Methods: We conducted a prospective cohort study composed of 41 active duty United States Army Rangers. Each subject was examined bilaterally. Subjects were placed in a lateral recombinant position and the ankle placed in a resting neutral position to visualize the tendon in a retromalleolar short-axis view. Next, maximum active ankle eversion followed by gravity inversion while the ultrasound probe was maintained in its original position. The distance from the fibrous lateral ridge of the retromalleolar groove to the anterior aspect of the peroneal brevis was measured in the short-axis in all three positions (Neutral, Eversion and Inversion). Results: The mean sagittal distance was 0.48 mm. No subjects demonstrated greater than 1 mm difference between the three positions, no dislocations were identified. The side to side difference and dominant vs non-dominant differences were not statically significant. Conclusion: The current study demonstrates the distance between the peroneal brevis and the lateral fibular ridge is consistent throughout extremes of motion in an asymptomatic population. These results help further the understanding of the peroneal tendons while performing a dynamic exam. Our findings also establish side-to-side consistency prompting a bilateral examination to help identify abnormal pathology. The current study also offers clinicians another means of evaluating reported peroneal tendon subluxation prior to MRI or further subspecialty consultation.
Hallux Valgus
Authors: Mierke Alex , Morris Stephen , Epperly Scott , Kidd Deon , Patton Daniel 
Published: September 2018

Category: Bunion Introduction/Purpose: Abnormal motion of the first tarsometatarsal (TMT) joint disrupts the anatomic alignment of the metatarsal head, sesamoid complex and proximal first phalanx. This anatomic disruption combined with the deforming forces of the extensor hallucis longus, adductor tendons, and extensor hallucis brevis result in a hallux valgus deformity. First TMT arthrodesis or the Lapidus procedure has been described as treatment for moderate to severe hallux valgus deformities by correcting hypermobility and restoring anatomic alignment of the first ray. The aim of this study was to evaluate the safety of a percutaneous approach to the Lapidus procedure and its relation to anatomic structures. Methods: A percutaneous, modified Lapidus procedure was performed on 19 embalmed cadaveric feet under fluoroscopic guidance. The specimens were then dissected to identify the extensor hallucis longus (EHL), extensor hallucis brevis (EHB), tibialis anterior (TA), median branch of the superficial peroneal nerve (MBSPN), intermediate branch of the superficial peroneal nerve (IBSPN), deep peroneal neurovascular bundle (DPNVB) and saphenous vein (SV). The structures were localized with reference to percutaneous burr and screw placement during the procedure. Results: The tibialis anterior and intermediate branch of the superficial peroneal nerve were a mean of 3.75 millimeters (mm) and 5.08 mm from the closest burr or screw placement. The extensor hallucis longus and extensor hallucis brevis were at greatest risk under the new approach with mean distances of .92 to 4.08 mm to nearby instrumentation. The extensor hallucis longus or extensor hallucis brevis were either directly pierced or <2 mm from instrumentation on 26 occasions. A terminal branch of the saphenous vein was also either pierced or within 2 mm of instrumentation on 4 occasions. The deep peroneal neurovascular bundle and median branch of superficial peroneal nerve were relatively safe, coming within 2 mm of percutaneous burr or screw placement on only 2 occasions each. Conclusion: The minimally invasive percutaneous Lapidus arthrodesis provides a safe alternative to the traditional, open approach for patients with moderate to severe hallux valgus deformities. This may be a beneficial alternative to conventional open Lapidus procedures by minimizing soft tissue dissection. Further clinical studies must be performed to compare deformity correction, fusion rate, and complications with the modified percutaneous Lapidus procedure.