bluuebunny/crossref_metadata_2025_split huggingface dataset:
3-D Morphometric Analysis of Talocalcaneal Joint in Stage II Posterior Tibial Tendon Dysfunction
Authors: Cain Jarrett D. , Lewis Gregory , Kunselman Allen 
Published: September 2018

Category: Hindfoot Introduction/Purpose: Posterior Tibial Tendon Dysfunction (PTTD) is common disorder that can lead to changes in function during the gait cycle due to decreased arch, increased hindfoot valgus, and forefoot abduction. These kinematic changes can have a structural impact on the joints throughout the foot. While previous studies have evaluated anatomical three-dimensional (3D) position of the subtalar joint, the purpose of this study was to perform morphological analysis of the anterior, middle and posterior facets in patients with stage II posterior tibial tendon dysfunction compared to normal controls. Methods: Clinical computed tomography images from 10 matched feet (i.e., 10 normal and 10 stage II PTTD) were obtained and used for 3D reconstruction in Mimics software (Materialise). From the3D reconstructions, morphometric evaluations of the subtalar joint were completed including 3D anatomic point placement and measurements of the length and width of the anterior, middle and posterior facets (Fig. 1) by 3 independent evaluators. Evaluators were blinded to experimental groups and to one another’s measurements. A linear mixed-effects model was used to assess the differences between control and PTTD subtalar joints with respect to morphometric measurements (mm). The concordance correlation coefficient (CCC) was used to assess the agreement between the 3 evaluators with respect to their recorded morphometric measurements per location (e.g., anterior, middle, posterior). Results: Although the mean distance of the length and width of the middle facet trended higher in the stage II PTTD compared to controls, this difference was not statistically significant (Table 1). Similarly, there was no difference detected between control and PTTD with respect to morphometric measurements in the anterior and posterior facets (Table 1). The agreement among the 3 evaluators with respect to morphometric measurements was the strongest in the length and width of the middle facets. Conclusion: Stage II posterior tibial tendon dysfunction has been shown to cause increase subtalar joint kinematics, joint contact pressure. Based on the results, there is a positive correlation involving morphologic changes of subtalar joint with the middle facet measurements being larger in the PTTD group. Further studies are needed with weight bearing CT scans in correlation with advance stages of posterior tibial tendon dysfunction.
Is Generalized Ligamentous Laxity a Prognostic Factor for Recurred Hallux Valgus Deformity?
Authors: Cho Byung-Ki , Choi Seung-myung 
Published: September 2018

Category: Bunion Introduction/Purpose: It is still unclear whether generalized ligamentous laxity is a risk factor for recurred hallux valgus deformity. This study was performed to evaluate the intermediate-term clinical outcomes after proximal chevron osteotomy for hallux valgus in patients with generalized ligamentous laxity, and to determine the effect on postoperative recurrence of deformity. Methods: A total of 198 feet from 169 female patients were treated with a proximal chevron osteotomy for hallux valgus with a mean follow-up of 46.3 months. When generalized ligamentous laxity was defined as Beighton score ≥ 5 points, there were 18 patients (10.7%) in laxity group and 151 patients (89.3%) in non-laxity group. Clinical evaluation consisted of the American Orthopaedic Foot and Ankle Society (AOFAS) scores, Foot and Ankle Ability Measure (FAAM), and radiographic measurement of hallux alignment. Risk factors associated with postoperative recurrence were evaluated using univariate analysis. Results: Recurrence rates were 21.7% in the laxity group and 17.1% in non-laxity group (p = 0.218), when defined as hallux valgus angle ≥ 20°. No significant differences of measurement at final follow-up were found between the 2 groups in terms of AOFAS score, FAAM, recurrence rate, hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA). Preoperative HVA and IMA were found to be predictive factors of recurrence (OR = 6.3, 4.2; P = .001, .018, respectively). Conclusion: There were no statistical differences in the clinical and radiographic outcomes between hallux valgus with and without generalized ligamentous laxity. Generalized ligamentous laxity demonstrated no definitive effects on postoperative recurrence of hallux valgus deformity.
Technique
Authors: Danna Natalie , Rizkalla James , Brodsky James 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: Sesamoidectomy is most often indicated for sesamoid fractures. The procedure may also be a useful option for cases of recalcitrant sesamoiditis, osteochondritis dissecans, and osteoarthritis. In instances of concomitant arthritis of the first metatarsophalangeal joint and the sesamoids, sesamoidectomy may be performed in tandem with first metatarsophalangeal joint fusion. This carries the additional benefit of harvesting bone graft from the excised sesamoid to include in the fusion construct. Though sesamoidectomy is commonly performed through a medial or plantar approach, neither of these approaches are suited to fusion of the first metatarsophalangeal joint. Sesamoidectomy can be performed effectively through a dorsal approach and is the preferred technique when performed in conjunction with first metatarsophalangeal joint fusion. Methods: A dorsal midline incision is made over the first metatarsophalangeal joint. Care is taken to protect the extensor hallucis longus tendon while dissection proceeds to the joint capsule. The capsule is incised and released so that the first metatarsophalangeal joint can be sufficiently mobilized. Next, the opposing joint surfaces are prepared, increasing the mobility of the joint and exposure of surrounding structures. Results: (technique, continued) A sharp retractor is used to elevate the metatarsal head. Hyperflexion of the metatarsophalangeal joint may increase visualization of the sesamoids. A fresh knife is used to tease the sesamoid away from the flexor hallucis longus tendon, beginning at one edge of the sesamoid. The bone is carefully elevated off the tendon while dissection proceeds around the perimeter. Once the sesamoid has been freed and excised, the tendon is examined for injury. The excised sesamoid can then be cleared of soft tissue and cartilage and morselized for bone graft. Conclusion: The dorsal approach is effective for sesamoidectomy and efficient when performed as an adjunct to first metatarsophalangeal joint fusion.
The Relationship Between Vertical Loadrates and Tibial Acceleration Across Footstrike Patterns
Authors: Davis Irene , Hayano Todd , Tenforde Adam 
Published: September 2018

Category: Other Introduction/Purpose: While the etiology of injuries is multifactorial, impact loading, as measured by the loadrate of the vertical ground reaction force has been implicated. These loadrates are typically measured with a force plate. However, this limits the measure of impacts to laboratory environments. Tibial acceleration, another measure of running impacts, is considered a surrogate for loadrate. It can be measured using new wearable technology that can be used in a runner’s natural environment. However, the correlation between tibial acceleration measured from mobile devices and vertical ground reaction force loadrates, measured from forceplates, is unknown. The purpose of this study was to determine the correlation between vertical and resultant loadrates to vertical and resultant tibial acceleration across different footstrike patterns (FSP) in runners. Methods: The study involved a sample of convenience made up of 169 runners (74 F, 95 M; age: 38.66±13.08 yrs) presenting at a running injury clinic. This included 25 habitual forefoot strike (FFS), 17 midfoot strike (MFS) and 127 rearfoot strike (RFS) runners. Participants ran on an instrumented treadmill (average speed 2.52±0.25 m/s), with a tri-axial accelerometer attached at the left distal medial tibia. Only subjects running with pain <3/10 on a VAS scale during the treadmill run were included to reduce the confounding effect of pain. Vertical average, vertical instantaneous and resultant instantaneous loadrates (VALR, VILR and RILR) and peak vertical and resultant tibial accelerations (VTA, RTA) were averaged for 8 consecutive left steps. Correlation coefficients (r) were calculated between tibial accelerations and loadrates. Results: All tibial accelerations were significantly correlated across all loadrates, with the exception of RTA with VILR for FFS (Table 1) which was nearly significant (p=0.068). Correlations ranged from 0.37-0.82. VTA was strongly correlated with all loadrates (r = 0.66). RTA was also strongly correlated with both loadrates for RFS and MFS, but only moderately correlated with loadrates for FFS (r = 0.47). Correlations were similar across the different loadrates (VALR, VILR, RILR). Conclusion: The stronger correlation between vertical tibial acceleration and all loadrates (VALR, VILR, RILR) suggests that it may be the best surrogate for loadrates when studying impact loading in runners.
Percutaneous Tendon Achilles Lengthening
Authors: de Cesar Netto Cesar , Phillips Sierra , Dos Santos Alexandre Godoy , Pinto Martim , Staggers Jackson , Smith Walter , Araoye Ibukunoluwa , Hudson Parke , Sahranavard Bahman , Naranje Sameer , Shah Ashish 
Published: September 2018

Category: Hindfoot Introduction/Purpose: Percutaneous Achilles tendon lengthening (TAL) is a common procedure used to address equinus contracture of the foot. A triple hemisection technique has become popular due to its ease and efficiency. Several studies evaluate the surgical outcomes of this procedure, but currently, descriptive anatomical studies are lacking. The objective of the study was to evaluate the accuracy of performing Achilles tendon percutaneous hemisections, the amount of tendon excursion in the tensile gaps of the cuts after forced dorsiflexion and the improvement in the range of motion for dorsiflexion of the ankle joint. Methods: Ten fresh-frozen above-knee cadaveric specimens were used. A percutaneous triple hemisection of theAchilles tendon (proximal, intermediate, and distal) was performed. Maximum ankle dorsiflexion was evaluated pre- and postprocedure with a digital goniometer. After proper dissection, the relative width of the cuts was noted. Followingforced ankle dorsiflexion, displacement in the tensile gaps was measured in all 3 cuts with a precision digital caliper. Results: The overall relative width of the percutaneous cut was 51.3% ± 16.3% of the Achilles tendon diameter, 44.3%± 13.6% for the proximal cut, 50.3% ± 15.6% for the intermediate cut, and 59.3% ± 18.4% for the distal cut. Tendonexcursion averaged 13.0 ± 3.8 mm for the proximal cuts, 12.5 ± 4.7 mm for the intermediate cuts, and 8.2 ± 3.7 mm forthe distal cuts. One cadaver had a complete rupture of the Achilles tendon and was excluded from the excursion dataanalysis. The mean range of motion for ankle dorsiflexion was 8.1 ± 3.9 degrees preprocedure and 27.6 ± 5.3 degreespostprocedure. The dorsiflexion angle significantly increased (P < .0001) at an average of 19.5 ± 5.0 degrees following TAL. Conclusion: Our cadaveric study demonstrated that the percutaneous triple hemisection of the Achilles was an accuratetechnique that provided successful lengthening of the tendon and increased ankle dorsiflexion. Complete ruptures arepossible complications. Our cadaveric study showed that in a clinical situation, triple hemisections of the Achilles tendon can be performed reliably, with significant improvement of the ankle dorsiflexion, mainly through increased tendon excursion at the proximal and intermediate cuts, and with low risk of complete ruptures.
A Comparison of Kinesiology and Athletic Taping on Ankle Range of Motion
Authors: Folmar Eric , Thomas Adam 
Published: September 2018

Category: Other Introduction/Purpose: A high prevalence of ankle sprains exists in athletic and non-athletic populations. White athletic tape (WAT), commonly used for prevention and treatment, provides ankle stability while limiting mobility. Athletic taping has demonstrated the ability to limit ROM in all directions, particularly ankle inversion, as inversion injuries represent a vast majority of ankle sprains. Use of kinesiology taping (KT) for the purpose of limiting mobility in the ankle has not been examined. While limiting inversion range of motion may be beneficial in prophylactic management of ankle injuries, limiting ROM in other directions may impact kinematics of other joints in the kinetic chain. To determine the effectiveness of an innovative KT technique for limiting ankle inversion ROM while allowing movement in the other movements of the ankle. Methods: Fifty-three healthy 18-25 year old college students were recruited for this study. Subjects received each of the taping conditions (traditional basket weave WAT, a novel KT method, and no tape) in a randomized order. Manual goniometer measurements were taken in non-weight bearing in the inversion, eversion, dorsiflexion and plantarflexion directions. A handheld inclinometer was used to measure weight bearing ankle dorsiflexion. Measures for each were compared across each taping condition. A repeated measures ANOVA was performed. Results: Significant decreases in ankle ROM (p <.01) were observed in all measures between WAT and no tape. KT demonstrated significant decreases in all ROM compared to no tape (p <.01), except for a minimal decrease in weight bearing ankle dorsiflexion (p>.05). WAT demonstrated significantly greater ROM restriction in all directions than did KT (p<.01), including weight-bearing ankle DF. Conclusion: These results suggest that KT allows for more ankle ROM than traditional WAT in non-weight bearing and weight bearing measures, while still providing significant motion limitation in all motions except weight bearing dorsiflexion (in comparison to no tape). Limiting excessive inversion while simultaneously allowing closer to normal ROM in all other planes may decrease the risk of negatively impacting kinetic chain kinematics associated limited mobility of the ankle.
Performance Function Tests in Healthy Athletes
Authors: Greisberg Justin , Vosseller J. Turner , Gould Peter , Ahmad Christopher 
Published: September 2018

Category: Sports Introduction/Purpose: A challenge for physicians is determining when an injured athlete is ready to return to competition. While a wide variety of ankle strength and fitness tests have been described, there are no norms or minimum performance thresholds for any of them. In this study, healthy athletes were given a series of functional tests to complete. We propose that there will be a minimum performance level for each of the tests that all athletes can complete. We also propose, for tests which assess the right and left legs independently, that performance of the right leg will consistently be within 10% of the left. Finally, we propose that performance on one of the functional tests will be predictive of function on all of the tests. Methods: Healthy college athletes were put through a testing protocol, beginning with simple range of motion assessment and progressing through a series of functional ankle tests of increasing difficulty. The athlete began with the dorsiflexion lunge test, and then progressed to single leg heel raising, single leg hopping, side hopping, front-back hopping, functional hop test, and finally 180 degree rotational jump. Right and left legs were recorded separately for the first five tests. For each test, means, ranges, and standard deviations were calculated. Results: Eighty-one athletes (male and female from different sports) completed the protocol; no athlete was unable to finish the testing sequence. There was a wide variation in performance ability between athletes; the standard deviation for any of the individual tests was too high to determine a minimum threshold of normal performance. However, when comparing right to left leg in any one athlete, the difference in performance testing was always less than 10%. Furthermore, performance on any of the hopping tests was predictive of performance on all of them. Conclusion: Ideally, an athlete could be deemed ready to return to sports activity if he or she performed above a certain threshold on a performance test. Unfortunately, athletes had such a wide range of performance that it is not possible to define a minimum threshold for any of these tests. However, right and left leg performance was always within 10% of each other. For an athlete with a single leg injury, we propose that performance on a functional hopping test less than 10% different from the uninjured leg should be the standard.
A 27-year Meta-analysis of Ankle Arthroplasty
Authors: Gross Christopher , Haddad Steven , Morris Jesse , Durante Elizabeth , Kirn Philip 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty is an alternative to ankle arthrodesis for the treatment of end-stage arthritis while maintaining greater ankle motion and functionality. Early generation implants had unacceptably high complication rates. However, increasing surgical experience and newer third-generation designs have the potential to offer better outcomes. A previous systematic review reported results from studies published between 1990 and 2005, focusing on second-generation implants. We performed a systematic review of the literature addressing the intermediate-long-term outcomes of interest in total ankle arthroplasty studies published since 2006, and we compared our findings to those from earlier generation implants. Methods: A comprehensive search of MEDLINE for all articles published from 3/25/2006 to 2/1/2017 was conducted with a minimum two-year follow-up. Two reviewers evaluated each study to determine whether it was eligible for inclusion and abstracted the data of interest. Meta-analytic pooling of group results across studies was performed. The analysis focused on third-generation ankle implants. Results: The previous systematic review identified 10 studies (n=852), whereas we identified 40 studies (n=4835). The prior study showed a five and ten-year survival rate of 78% and 77%, respectively; respective rates were 86% (p=0.001) and 76% (p=0.53) in ours and similar to the previous study. The revision rate following TAR was 7% in the earlier review (loosening/subsidence, 28%). In ours, the revision rate following TAR was 9.6% (p=0.10) (component loosening, 37%); 3.4% (p=0.02) of ankles were converted to arthrodesis. The mean post-operative Ankle-Hindfoot score was 78.2 points in the prior review and 80.1 (p=0.20) points for ours. There is significant (p<0.0001) heterogeneity (I2=92.94%) between the studies; a meta-analysis of proportions showed that 81.6%of subjects had good outcomes while 46.6% had an excellent outcome. Conclusion: Based on these findings, the outcomes for third-generation total ankle arthroplasty have no significant differences in survival rates when compared to second-generation implants. However, functional scores, range of motion, and overall patient outcomes were significantly higher in the third-generation implants. However, data from early generation studies were sparse in comparison, so direct comparative studies are needed to strengthen this conclusion.
Deformity and Clinical Outcomes for Surgical Correction of Charcot Ankle
Authors: Harkin Elizabeth , Schneider Andrew , Murphy Michael , Schiff Adam , Pinzur Michael 
Published: September 2018

Category: Diabetes Introduction/Purpose: Charcot Foot is a complex neuro-arthropathy associated with acquired progressive deformity and a significant impact to patients’ quality of life. Recent reports have suggested that preoperative deformity is predictive of clinical outcomes following surgical correction of the acquired deformity associated with midtarsal diabetes-related Charcot Foot arthropathy. Methods: A retrospective analysis was performed of 56 patients who underwent surgical reconstruction of Charcot ankle arthropathy by a single surgeon over a 14-year time period. Preoperative tibiotalar alignment was reviewed in the coronal and sagittal plane. Preoperative patient characteristics including age, sex, hemoglobin A1c, BMI, insulin use, and presence of a wound or infection at the time of surgery were also recorded. Preoperative coronal plane deformity was observed as valgus 16/56 (28.6%), varus 31/56 (55.4%), and neutral 9/56 (16.1%). Surgery included debridement of active infection when present, corrective osteotomies, and an attempt at ankle arthrodesis with application of a ringed external fixator (39 of 56, 69.6%) when infection was present or retrograde intramedullary nail (17 of 56, 30.3%). Clinical outcomes of excellent, good, or poor were based on limb salvage, resolution of infection and chronic wounds, and the ability to ambulate with either a CROW, AFO, or therapeutic diabetic footwear. Results: The average total patient follow-up time from index surgery was 115.4 weeks. One patient died after 134.3 weeks of follow-up and 8 underwent amputation. The post-operative complication rate was 69.6% (39 of 56), 79.5% (31 of 39) of which underwent re-operation. Ultimately, only 25 of 55 patients (45.5%) achieved a favorable (excellent or good) clinical outcome. There was no meaningful association between surgical outcome, post-operative complication, reoperation, and amputation and patients’ pre-operative alignment, final alignment, treatment with either ex-fix or IMN, the presence of a wound or infection, age, HgA1c, or BMI. However, compared to insulin dependent diabetics, those not taking insulin were only 0.34 times as likely to have a poor outcome. Conclusion: Operative fixation of Charcot ankle arthropathy was performed with a goal of achieving a plantigrade post for ambulation void of infection or chronic wounds and easily accommodated with a supportive orthosis. This retrospective case series demonstrates a high complication rate in this complex patient population. Clinical outcomes of Charcot ankle can be used to counsel patients on the risks of surgical correction and as a benchmark for improved treatment strategies.