bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Computer Model Assessment of the Effect of Hindfoot Alignment on Mechanical Axis Deviation and Ankle Fractures
Authors: Duggal Naven , Williamson Patrick , Nazarian Ara 
Published: September 2018

Category: Basic Sciences/Biologics Introduction/Purpose: Conventional mechanical axis is calculated from the center of the femoral head to the center of the ankle. Mechanical axis deviation of the lower limb can be associated with a pes planus hindfoot. Malalignment of the lower limb has been shown to increase progression of osteoarthritis of the knee and ankle and decrease joint arthroplasty longevity. Clinically, a pes planus hindfoot has also been seen with patients who present with a stress fracture of the lateral malleolus. This biomechanical study aims to utilize computer modeling to evaluate the hypothesis that altered force transmission on the lateral malleolus with resultant stress fractures in a pes planus model is attributable to mechanical axis deviation. Methods: A free-body diagram of the fibula in single leg stance was generated by modeling the fibula as a uniform cylinder. It includes the axially applied load and a single evertor muscle force as an eccentric load applied to the mid-diaphysis . Previously derived relationships between body weight (BW = 667 N, 150lbs) and a) normal axial fibula load (BW*0.17) and b) muscle force (BW*0.25) were used. Fibula length (286.5 mm) and diameter (8 mm) were derived from anthropological data. Mechanical axis deviation in pes planus was simulated in two manners: 1) increased (2 and 3 times normal) axial fibula load and 2) increased evertor muscle force. The compressive stress along the length of the bone was determined through static analysis and the total applied load was compared to theoretical Euler buckling load. Results: Increasing the load on the fibula, either by increasing the axial load (Figure 1A) or the muscle load (Figure 1B), increases the maximum compressive stress below the lateral muscle origins, namely the section between the distal tibiofibular ligaments and the evertor muscles. The compressive stress for both cases was less than the compressive yield stress of cortical bone (200 MPa) and cancellous bone (100 MPa) even as the force was increased to the critical buckling value. This model serves as a first attempt to relate the spatial distribution of stress in the fibula with muscle force, axial load, and compressive stress in light of distal fibular fractures associated with pes planus. Conclusion: The importance of lower extremity mechanical axis deviation is well established in the progression of arthritis in the knee and ankle. The role of the mechanical axis in the predisposition of stress fractures around the ankle has not been evaluated in the literature. This biomechanical study represents the first attempt to understand how deviation of the mechanical axis can result in stress fractures of the lateral malleolus. Future studies including a finite element analysis will provide further information and the results of these studies may alter how clinicians treat patients with stress fractures of the fibula.
Successful Treatment Of Advanced Freiberg’s Disease With A Dorsal Closing Wedge Osteotomy
Authors: Halai Mansur , David-West Kenneth 
Published: September 2018

Category: Lesser Toes Introduction/Purpose: Treatment for Freiberg’s disease is largely conservative. For severe disease and refractory cases, there are various surgical options. Most studies are from the Far-Eastern population and have short follow-up. The purpose of this study was to report the 5 year clinical outcomes of a dorsal closing wedge osteotomy in the treatment of advanced Freiberg’s disease in a Caucasian population. Methods: Twelve patients (12 feet), with a mean age of 30.7 years (range 17-55), were treated with a synovectomy and a dorsal closing wedge osteotomy of the affected distal metatarsal. There were 10 females and 2 males. All patients were born in the United Kingdom. Clinical outcomes were independently evaluated pre and postoperatively using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and a subjective satisfaction score. Nine (75%) feet involved the 2nd metatarsal and 3 feet (25%) involved the 3 rd metatarsal. According to the Smillie classification, 6 feet were Grade IV and 6 feet were grade V. Radiological union was evaluated postoperatively. Results: No patients were lost to follow up and the mean follow-up time was 5.2 years (4-7). AOFAS scores improved from 48.1 +/- 7.4 to 88.9 +/- 10.1 postoperatively (p<0.001) giving a mean improvement of 40.8. 92% of patients were satisfied with their operation at latest follow-up, reporting excellent or good results. All patients had postoperative radiological union. One patient had a superficial postoperative infection that was successfully treated with oral antibiotics. Conclusion: A dorsal closing wedge osteotomy is an effective treatment of advanced Freiberg’s disease in a Caucasian population, with good outcomes and few complications.
Muller-Weiss Disease
Authors: Harnroongroj Thos , Chuckpaiwong Bavornrit 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: Numerous surgical treatments for Muller-Weiss Disease(MWD) have been reported. However, up to presence, there is no study about the natural history of the conservative treatment in MWD. Our objective is to provide the survival analysis of the conservative treatment in MWD to 5-year follow up and to identify the factors that correlated to the failure of conservative treatment. Methods: This retrospective cohort review examined 32 MWD patients, age > 18 and at least Maceira’s stage 3, received conservative treatment with follow-up period to 5 years. Demographic data; pretreatment visual analogue scale(VAS) for pain on walking; foot and ankle outcome scores(FAOS); and radiographs were reviewed. A survival analysis of successful conservative treatment was done using Kaplan-Meier Curve. The “starting-point” was the time started conservative treatment. The “end-point” was the time converted to surgery. “Failure of conservative treatment” was defined as conversion to surgery due to significant pain and disability within 5-Year follow up. Patients were divided into “Successful conservative group”(A) and “Conversion to surgery group”(B). The comparison of variables between 2 groups were done to identify the factor correlated to failure of conservative treatment. Results: Mean age was 57.5±10.4 years. Average body mass index was 24.3±3.4. According to survival analysis, mean follow up period was 43.1±21.0 months . Fourteen patients(43.75%) required subsequent conversion to surgery. Survivorship of conservative treatment was 56.3%(95%CI, 47.5- 65.1) with mean survival time of 43.1 months(95%CI, 35.9- 50.3). VAS of pain on walking, FAOS in subscale of pain and quality of life(QoL) were 6.2±2.5, 58.1±24.7 and 52.8±16.6, for group A; 7.9±1.6, 33.5±16.6 and 28.9±19.0, for group B. There were significant worse of both clinical scores in group B compared to A(p<0.05). The radiographic anteroposterior Meary angle in group A and B were abducted 4.8±12.6 and 13.7±10.0. The statistical analysis showed significant more midfoot abduction in group B than A, hazard ratio 1.056(95% CI,1.003 -1.111, p=0.04). Conclusion: Survivorship of conservative treatment in MWD is only 56.3% at 5-year follow up. The failure of conservative treatment associates with degree increment of midfoot abduction.
Total Ankle Arthroplasty for Rheumatoid Arthritis
Authors: Hirao Makoto , Hashimoto Jun , Tsuboi Hideki , Noguchi Takaaki 
Published: September 2018

Category: Ankle Introduction/Purpose: Outcomes after total ankle arthroplasty (TAA) combined with additive techniques (1. augmentation of bone strength, 2. control of soft tissue balance, 3. adjustment of the loading axis) for rheumatoid arthritis (RA) cases were evaluated after mid to long-term follow-up. The influences of biologic treatment on the outcomes after TAA were also evaluated. Methods: We performed a retrospective observational study involving 50 ankles (44 patients) that underwent TAA for the treatment of rheumatoid arthritis. The mean duration of follow-up was 7.1 years. Clinical outcomes were evaluated with use of the Japanese Society for Surgery of the Foot (JSSF) scale score and a postoperative self-administered foot-evaluation questionnaire (SAFE-Q). Radiographic findings were evaluated as well. These parameters also were compared between patients managed with and without biologic treatment. Results: This procedure significantly improved the clinical scores of the JSSF rheumatoid arthritis foot and ankle scale (p < 0.0001). Forty-eight of the 50 ankles had no revision TAA surgery. Subsidence of the talar component was seen in 8 ankles (6 in the biologic treatment group and 2 in the non-biologic treatment group); 2 of these ankles (both in the biologic treatment group) underwent revision TAA. The social functioning score of the SAFE-Q scale at the time of the latest follow-up was significantly higher in the biologic treatment group (p = 0.0079). The dosage of prednisolone (p = 0.0003), rate of usage of prednisolone (p = 0.0001), and disease-activity score (p < 0.01) at the latest follow-up were all significantly lower in the biologic treatment group. Conclusion: TAA is recommended for RA cases, if disease control, augmentation of bone strength, control of soft tissue balance, and adjustment of loading axis are taken into account. The prevention of talar component subsidence remains a challenge in patients with the combination of subtalar fusion, rheumatoid arthritis, and higher social activity levels.
Long-Term Outcomes of Total Ankle arthroplasty with mobile bearing in 124 ankles, Over eight years of follow-up
Authors: Hwang Yeokgu , Park Kwang Hwan , Han Seung Hwan , Lee Jin Woo 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is increasingly recommended for patients with end-stage ankle osteoarthritis. However, there were few studies which had investigated long-term clinical outcomes with mobile baering system. We analyzed the patient reported results of 124 arthroplasties performed with one type of three-component total ankle prosthesis. This prospective cohort study analyzed long-term outcomes of total ankle arthroplasty with use of the Hintegra prosthesis at one center. Methods: Consecutive patients who received the hintegra prosthesis between September 2004 and December 2009 were enrolled at one large, university hospitals. Patients were annually evaluated clinically, and the patients reported survey with visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS) and revision rate. Kaplan-Meier survival result showed survival outcomes of TAA in long-term follow-up. Results: One hundred and twenty-four ankles underwent arthroplasty with the Hintegra prosthesis. The mean age of patient at operation time was 64.2 years old (range, 47 to 84 years old). The mean duration of follow-up for all living patients without revision (Eighty-six ankles) was 10.0 ± 1.3 years. The mean change from baseline to final follow-up was -6.7 ± 4.3 points for Visual analog scale, and 26.1 ± 10.3 points for the AOFAS score. . Seven (5.6%) of the ankles required metal component revision at a mean of 2.9 ± 1.8 years (range, 0.5 to 5.8 years). Ten (8%) of the prostheses underwent polyethylene bearing exchange, mostly due to asymmetric wear, at a mean of 2.8 ± 1.8 years (range, 0.1 to 9.1 years). Conclusion: Long term outcomes were good after ankle arthroplasty with the Hintegra prosthesis performed by experienced surgeons, and long-term outcomes demonstrated. The revision rate was substantially higher among the first fifty ankles than among subsequent ankles. Further study to elucidate possible reasons for osteolysis and subjective pain after TAA is warranted.
Diagnosis, Physical Exam, and Imaging for Osteochondral Lesions of the Talus
Authors:   International Consensus Group on Cartilage Repair of the Ankle
Published: September 2018

Category: Ankle Introduction/Purpose: Cartilage lesions of the talus are a challenging clinical pathology for orthopaedic surgeons. To date, the treatment guidelines for these lesions have been based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions on key topics regarding cartilage lesions of the talus. Diagnosis, physical exam and imaging were discussed as one portion of the first International Consensus Meeting on Cartilage Repair of the Ankle. The purpose of this abstract is to explain the process and delineate the consensus statements derived from this consensus meeting on the diagnosis, physical exam and imaging for osteochondral lesions of the talus. Methods: 75 national and international experts in cartilage repair of the ankle, representing 25 countries and all six continents, were convened and participated in a process based on the Delphi method of achieving consensus. Experts were assigned to groups separated by topics, including diagnosis, physical exam and imaging. Questions and statements were drafted within the groups and a comprehensive literature review was performed and, where possible, used to confirm or dispute the recommendations made. In addition, the available evidence for each statement was graded. Once the statements achieved majority vote within the working groups, a vote to the overall group was undertaken. The statements were then further edited on the basis of the discussion and votes within the entirety of the consensus group. A final vote then occurred, and the strength of consensus was characterized as follows: consensus: 51 - 74%; strong consensus: 75 - 99%; unanimous: 100%. Results: 12 statements addressing diagnosis, physical exam and imaging for cartilage lesions of the talus reached some degree of consensus. These included conclusions on how suspected lesions should be evaluated. There was a consensus that: [1] Weight-bearing AP, lateral, and mortise radiographs should be utilized to evaluate a known or suspected cartilage lesion of the ankle. [2] Lesion size should be estimated in three planes including surface area and depth of the lesion. [3] If precise measurement is required including depth, the use of CT is recommended, but for daily practice, a size estimate using MRI is appropriate. [4] Diagnostic arthroscopy is of limited value and seldom influences treatment approach in the assessment of a known or suspected cartilage lesion of the ankle. Conclusion: There is a lack of evidence-based guidelines available to direct treatment for clinicians when managing cartilage lesions of the ankle. This international consensus derived from leaders in the field will assist clinicians with a combination of expert- and evidence-based guidelines to consider in the evaluation of a cartilage lesion of the talus including diagnosis, physical exam and imaging.
Relationship between osteophyte and arthroscopic findings in osteoarthritis of ankle
Authors: Kanemitsu Munekazu , Nakasa Tomoyuki , Sawa Mikiya , Yoshikawa Masahiro , Tsuyuguchi Yusuke , Ota Yuki , Adachi Nobuo 
Published: September 2018

Category: Ankle Introduction/Purpose: Mortise view weight-bearing radiograph is widely used for the diagnosis of osteoarthritis of ankle. Thickness of the articular cartilage cannot be accurately evaluated in the evaluation of joint space from weight-bearing radiograph, because lateral tibiotalar joint space is maintained in valgus type osteoarthritis in some cases. There are few reports on the relation between osteophyte and the articular cartilage injury. We considered that it might be possible to estimate the cartilage injury more accurately by examining osteophytes. The purpose of this study is to analyze the relationship between the location and grade of osteophytes in weight-bearing radiograph and cartilage injury in arthroscopic findings was analyzed. Methods: Twenty-one anklets of 21 patients consisted of 10 males and 10 females, with mean age of 61.4 years (31-79 years), who underwent arthroscopic surgery for osteoarthritis in our department were included. Weight-bearing radiograph were taken before surgery. Location and grade of osteophytes were evaluated using Ankle and Hindfoot Radiographic Osteoarthritis Scoring reported by Kraus et al. Arthroscopic findings were evaluated with International Cartilage Repair Society (ICRS) Grade at a total of 20 sites (9 areas of tibia and talar in tibiotalar joint, medial malleolus and lateral malleolus). The correlation between radiographic findings and arthroscopic findings were analyzed. Results: In Mortise view, strong correlations were found between lateral tibial osteophyte grade and ICRS grade of the center (talus R = 0.69, tibia R = 0.76), the central lateral (tibia R = 0.79), the posterior center (talus R = 0.72, tibia R = 0.74) and the posterior lateral of the tibiotalar joint (talus R = 0.63, tibia R = 0.76). There are moderate correlations between distal fibular osteophyte grade and ICRS grade of the medial inner (tibia R = 0.74) and the posterior medial of the tibiotalar joint (talus R = 0.61, tibia = 0.63). In lateral view, there are moderate correlations between posterior talar osteophyte grade and ICRS grade at the center of the tibiotalar joint (talus R = 0.61, tibia R = 0.60). Conclusion: From this study, there was a strong correlation between location and grade osteophyte and the articular cartilage injury. Osteoarthritis progression is caused by degeneration of the cartilage because of the joint instability, and osteophytes were formed by traction force or impaction. This study showed that local cartilage injury is thought to be related to osteophytes. By evaluating the location and size of osteophytes, the articular cartilage injury might be predicted accurately before arthroscopic surgery.
The Efficacy of Different Ropivacaine Concentrations (0.5%, 0.6% vs 0.75%) for Regional Nerve Block in Lower Extremity
Authors: Kang Chan , Lee Gi-Soo , Lee Jeong-kil , Kim Dong Yeol , Seo Gangwon , Choi Bo Sung , Hwang Sungjin , Ahn Ki jun , Song Jae-Hwang , Song Seokhwan 
Published: September 2018

Category: Basic Sciences/Biologics Introduction/Purpose: There have only been a few studies on optimal concentrations, doses, and volume of injection material in the regional nerve block for lower extremity operations. The purpose of this study was to evaluate the efficacy of different concentrations of ropivacaine with respect to anesthetic time, intraoperative, postoperative pain, and patient’s satisfaction. Methods: A total of 339 patients underwent lower extremity surgery under ultrasound-guided nerve block (combined femoral and sciatic nerve block) at a single institution between March 2016 and February 2017 and were randomly assigned to three groups: Group A (0.5% 42 ml), B (0.6%, 30 ml), and C (0.75%, 30 ml). The interval between nerve block procedure and onset of the complete anesthetic effect (complete anesthetic time) was investigated. The degrees of intraoperative pain (during the first 10 minutes of the surgical procedure), and postoperative pain (6, 12 hours after operation) were evaluated using a visual analog scale (VAS) score. Patient’s satisfaction (0~10) was investigated 12 hours after the operation. To evaluate the efficacy in accordance with the concentration under the same dose and same volume, group A and B were compared with group C respectively. Results: There were 108, 118, and 113, in groups A, B, and C, respectively. The complete anesthetic times were 78.5, 76.4, and 58.6 minutes, respectively. The intraoperative VAS scores were 2.04, 0.62, and 0.24; and the postoperative VAS scores (6hours / 12hours) were 2.41 / 4.08, 0.26 / 1.24, and 0.38 / 1/53. The patient’s satisfactory scores were 8.53, 9.38, and 9.4 respectively. Compared with group C, group A showed significantly longer complete anesthetic time (p<0.05) and higher intra, postoperative VAS scores (all p<.05). Group B showed longer complete anesthetic time (p<0.05), but no significant difference of intra, postoperative VAS scores (all p>.05). Patient’s satisfactory scores in both group A and B were similar to group C(p>.05, p>.05). There were no adverse reactions in all groups. Conclusion: Ropivacaine 0.6% as well as 0.75% are safe and effective anesthetics under the same volume (30 ml) for regional nerve block of the lower extremity. However, taking into account of the longer complete anesthetic time, the operation start time must be adjusted.
Comparison of the period of return to practice in All-Inside Arthroscopic and Open Techniques for the Modified Broström Procedure for Ankle Instability
Authors: Lee Young Koo , Lee Sun Geun 
Published: September 2018

Category: Arthroscopy Introduction/Purpose: Lateral ankle instability (LAI) is common injury in general population and open modified Broström operation (OMBO) is standard treatment of lateral ankle instability. Recently arthroscopic modified Broström operation (AMBO) is performed and many studies show that there are no difference in clinical & radiologic outcomes between open and arthroscopic operation. But not previously reported, comparison between OMBO and AMBO with the period of return to practice. The purpose of this study is to evaluate the time of return to practice in patients with clinical functional outcomes. Methods: From January 2012. to July 2014. 60 patients were included. They were divided into 2 groups: AMBO (30 patients) and OMBO (30 patients.). All patients followed a standardized treatment and rehabilitation program. We measured the period of return to practice by 7 Questions asked in each groups to compare period of return to practice. Survey is consisted of about time of walking, running, jumping, squatting, climbing stairs, rising up heels and toes without pain. And we also compared the time from the symptom of instability onset to date of operation. And for clinical outcome, evaluations were performed preoperatively, postoperatively, and 6months postoperatively using the AOFAS ankle-hindfoot score, pain VAS score and subjective satisfaction for rehabilitation, activity level of patients. Results: For comparison of the dates of operation, the average period of AMBO was faster (6.37±3.378 weeks) than OMBO (14.47±5.794 weeks). And for return to practice, AMBO showed faster return to practice (7.07±2.96 weeks) in walking without pain than OMBO (11.03±8.58 weeks). And other survey showed no difference in period of return to practice between OMBO and AMBO. There were no difference in postoperatively 6 month AOFAS and VAS score, but postoperatively VAS score showed significantly lower in AMBO than OMBO. AMBO was found to be faster return to practice in 2 out of 7 questions in high physical activity group, and also subjective satisfaction rate for rehabilitation of AMBO was higher than OMBO. Conclusion: For general population, except walking, there was no difference in the period of return to practice and clinical outcomes between the AMBO and OMBO for the treatment of lateral ankle instability. However, this study showed that AMBO was able to receive the surgery more quickly than OMBO. and AMBO can be a treatment option and should be considered carefully in atheletes who have lateral ankle instability that AMBO showed good results in higher activity level group for period of return to practice, subjective satisfaction, lower postoperatively pain.