bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Lower Back Pain on Functional Outcomes for Ankle Arthritis Treated with Arthroplasty and Arthrodesis
Authors: Symes Michael , Younger Alastair , Penner Murray , Veljkovic Andrea , Wing Kevin 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: Numerous studies have demonstrated that concomitant lower back pain (LBP) results in worse functional outcomes in patients undergoing surgical treatment for the management of end stage hip and knee arthritis. However, no equivalent studies have analysed the impact of back pain on the outcomes of patients with end stage ankle arthritis. Furthermore, given that two widely accepted surgical options exist in the treatment of ankle arthritis, namely total ankle arthroplasty (TAA) and ankle arthrodesis (AA), it is possible that one surgical technique may be superior in patients with LBP. The aim of this study was to determine the incidence of LBP in people with ankle arthritis, analyse its effect on functional outcomes, and explore whether there was a treatment advantage from either TAA or AA. Methods: Prospectively collected data from the Canadian Orthopaedic Foot and Ankle Society (COFAS) database of ankle arthritis was analysed in this study. All patients with ankle arthritis who underwent surgery performed by three fellowship-trained foot and ankle surgeons at a single institution between January 2003 and July 2012 were studied. Patient demographics were collected pre-operatively, including the absence or presence of back pain, and post-operative follow up was performed at 2 and 5 years, evaluating patient-reported functional outcome measures including the Ankle Arthritis Score (AAS) and the 36-item short form survey (SF-36). Using a linear regression model, a multivariate analysis was performed to examine the relationship between back pain, TAAs and AAs. Results: In total, 451 patients were studied. 164 patients (36.4%) presented with concomitant LBP. At presentation, the LBP group had worse AAS scores (54.8 vs 57.8 p < 0.04), SF-36 PCS (32.5 vs 28.9 p <0.01), and SF-36 MSC (51.8 vs 47.8 p < 0.01). At 2 years postoperatively, the AAS score was the same in both groups (28.9 vs 26.8 p = 0.3), but patients with LBP had worse SF-36 PCS (42.1 vs 36.6 p <0.02) and SF-36 MSC (54.1 vs 51.1 p < 0.001). These results where repeated at the 5 year mark. There was no difference between TAA or AA (p > 0.05) in any of the functional outcome scores at 2 or 5 years post-operatively. Conclusion: The results of this study suggest there is no advantage of TAA over AA in the treatment of ankle arthritis in patients with concomitant lower back pain. Although pre-operative back pain resulted in worse SF-36 outcomes at 2 and 5 years post-operatively, this was not the case for AAS scores.
The Other Adjacent Joint
Authors: Symes Michael , Veljkovic Andrea , Penner Murray , Younger Alastair , Younger Alastair , Wing Kevin 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: Accepted surgical treatment options for end-stage ankle arthritis include total ankle arthroplasty (TAA) and ankle arthrodesis (AA). Although they have comparable clinical outcomes, TAA is growing in popularity and one reason for this is that TAA, compared to AA, better preserves range of motion and function at the ankle, and results in a gait pattern that more closely replicates normal controls. This has the theoretical benefit of protecting adjacent articulations and thereby limiting degenerative changes from occurring in other joints. Although multiple studies have analysed the impact of both TAA and AA on adjacent joint disease in the foot, little data exists on their impact on the knee. This study explored the relationships between knee pain, TAA and AA in patients with end-stage ankle arthritis. Methods: Prospectively collected data was used from the Canadian Orthopaedic Foot and Ankle Society (COFAS) database of ankle arthritis at a single institution by three fellowship-trained foot and ankle surgeons between January 2003 and July 2012. In total, 342 patients were studied, with patient demographics collected pre-operatively, and post-operative follow up performed at the 5 year mark. All patients were examined for the development or resolution of knee pain, as well as patient-reported outcome measures including the Ankle Osteoarthritis Scale (AOS). Using a linear regression model, a multivariate analysis was performed to examine the relationship between knee pain, TAAs and AAs. Results: In the 233 patients that presented without knee pain pre-operatively, 22% who underwent TAA developed knee pain at 5 years, compared to 16% of AA patients (p>0.05). In this group, patients who underwent TAA had statistically significant better outcomes in terms of AOS Pain (p<0.02), AOS Difficulty (p<0.05) and AOS Total Scores (p<0.02). In the 109 patients who presented with knee pain, knee pain resolved in 47% of TAA patients vs 38% of AA patients at 5 years (p<0.05). There was no statistically significant difference in AOS outcomes (p>0.05) between patients who underwent TAA and AA. Compared with patients who did not have knee pain pre-operatively, the presence of pre-operative knee pain resulted in worse AOS (p<0.02), with no difference between TAA and AA. Conclusion: In those patients presenting without knee pain, TAA did result in more superior functional outcomes, with no significant difference in development of knee pain compared to AA. In patients with pre-operative knee pain, TAA had benefits of improved resolution of knee pain, with no difference in functional outcomes when compared with AA. Regardless of surgical technique, the presence of pre-operative knee pain was an independent adverse predictor of outcome in patients with tibiotalar arthritis.
3D-printed Talar Components for the Reconstruction of Large Osteochondral Lesions of the Talus
Authors: Wang Bibo 
Published: September 2018

Category: Ankle Introduction/Purpose: The reconstruction of large osteochondral lesions of the talus (OLTs) presents a clinical challenge. In this study, a biomechanical experiment was performed using 3D-printed talar components for the reconstruction of large talar lesions, and intra-articular stress tests were conducted before and after implantation. Methods: Eight cadaveric ankle specimens were used in this study. After the specimen was fixed on an Instron mechanical testing machine, a piece of Fuji pressure-sensitive film was inserted into the articular cavity. A vertical pressure of 1500-N was applied to the ankle when it was in different positions, i.e. neutral, 10 degrees of dorsiflexion, and 14 degrees of plantar flexion. The total pressure-bearing area and the pressure intensity (MPa) on the talus were calculated to determine their changes before and after implantation. Results: The pressure-bearing area of the talus varied with the ankle position in the following order: 10 degrees of dorsiflexion > neutral position > 14 degrees of plantar flexion (P<0.05). The pressure intensity exerted on the talus varied in ascending order: 10 degrees of dorsiflexion < neutral position < 14 degrees of plantar flexion (P<0.05). However, the intensity of the pressure on the graft was insignificantly different from the overall pressure intensity on the talus (P>0.05). Conclusion: Treatment using a 3D-printed talar component can achieve precise reconstruction of a large OLT after the surgical removal of the talar lesion. The pressure intensity on the repaired site did not change before and after the operation, indicating the clinical feasibility of this approach.
Primary Arthrodesis Compared with Open Reduction and Internal Fixation for Lisfranc Injuries with the First Tarsometatarsal Joint Dislocation
Authors: Zhang Ming-Zhu , Yu Guang-rong , Myerson Mark 
Published: September 2018

Category: Trauma Introduction/Purpose: The first tarsometatarsal (TMT) joint is very crucial for midfoot stability. To address its importance, retrospective analyses of treatment for the first TMT joint dislocation with Lisfranc injury was performed in a multi-center manner. Comparison of open reduction internal fixation (ORIF) and primary arthrodesis was conducted for the injury. Methods: This multi-center study was involved ten clinical institutions in different area of China. .From January 2003 to June 2015, 126 Lisfranc injuries with first TMT joint dislocation underwent surgical intervention. Of this group, forty one (32.5%) feet were first TMT joint dislocation only. Eighty five feet were first TMT joint dislocation and fractures. They were 76 males (60.3%) and 50 females (39.7%) with a mean age of 45.5 (range, 20-87) years. The duration from injury to surgery is 11.7 (range, 4-26) days. Two groups were divided by surgery methods as open reduction internal fixation (ORIF) group and primary arthrodesis group. Ninety two patients were performed by ORIF, while primary arthrodesis group including 34 cases. Outcome measures included clinical examination, radiographs, AOFAS ankle-hindfoot scores, visual analogue scale (VAS) and SF-36 scores. Complications and revision rate were analyzed as well. Results: 126 patients were followed up for 29.5 months. At 1.5 years postoperatively, the AOFAS score was 79 and 85 in ORIF group and arthrodesis group.The VAS score was 3.1 separately in two groups.The mean Physical Functioning sores of SF-36 was 80.3 points and 83.5• points. The Bodily Pain score of SF-36 was 76.1 points and 84.6• points.Redislocation of first tarsometarsal joint were observed in 16 cases among ORIF group.36 patients in ORIF group had pain in midfoot, eight of them had persistent pain with the development of deformity or osteoarthrosis.No redislocation and no hardware failure was identified in arthrodesis group Conclusion: Primary stable arthrodesis of the first ray gives a better short and medium term outcome than open reduction and internal fixation for Lisfranc injury with the first ray dislocation. Possible complication and revision could be avoided by primary arthrodesis for dislocated first ray injuries.
Peroneal tendon dislocation in Talus fracture and diagnostic value of fleck sign
Authors: Attia Ahmed , Khamis Karim Mahmoud , Taha Tarek , Aldahamsheh Osama , Mekhaimar Mohamed Maged 
Published: September 2018

Category: Trauma Introduction/Purpose: INTRODUCTION: Talus fractures are not uncommon and one of the serious fractures in foot and ankle. Peroneal tendon dislocation is one of the commonly missed soft tissue injuries which may have significant impact on the outcomes including persistent pain and swelling. AIM: To report the incidence of peroneal tendon dislocation in talus fracture and the significance of fleck sign in the diagnosis of peroneal tendon dislocation. Methods: We retrospectively reviewed 100 consecutive talus fractures in the period between 1/1/2011 to 1/7/2017. Inclusion criteria were: The patient underwent open reduction and internal fixation, had pre-operative CT scan that is available for review and 3 views ankle plain radiographs. 2 independent authors review the radiographs for peroneal tendon dislocation, fleck sign and fracture classification if any. Any dispute was resolved by the senior author. Patient records were reviewed for laterality, age, sex, mode of injury, associated injuries and operative interventions. 43 ankles met inclusion criteria. 42 were males, mean age was 31 year and the predominant modes of injury were fall from height or unknown. Results: Peroneal tendon dislocation was found in 9 patients out of 43. (20%). All dislocations were found in talar neck fractures, and up to 67% of Hawkins type III and IV Talar neck fractures were associated with peroneal tendon dislocation. Risk of dislocation increased with severity of the fracture. 5 cases of peroneal tendon dislocation out of 9 were associated with lateral or bimalleolar fractures. Most of the dislocations were missed and no additional procedures were done to address such injury. Fleck sign sensitivity was 44.4% while specificity was 88%. The Negative Predictive Value (PPV) was 86%. Conclusion: Peroneal tendons dislocation is associated with 20% of talus fractures. The incidence of dislocation increases with neck fracture and severity of these fractures. Fleck sign is highly specific radiographic sign and hence we recommend intra-operative assessment of peroneal tendons in patients with fleck sign.
Prevalence of Hallux Rigidus in Patients with Ankle Arthritis
Authors: Bejarano-Pineda Lorena , Easley Mark , Adams Samuel , Nunley James 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus (HR) is a degenerative disease of the first metatarsalphalangeal (MTP) joint, and the most common type of foot arthritis. It affects 2.5% of population aged over 50 years. During the gait cycle, the MTP joint normally carries a force of about 119% body weight. We hypothesize that the altered gait mechanics in patients with end stage ankle arthritis would increase the stress on the MTP joint resulting in hallux rigidus. The purpose of the study was to evaluate the prevalence of radiographic hallux rigidus in a population with ankle arthritis, its association with factors such as gender, age, and severity of the disease compared to the normal population. Methods: Patients from a prospectively-collected total ankle database were screened for the inclusion in the present study. All patients with ankle arthritis who underwent a primary total ankle arthroplasty (TAA) between November 2006 and November 2017 with anteroposterior and lateral views on foot x-rays within 3 months pre or postoperative were included. Foot x-rays were reviewed to assess the prevalence of radiographic hallux rigidus and to grade the severity of diagnosis according to Couglin and Shurnas Radiographic Classification. The association among the grades of severity, demographics, and bilateral involvement were evaluated. Results: A group of 870 patients out of 1044 patients who underwent TAA were included in the study. The mean age was 63 years (standard deviation 10.3). The prevalence of HR in the total group was 72.9% with a slightly higher proportion in males compared to females (51.7% versus 48.3%). The distribution among the grades of severity was grade 1, 58%; grade 2, 24%; and grade 3, 18%. Although, we did not find an association between prevalence and gender (P=0.2) or severity (P=0.37); HR grade 2 and grade 3 were higher in females. Bilateral involvement was found in 16.4% of patients with HR. Conclusion: The prevalence of radiographic hallux rigidus in a population with altered gait mechanics was significantly higher compared to that reported in the literature in the normal population. However, no association among demographic factors such as age or gender was found. Women tended to present a more severe diagnosis compared to men but the difference was no statistically significant.
Transverse versus longitudinal incision for minimally invasive Achilles tendon repair
Authors: Bohl Daniel , Barnard Eric , Movassaghi Kamran , Hamid Kamran , Schiff Adam 
Published: September 2018

Category: Sports Introduction/Purpose: The rate of wound complications following traditional open Achilles tendon repair is reported at 7-8%. In an effort to reduce the rate of wound complications, orthopaedic surgeons have adopted novel minimally invasive techniques. The purpose of this study is to characterize the rate of wound and other early complications following a minimally invasive Achilles tendon repair, to identify any factors associated with increased risk. Methods: The postoperative courses of 55 patients who underwent minimally invasive Achilles tendon repair by two surgeons at separate academic medical centers were retrospectively reviewed. Repair technique was similar in all cases, making use of the same commercially available suture-guidance jig, silicone-impregnated deep suture material, and locking stitch technique. However, 31 procedures used a longitudinal incision and a tourniquet (one surgeon’s preference), while 24 procedures used a transverse incision and no tourniquet (the second surgeon’s preference). Of the 24 procedures using transverse incisions, 2 had to be converted to L-shaped incisions to achieve better access to the tendon. The rates of early complications within 3 months after surgery were characterized and compared between patients with differing procedural characteristics. Results: Of the 55 patients included in the study, 2 (3.6%) developed wound complications. Both wound complications appeared to be reactions to the deep suture material (see Table 1 for details). There was no statistical difference in the rate of wound complications between patients in the longitudinal incision/tourniquet group and patients in the transverse incision/no tourniquet group (6.5% versus 0.0%; p=0.499). Three patients (5.5%) developed sural neuropraxia, which manifested as mild-to-moderate subjective numbness with sensation remaining intact to light touch. There were no cases of re-rupture. At 3-month follow-up, all 55 patients had intact Thompson tests and well-healed wounds. Conclusion: The rate of wound complications following minimally invasive Achilles repair is low at 3.6%. The present study could not demonstrate a difference in risk for wound complications between patients treated with a longitudinal incision and tourniquet and patients treated with a transverse incision and no tourniquet. The wound complications we observed were primarily attributable to inflammatory reactions to the silicone-impregnated deep suture material. Patients should be counseled that although risk for wound complications may be lower with minimally invasive techniques, such techniques do risk sural neuropraxia and deep suture reaction. Further prospective analysis is warranted.
Syndesmotic Anatomy as a Risk Factor for Syndesmotic Injury and Syndesmotic Malreduction
Authors: Boszczyk Andrzej , Rammelt Stefan 
Published: September 2018

Category: Trauma Introduction/Purpose: The anatomy of the syndesmosis is variable, yet little is known on the correlation between morphology and the risk of syndesmotic disruption and malreduction with operative fixation. The study aims at (1) comparing the bony anatomy of the syndesmosis in patients who sustained a high fibular fracture with syndesmosis disruption and that of the non-injured population and (2) at identification of certain anatomical features correlating with syndesmotic malreduction. Methods: For the first research question, the CT examinations of 75 patients who sustained a high fibular fracture with syndesmosis disruption and a control group of 75 patients with unrelated foot problems and without ankle pathology were compared. For the second research question, the bilateral postreduction ankle CTs of 72 patients were analyzed. Incisura depth, fibular engagement into the incisura and incisura rotation (Figure) of the injured patients were compared with those of uninjured controls and correlated with degree of syndesmotic malreduction in the coronal plane, sagittal plane, and rotational malreduction. Results: With the median values of the control group as cutoff there were 71% shallow, 71% disengaged and 77% retroverted syndesmoses in the injury group. The differences between the groups were statistically significant for every measure (P< .002 to P> .0001). Clinically relevant syndesmosis malreduction in coronal plane, sagittal plane and rotation affected 8.3; 27.8; and 19.4% of, patients, respectively. The syndesmoses with a deep incisura and the fibula not engaged into the tibial incisura were at risk of overcompression (P< .05). Syndesmosis with an anteverted incisura were at risk of anterior fibular translation and those with a retroverted incisura were at risk of posterior fibular translation (P< .05). Conclusion: Patients with a shallow, disengaged and retroverted bony configuration of the tibial incisura at the syndesmosis are overrepresented among patients with syndesmotic disruption. Intraoperative overcompression of the syndesmosis is significantly more common in patients with a deep and less engaged incisura. Anteversion of the incisura correlates with anterior displacement of the fibula while retroversion of the incisura is correlated with posterior fibular displacement. Knowledge of the individual incisura morphology could be helpful when planning and performing reduction of an unstable syndesmosis.
Treatment of osteochondral lesions in the ankle with a particulated juvenile cartilage allograft
Authors: Boukhemis Karim , Kreulen Christopher , Coetzee J. Chris , Neufeld Steven , Berlet Gregory , Dowd Thomas , Ryan Paul , Robbins Justin , Giza Eric 
Published: September 2018

Category: Ankle Introduction/Purpose: Numerous treatment modalities are in use today to treat symptomatic osteochondral lesions in the ankle; however, there are ongoing challenges with the treatment of certain types of lesions and concern regarding the long-term effectiveness of current common techniques. Methods: The purpose of this study was to collect mid and long-term clinical outcomes of pain, function, and activity level (VAS, SF-12, FAAM ADL, FAAM sports) Single-arm, multi-center study collected outcomes prospectively in standard clinic patients who would be undergoing or who had previously undergone treatment with DeNovo NT. The main exclusion criteria were high surgical risk, clinically diagnosed autoimmune diseases, or an active joint infection; all other patients receiving DeNovo NT could be approached for the study. The outcome analysis for this abstract focused on enrolled subjects’ final follow-up to date. Results: Clinical outcomes have been prospectively collected for 24 subjects with a total of 48 months follow-up. Twenty four of the treated lesions were located on the talus, none on the tibia. Out of the 24 patients, 23 had a single lesion and 1 had more than one. The average lesion size was 108.1 mm +/- 60.0 [23]. The Hepple classification was used to categorize each lesion. Interestingly, 19/24 were classified as 3 or higher. Cartilage ICRS was also used for classification. Out of the subjects, 23/24 were ICRS grade 3 or 4. There was also a concomitant procedure for 22/24 patients. Pre and post op VAS scores of 47.5 (+/- 23.1) and 12.2 +/- 17.8. SF-12 scores pre and post of 38.0 +/- 8.5 and 50.1 +/- 8.2. FAAM ADL’s pre and post 60.4 +/- 16.3 and 90.4 +/-11.8. FAAM sport scale scores pre and post 28.8 +/- 16.7 and 74.5 +/- 22.4. all outcome measures were statistically significant. Conclusion: Four year complete data is a challenge in this particular clinical population. This data set encompasses symptomatic osteochondral lesions of the talus treated with particulated juvenile cartilage allograft. The outcomes reflect an improvement in symptoms and patient satisfaction when treated with this technique. Based on these final outcome measures (V AS, SF-12, FAAM ADL’s, FAAM sport scale score) and satisfaction, it can be concluded that this is a viable option to get patients back to their pre-injury state.