bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient reported disability of ankle, hindfoot, midfoot and hallux metatarsophalangeal arthritis
Authors: Christian Matthew , Jeng Clifford , Cerrato Rebecca , Campbell John T. , Koenig Scott , O’Hara Nathan , Hull Michael 
Published: September 2017

Category: Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: There has been in increased interest in foot and ankle arthritis in the literature in recent years. A significant focus of the literature has been which operative techniques are best for managing these problems. Some work has been done analogizing disability due to ankle arthritis to more familiar joints such as the hip. There is little data explaining how much patient reported disability is associated with each type of isolated foot and ankle arthritis. Various clinical rating scales have proven how debilitating foot and ankle arthritides can be to patients. The purpose of our study was to use Functional Foot Index (FFI) and Short Form-12 (SF-12) rating scales to compare the patient reported disability associated with ankle, hindfoot, midfoot, and hallux metatarsalphalangeal (MTP) arthritides. Methods: We retrospectively reviewed the FFI and SF-12 (both Physical Component Scores (PCS) and Mental Component Scores (MCS)) of patients who presented to a high volume orthopaedic foot and ankle practice between 2010 and 2016 with either ankle, hindfoot, midfoot or hallux MTP arthritis. We included patients between 18-65 years of age who underwent a surgical procedure for arthritis within 6 months of their initial presentation. We excluded patients with any medical or surgical co-morbidities known to affect disability scores. A total of 214 FFI and 195 SF-12 data sets were included. Results: Study population SF-12 PCS scores for all patients with ankle or foot arthritis were significantly lower than US age-based norms. Patients with ankle arthritis had the highest disability (FFI score 46.5, SF-12 PCS 32.3). Patients with midfoot and hindfoot arthritis had intermediate disability (Midfoot FFI score 34.9, SF-12 PCS 34.5; Hindfoot FFI score 44.3, SF-12 PCS 34.5). Patients with hallux MTP arthritis had the lowest disability (FFI score 32.9, SF-12 PCS 40.7). All FFI and SF-12 PCS scores were statistically significant. SF 12 MCS were not statistically significant. Conclusion: All patients with foot and ankle arthritis had increased disability compared to US age-based norms. Patients with ankle arthritis experience the most self-reported disability and patients with hallux MTP arthritis experience the least self- reported disability of the isolated types of arthritis in orthopaedic foot and ankle.
Short-term outcome of Lisfranc injuries treated with single dorsal plate fixation
Authors: Chun Sangho , Lee Kyoung min , Park Moon Seok , Sung Ki Hyuk , Koo Seungbum , Kim Sung Jin , Choi Hyun , Sangyeop Shin , Lee Seung Yeol 
Published: September 2017

Category: Ankle, Trauma Introduction/Purpose: Several methods like cortical screw, Kirschner (K) wire have been used for stabilizing the Lisfranc joint. We performed this study to assess whether single dorsal plating can be used as an alternative treatment method for a Lisfranc injury. Methods: Patients were followed up for more than 1 year after the initial surgery.Following open reduction of the joint with a bone reduction clamp, a single dorsal plate was used to perform Lisfranc joint fixation. The plate was fixed with 2.7-mm locking screws on the first metatarsal, second metatarsal, medial cuneiform, and intermediate cuneiform. Three weeks postoperatively, the cast was removed, and patients progressively advanced to full weight bearing while wearing a postoperative shoe. The plate was removed 3 months postoperatively. One year postoperatively, weight-bearing foot radiographs and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale score were obtained. Results: Eighteen patients with a Lisfranc injury who were treated with open reduction and internal fixation using a single dorsal plate were included. The average AOFAS midfoot score for pain was 35, and the total score was 80.8 (range, 67–95). Six patients (33.3%) had an excellent outcome (score =90); eight (44.4%) had a good outcome (90 > score = 75); and four (22.2%) had a fair outcome (75 > score = 50). Radiographs during the follow-up period showed no loss of reduction or arthritic change. Screw breakage occurred in 3 cases. But the injury ultimately healed anatomically. Conclusion: Single dorsal plating can be an alternative treatment method for a Lisfranc injury, as it provides a good short-term outcome without causing further joint injury.
Tenogenic differentiation of tonsil-derived mesenchymal stem cells
Authors: Chun Sangho , Lee Kyoung min , Lee Seung Yeol 
Published: September 2017

Category: Basic Sciences/Biologics Introduction/Purpose: Human palatine tonsil-derived mesenchymal stem cells (T-MSCs) are known to be a new source of progenitor cells. Using waste tissue after tonsillectomy as a cell provider can be the biggest benefit of T-MSCs, compared with other stem cells. The purpose of this study was to investigate tenogenic differentiation of T-MSCs and to access the differential effects of TGF-ß3 on the tenogenesis of T-MSCs. Methods: Human tonsil was obtained after tonsillectomy.Using a cytometric analysis, we were able to find that the T-MSCs had typical mesenchymal stem cell markers: positive for CD73, CD90 and CD105, and negative for CD14, CD34 and CD45. Using a Transforming growth factor beta 3 (TGF-ß3), the expressions of tenocyte-specific genes and proteins, such as Collagen type I (COL1), Tenomodulin (TNMD), and Scleraxis (SCX), were measured by a quantitative polymerase chain reaction (PCR) assay, immunofluorescence staining, immunohistochemistry and Western blot analysis. Results: Quantitative PCR assay showed that TGF-ß3 significantly increased the expressions of tenocyte lineage marker genes, including Collagen type I (COL1), Tenomodulin (TNMD), and Scleraxis (SCX), at a 3-day treatment, compared with control. However, these increases were not found at long-term exposures (7 or 10 days), except that TNMD expression was maintained at 50 ng/ml at 7-day exposure to TGF-ß3 (Fig). Like genes, the protein expression levels of COL1, TNMD, and SCX were also induced in TGF-ß3-treated T-MSCsin 3-day treatments. Moreover, the protein levels were maintained for 10 days, as evidenced by immunofluorescence staining, immunohistochemistry and Western blot analyses. Conclusion: This study demonstrated that T-MSCs in tenogenic stimulation with TGF-ß3 have high tenogenic differentiation potential.
Outcomes following repeat ankle arthroscopy for osteochondral lesions of the talus (OLTs)
Authors: Cusworth Brian , Nixon Devon , Klein Sandra , Johnson Jeffrey , McCormick Jeremy J. 
Published: September 2017

Category: Ankle, Arthroscopy Introduction/Purpose: Management of symptomatic osteochondral lesions of the talus (OLTs) previously treated with arthroscopy remains controversial. Many advocate for open surgical intervention, particularly in patients with larger OLTs. Minimal data, however, exists on the role for repeat ankle arthroscopy. Here, we describe our experience with repeat arthroscopy for symptomatic OLTs, hypothesizing similar pain and satisfaction scores regardless of OLT size. Methods: Our surgical database was queried to identify patients who underwent repeat arthroscopy from February, 1997 – May, 2015. From that cohort, we identified a subset of patients with a diagnosis of symptomatic OLT who were treated with arthroscopic debridement and microfracture. We then performed a retrospective chart review. Phone surveys were conducted to assess clinical outcomes including pain and satisfaction scores as well as to record any subsequent surgery reported by the patient. Using previously defined criteria for size threshold, OLTs were categorized as either small (=150 mm2) or large (> 150 mm2) based on operative dimensions noted at the time of repeat surgery. Results: We identified 15 patients who underwent repeat arthroscopy for symptomatic OLTs. Patients reported reasonable satisfaction (average: 7.3, SD: 2.7) but moderate residual pain (average: 4.6, SD: 3.3) at midterm follow-up (average: 5.0 years, SD: 2.8). Further surgery after repeat arthroscopy was performed in 20% (3/15) of patients. Only 1 patient developed a postoperative complication (superficial DVT treated with observation). Small (n=6) and large OLTs (n=9) had similar postoperative pain scores (4.2 ± 3.7 versus 4.9 ± 3.2), postoperative satisfaction levels (7.5 ± 3.4 versus 7.2 ± 2.3), and reoperation rates (33% versus 22%) (P>.05). Patients with larger OLTs were younger at the time of repeat arthroscopy (P=.026) with no differences in sex or BMI (P>.05) between groups. Conclusion: At midterm follow-up, repeat arthroscopy for symptomatic OLTs demonstrated reasonable satisfaction but with moderate residual pain and a 20% rate of subsequent surgery. There was no statistically significant difference in postoperative pain scores, satisfaction scores, or reoperation rates between small and large OLTs. Repeat arthroscopy for symptomatic OLTs can be done safely – however, patients should be educated to have guarded optimism regarding their outcome.
Retrospective Analysis of the Non-Union Rate Associated with the Peri-operative use of Toradol in Osseous Foot and Ankle Surgery
Authors: DiDomenico Lawrence , Butto Danielle , Flynn Zachary 
Published: September 2017

Category: Ankle, Hindfoot, Midfoot/Forefoot Introduction/Purpose: To evaluate the risk for non-union in patients who received Toradol in the perioperative period following osseous foot & ankle surgery.We propose there is ni significant difference in non-union rate between patients who received Toradol in the perioperative period following osseous surgery, compared to those the literature reports of using NSAIDs in the post operative period. Methods: Study Design: Random, Retrospective Chart Review of a single surgeon. 186 met the inclusion criteria with 172 complete charts available for review Procedure: Osseous foot and ankle surgery including osteotomies, fusions, and fracture repair. (1st MPJ fusions, Lapidus, Ankle, TTC) Inclusion Criteria: Undergo osseous surgery including osteotomies, fusions, or fracture repair Received Toradol in the perioperative period Complete chart with radiographs Outcomes: Radiographic and chart analysis for non-union between the initial post-operative visit and the final visit Results: A total of 186 patients were identified in having undergone a boney procedure and having received Toradol in the post - operative period. Out of the 186 patients, 172 charts were available for review. 165 of the 172 patients underwent unremarkable post operative healing. Seven patients (4.1%) were identified to have a clinical, radiographic or advanced imaging confirmed non- union. This was found to be not statistically significant with a p-value of < 0.005 Conclusion: Since the mainstream data available has been unable to draw a clear conclusion regarding NSAID use in bone surgery cases, our study aimed to present a large patient group that had no ill effects from its usage post operatively in osseous foot & ankle surgery. As the data demonstrates, there was no correlation that post operative use of potent NSAIDs increased the risk of non-union in the patient group.
Use of ankle resting angle as a surrogate for tendon elongation in individuals following Achilles tendon rupture
Authors: Gotha Heather , Zellers Jennifer , Silbernagel Karin 
Published: September 2017

Category: Ankle, Sports Introduction/Purpose: Tendon elongation is associated with poor functional outcome in individuals after Achilles tendon rupture. While imaging modalities are reliable to measure Achilles tendon length, alternative time- and cost-effective measures are of interest. The resting angle of the ankle in prone both with knee extended1 and knee flexed2 have been used in the literature as surrogates for measuring Achilles elongation, however, their relationship to tendon length is not well-established. The purpose of this study is to validate the ankle resting angle as a measure of tendon elongation and examine the relationship of ankle resting angle to tendon elongation and calf strength. Methods: Individuals following unilateral Achilles tendon rupture, treated surgically, were included in this cross-sectional study. Individuals were excluded if they had deep wound infection or lumbar radiculopathy affecting the ankle plantar flexors. Ankle resting angle with knee extended and knee flexed to 90 degrees was measured using a digital inclinometer positioned on the lateral, plantar surface of the foot. Relative resting angle was calculated by subtracting the uninjured from the injured side. Tendon length to gastrocnemius was measured using B mode, extended field of view ultrasound imaging3 (tendon elongation = ruptured- uninjured). Calf strength was measured using the heel-rise test4. Limb symmetry indexes (LSI) were calculated (ruptured/uninjured sidex100) for total work performed on the heel-rise test. Results: Twenty-five individuals, a mean(SD) age of 44.2(13.6) years and mean(SD) of 22.5(39.1) months post-rupture, were included in this study. Mean(SD) relative resting angle with knee flexed was -5.4(6.4)° and mean (SD) relative resting angle with knee extended was -6.7(8.8)°. Mean(SD) tendon elongation was 1.56(1.20)cm. Mean(SD) heel-rise test work LSI was 45.8(23.8)%. Ankle resting angle with knee flexed related to elongation (r = -0.452, p = 0.027) and heel-rise test work LSI (r = 0.591, p=0.006). Ankle resting angle with knee extended related to elongation (r=-0.528, p=0.008) (Figure 1) but not heel-rise test work LSI. Conclusion: The results of this study suggest that ankle resting angle with knee extended and flexed are related to tendon elongation, however, calf strength also has a relationship to resting angle with knee flexed. This suggests that the ability of the calf to put passive tension on the foot is also a component of resting angle. The relationship between tendon elongation and resting angle with knee flexed may have been limited by methodological concerns, as tendon length was measured with the participant positioned with knees extended.
Location of Activation on Ankle SPECT CT Scan is Prognostic for a Successful Supramalleolar Osteotomy in Patients with Asymmetric Ankle Arthritis
Authors: Gross Christopher , Knupp Markus , Hirschmann Michael , Hintermann Beat , Rasch Helmut , Schweizer Christine 
Published: September 2017

Category: Ankle, Ankle Arthritis, Hindfoot Introduction/Purpose: Combined single-photon emission computed tomography and conventional computed tomography (SPECT/CT) is a hybrid imaging modality that shows a combination of metabolic and structural information about the ankle. Recently, its use has expanded for pre-operative evaluation of supramalleolar osteotomies (SMO) for asymmetric ankle arthritis. It is unclear if the location of bone scan activation is related the success of the operation. We hypothesize that uptake in specific locations within the ankle joint can be associated a failure of the supramalleolar osteotomy. Methods: 85 pre-operative SMO patients with varus (37), valgus (41), or neutral (7) alignment of the hindfoot were assessed using SPECT/CT. The level of activation on SPECT/CT scans was measured. Activation was assessed on both the tibia and talus including 18 locations on axial scans, 8 locations sagittally, and 12 locations coronally on SPECT/CT imaging. Failure (conversion to total ankle arthroplasty (TAR) or arthrodesis) was recorded for each patient at an average of 3.7 years post-operatively. We compared the patients who had failures with those who did not with a chi-square analysis to look for any prognostic factors. Results: Ten patients (11.8%) had a treatment failure. Six patients were successfully converted to a TAR and another four to an arthrodesis. Pre or post-operative alignment did not correlate to a treatment failure. It was noted that the failures were more likely to have cystic lesions (20%), bipolar lesions (50%) anterocentral activation on tibia (30%), or anterocentral/media/dome activation on the talus (20%). 90% of the failure patients had post-traumatic lesions. The only statistically significant (p=.036) poor prognostic indicator was a bipolar lesion. Conclusion: Pre-operative SPECT/CT evaluation of an ankle before a SMO can be used to prognosticate on the success of the procedure. We caution against performing a SMO in patients with bipolar activation on a pre-operative SPECT-CT scan.
Comparative Cost of Surgical and Nonsurgical Treatment of Acute Achilles Tendon Rupture
Authors: Harkin Elizabeth , Schiff Adam , Pinzur Michael , Schiffman Corey 
Published: September 2017

Category: Sports, Practice Management Introduction/Purpose: Treatment of acute achilles tendon rupture (AATR) is controversial. Prospective clinical trials have demonstrated similar functional and quality of life outcomes following surgical repair and nonoperative care when a functional rehabilitation protocol is utilized. Meta-analysis would suggest that the apparent benefit of surgical treatment is an earlier return to function at the cost of an increased risk for surgical wound morbidity. The goal of this investigation was to perform a cost analysis of patients in a single orthopaedic clinic comparing operative and nonoperative treatment of acute achilles tendon rupture. Methods: After receiving IRB approval, patients whom were treated for acute Achilles tendon ruptures were retrospectively selected. A total of 13 adult patients with AATR, 6 non-operative and 7 operative, were identified in the period between June 1st 2014 and January 1st 2016. All patients participated in the same functional rehabilitation protocol. All patients had 1 year follow- up. Results: Operative treatment resulted in 3.7 times higher cost of total care compared to nonoperative treartment ($25,239 vs $6,785). Surgeon charges were 3.3 times higher in the operative group as well. ($4,543 vs $1,395). During the total length of treatment, patients in the operative group had an average of 7.4 physician visits and produced 11.9 surgeon relative value units (RVUs) while the non-operative group had 9.2 visits (p=0.0431) and produced 9.68 surgeon RVUs (p=0.102). Conclusion: Operative treatment of AATR had 3.7 times higher per patient treatment cost, 3.3 times higher billed surgeon charges, and slightly fewer physician visits, but with no statistically significant difference in the number of physician RVUs produced. This study questions the cost-effectiveness of operative treatment for AATR given previous long-term studies demonstrating equivalent 1-year patient outcomes.
Salto Talaris Total Ankle Arthroplasty
Authors: Hendy Benjamin , Pedowitz David , McDonald Elizabeth , Raikin Steven , Rogero Ryan , Shakked Rachel 
Published: September 2017

Category: Ankle, Ankle Arthritis Introduction/Purpose: Reports of range of motion and how it affects patient outcomes following total ankle arthroplasty (TAA) have been mixed. Furthermore, recent studies have relied on clinical exam to obtain postoperative range of motion and have lacked preoperative functional scores. The purpose of our study was to analyze how preoperative range of motion and functional scores change with time following TAA using postoperative functional scores and radiographs for range of motion calculations. Methods: A retrospective chart review was performed on 145 consecutive patients (149 ankles) that had undergone Salto-Talaris fixed-bearing implant (Integra, Plainsboro, New Jersey) TAA by a single surgeon between 2010 and 2014. Preoperative range of motion was gathered clinically in office by the senior author. Postoperative range of motion through the ankle joint was evaluated with dedicated weight-bearing dorsiflexion and plantar-flexion lateral radiographs at 3 months, 6 months, 1 year and 2 years. The range of motion was measured using the angle measurement tool on the PACS system. Patients completed visual analogue scale (VAS) for and the Foot and Ankle Ability Measure (FAAM) questionnaire subcategorized into activities of daily (ADL) and sports subscale preoperatively and at postoperative intervals of 3 months, 6 months, 1 year and 2 years. The mean age was 65 years (range, 31-83 years). Mean BMI was 25.6 (range, 14.9-44.9). There were 73 males (50%). Results: The total arc of motion preoperatively was 17.7 degrees and improved significantly (p < 0.001) to 27.9, 33.8, 32.6, and 32.2 degrees at 3 months, 6 months, 1 year and 2 years, respectively (Figure 1). VAS score preoperatively was 67.7 and improve significantly (p < 0.001) to 27.8, 24.84, 23.7 and 24.46 at 3 months, 6 months, 1 year and 2 years, respectively. FAAM ADL score preoperatively was 48.0 and improved significantly (p < 0.001) to 55.7, 71.2, 76.7, and 77.6 at 3 months, 6 months, 1 year and 2 years. FAAM sports score preoperatively was 21.4 and decreased at 3 months to19.1 (p > 0.05), but then significantly improved (p < 0.001) thereafter to 41.5, 47.4, and 52.6 at the same aforementioned time intervals. Conclusion: Patients undergoing fixed-bearing TAA had continued and sustained improvement from preoperative total arc of motion, pain, and function at each postoperative visit, up to 2 years. Ankle range of motion was noted to peak at 6 months postoperatively. Though pain and function may continue to improve even as far out as 2 years postoperatively, it is not likely that range of motion will continue to increase.