bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Foot Position and Local of Measurement Influence on Ankle Medial Clear Space?
Authors: Baumfeld Tiago , Baumfeld Daniel , Cangussú João , Macedo Benjamim , Silva Thiago , Raduan Fernando , Nery Caio 
Published: September 2017

Category: Ankle, Sports, Trauma Introduction/Purpose: The ankle Medial Clear Space (MCS) is frequently used in foot and ankle surgery for determining the competence of the deltoid ligament in Weber B ankle fractures. A widened MCS indicates deltoid ligament incompetence, requiring surgery to prevent lateral talar shift. Controversy still exists regarding Medial Clear Space (MCS) normal and abnormal values, and its possible variation in previously uncontrolled biases. Sex, height, foot position, and type of radiograph were all described as possible influencing factors. The objective of this study was to access how much different degrees of plantar flexion, all performed with and without stress, influence on MCS width. Methods: We submitted 30 volunteers to six different anteroposterior non-weight bearing digital radiographs of the ankle in the following positions: neutral, neutral with external rotation stress, physiologic plantar flexion (FPF), physiologic plantar flexion with external rotation stress, maximum plantar flexion (MPF) and maximum plantar flexion with external rotation stress. The medial clear space MCS oblique (MCSo) and perpendicular (MCSp) were measured in all images by an experienced foot and ankle surgeon. Results: The data analysis showed with statically significance that the position of the foot does influence in the value of both MCSp and MCSo (p<0,05), regardless of three exceptions. MCSo does not change statistically between FPF with stress and MPF with stress. On the other hand, MCSp did not change in two situations: between FPF and Neutral with stress and between MPF and FPF with stress. It is noteworthy that MCSo, on average, was 15% wider than MCSp in all positions tested. It is also noticeable that, from the neutral position, plantar flexing the ankle has a great impact on MCS than external rotation stress, increasing MCSp by 25% and 22% respectively. MCSo follows the same pattern, with 21% and 17% respectively. Conclusion: This study is unique on showing that many different ways of positioning the foot and making stress radiographs do result in completely different MCS values, and that these values differ depending on the anatomical site they are measured. All these data indicates that we need to establish a gold standard for measuring MCS, taking into account patient sex, height, local of measurement of MCS, position of the foot and type of radiograph (AP or Mortise). This study was not able to address all variables that influence directly on MCS and therefore did not intended to establish this new gold standard.
Supramalleolar Osteotomy for Tibial Component Malposition in Total Ankle Replacement
Authors: Deforth Manja , Krähenbühl Nicola , Zwicky Lukas , Knupp Markus , Hintermann Beat 
Published: September 2017

Category: Ankle Introduction/Purpose: A key for success in total ankle replacement is a balanced ankle joint. If the tibial component is misaligned, the ligamentous structures, the malleoli and the tendons may be overused, which, may lead to pain and impairment during gait. A misaligned tibial component can be revised using a corrective bone resection and re-insertion of a new component or using a corrective osteotomy of the distal tibia above the stable implant. The aim of this study was to review a series of patients, in whom a corrective supramalleolar osteotomy was performed to realign a misaligned tibial component in total ankle replacement. Methods: Twenty-two patients (nine male; 13 female; mean age, 62.6 years; range, 44.7 – 80.0) were treated with a supramalleolar osteotomy to correct a painful dysbalanced ankle, following a varus implanted tibial component. Following radiological and clinical outcomes were recorded preoperatively and at the follow-up examination within the first 24 months: the tibial anterior surface angle (TAS), the tibial lateral surface angle (TLS), patient’s pain measured with the Visual Analogue Scale (VAS), the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score, range of motion (ROM) of the ankle and patient’s satisfaction. Furthermore, postoperative complications were reviewed. Results: The TAS changed on average from 85.2 ± 2.5 degrees preoperatively to 91.4 ± 2.9 degrees postoperatively (p < 0.0001), the AOFAS score increased from 46 ± 14 to 66 ± 16 points (p < .0001) and the VAS pain score decreased from 5.8 ± 1.9 to 3.3 ± 2.4 (p < .001). No statistical difference was found in the TLS and the range of motion. The osteotomy healed in 19 patients (86%), re-osteosynthesis was successful in the remaining three patients. In one of these three patients, a chronic infection of the ankle joint led to a below-knee amputation. Fifteen patients (68%) were (very) satisfied, four (18%) moderately satisfied and three (14 %) patients were not satisfied with the obtained postoperative result. Conclusion: The supramalleolar osteotomy was found to be an efficient alternative to correct the misaligned tibial component in total ankle replacement. Pain could be successfully addressed in the majority of the patients. The treatment of a malpositioned, well anchored tibial component with a supramalleolar osteotomy, instead of exchanging the tibial component, allows preservation of the bone stock. However, non-union should be mentioned as a possible complication of this surgery. Nonetheless, this method might be a feasible treatment option, especially for younger patients.
Comparison of Contact and Damage to Anatomic Structures in the Fixation of Zone II Fifth Metatarsal Fractures with an Intramedullary Screw or an Intramedullary Nail
Authors: Garras David , Adams Samuel , Burgess Brian 
Published: September 2017

Category: Sports, Trauma Introduction/Purpose: Percutaneous intramedullary screw fixation of Zone II fifth metatarsal fractures has become commonplace. The potential for injury to the important surrounding anatomy has not been well documented, though some authors have reported unexplained postoperative pain and paresthesia over the lateral aspect of the foot despite hardware removal. The purpose of this study was to determine the contact and injury rate of surrounding anatomic structures with either the use of the traditional intramedullary screw (IMS) inserted “high and inside” or a novel intramedullary nail (IMN) inserted “low and outside” through a relative “safe-zone.” Methods: Zone II fifth metatarsal fractures were created in ten cadaver matched-pairs using a 1 mm thick saw through a small incision. Fractures were randomized to receive either an IMS or an IMN. The surgical technique was performed in accordance with the manufacturer’s instructions. For the IMS group, the guide pin was inserted percutaneously according to the “high and inside” starting point on the base of the fifth metatarsal using fluoroscopy; followed by insertion of the 3.5 mm drill, tissue protector, tap, and screw. For the IMN group, the guide pin was inserted percutaneously “low and outside,” positioned slightly medial and dorsal to the tip of the tuberosity of the fifth metatarsal; followed by the 5.2 mm reamer, tissue protector, and IMN. Dissection was performed to identify damage or contact to the peroneus brevis tendon (PB), peroneus longus tendon (PL), sural nerve (SN), lateral insertion of the plantar fascia (PF) and cuboid-fifth metatarsal jointspace. Results: There were significantly more episodes of PB injury, PL contact, SN contact, and presence in the cuboid-fifth metatarsal jointspace for the IMS group. There were significantly more episodes of contact of the PF with the IMN group but no episodes of damage. The results are summarized in Table 1. Images of contact and damage are shown in Figure 1. Fluoroscopic images of the IMN inserted through the “low and outside” position are shown in Figure 2. Conclusion: We have demonstrated significant contact and injury to surrounding structures with the placement of a “high and inside” IMS for the fixation of Zone II fifth metatarsal fractures. We believe there is a relative safe zone at the “low and outside” position that affords less potential damage to the important surrounding structures. Consideration should be given to the development of implants inserted through the relative safe zone.
The Value of Motion
Authors: Hamid Kamran , Dekker Travis , Easley Mark , Nunley James , Adams Samuel 
Published: September 2017

Category: Ankle, Ankle Arthritis Introduction/Purpose: The onus has been placed on surgeons to prove the value of procedures to patients, payers, policymakers and other key stakeholders. Demonstration of patient reported outcome measures (PROMs) constitutes an integral component of success within the context of value-based healthcare. The proposed benefit of total ankle replacement (TAR) over ankle fusion is preserved ankle motion, thus we hypothesized that an increase in range of motion (ROM) is positively correlated with validated PROMs in individuals receiving TAR. Methods: Patients undergoing TAR at a single academic medical center between 2007-2013 were evaluated in this study. In addition to a minimum of two-year follow-up, complete preoperative and postoperative outcome measures for the Foot and Ankle Disability Index (FADI), Short Musculoskeletal Function Assessment (SMFA) Bother and Function Indices, Visual Analog Scale (VAS) and 36-Item Short Form Health Survey (SF-36) were requisite for inclusion. Standardized weightbearing maximum dorsiflexion and plantarflexion sagittal radiographs were obtained and previously described ankle and foot measurements were performed to determine ankle ROM. Results: Eighty-eight patients met inclusion criteria (33 INBONE, 18 Salto-Talaris, 37 STAR). Mean time to final ROM radiographs was 43.8 months (range: 24-89 months). All aforementioned PROMs improved between preoperative evaluation and most recent follow-up (p<0.01). Final ankle ROM was significantly correlated with postoperative FADI, SF-36 Mental Component Summary (MCS), SMFA Bother and Function Indices, and VAS. Additionally, dorsiflexion was positively associated with FADI, SF-36 MCS and SMFA Function (p<0.05) but plantarflexion had no such influence on outcomes. No differences were identified with subset stratification by prosthesis type, fixed versus mobile-bearing design or etiology. Conclusion: In this TAR cohort with prospectively collected outcomes data, radiographic sagittal plane ankle motion was positively correlated with multiple PROMs. Disease-specific and generic health-related quality of life PROMs demonstrated improvement postoperatively in all domains. TAR is a viable option for patients with end-stage ankle arthritis and increased ROM is associated with improved patient-centric metrics.
CT Arthrography Visualizes Joint Regeneration after Microfracture of OLT
Authors: Lee Dong-Oh , Jung Hong-Geun , Sun Mao Yuan , Kang Hwa Jun 
Published: September 2017

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Little is known about arthroscopic or radiographic outcome after arthroscopic microfracture for osteochondral lesions of the talus (OLTs). The purpose of this study was to investigate tissue growth after arthroscopic microfracture for OLT using computed tomography arthrography (CTA) and to correlate this defect filling with clinical outcomes. We hypothesized that the morphology of the repaired tissue would be similar to that of normal anatomy and related to the clinical outcome. Methods: Forty-two ankles treated using arthroscopic microfracture for OLT from 2009 to 2014 were monitored. CTA was performed postoperatively at 6 months, 1, and 2 years. The postoperative thickness of the repaired tissue associated with OLT (grade) and the volume of the subchondral cystic lesions were evaluated using CTA. Clinical outcomes, including a pain visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) ankle functional score, were evaluated and correlated with CTA. Results: The proportion of fully grown tissue (grade 3) increased over time; specifically, the rates were 12/40 (33.3%) at postoperative 6 months, 11/18 (61.1%) at 1 year, and 8/10 (80%) at 2 years (p=0.005). VAS pain (p<0.001) and AOFAS scores (p<0.001) also improved at the final follow-up; however, they were not associated with repaired tissue thickness on CTA (p=.409 and .579, respectively). Conclusion: Tissue growth after arthroscopic microfracture for OLT was detected in 96% of patients using ankle CTA, with which joint congruency remodeling and subchondral bone formation were well visualized. However, CTA findings were not related to clinical outcomes.
Reliability of Hindfoot Alignment Using Weightbearing CT Semi Automatic Software
Authors: Lintz Francois , Welck Matthew , Bernasconi Alessio , Thornton James , Cullen Nicholas , Singh Dishan , Goldberg Andrew 
Published: September 2017

Category: Ankle, Hindfoot, Imaging Introduction/Purpose: Hindfoot Alignment (HA) on 2D radiographs presents anatomical and operator-related bias. In this study, weightbearing CT (WBCT) was used to measure HA using a semi-automatic software which gives HA as a value of Foot Ankle Offset (FAO) after selecting four landmarks (weight bearing points of first and fifth Metatarsals, Calcaneus and center of the ankle joint). We assessed the intra and interobserver reproducibility and the distribution of FAO values in a series of datasets from clinically normal, varus and valgus cases. We hypothesized that reproducibility would be excellent. Furthermore, FAO in normals should have a Gaussian distribution and be significantly different to the varus and valgus groups. Methods: In this level 3, retrospective comparative study, WBCT (PedCAT ®, CurveBeam LLC, Warrington, PA, USA) datasets were obtained from an existing database. The 135 feet were assessed by a senior foot and ankle surgeon as normal, varus or valgus (57, 38 and 40 respectively). Two surgeon investigators (one senior and one trainee) independently analyzed each case using a semi-automatic HA measurement tool (TALAS ™, CurveBeam LLC, Warrington, PA, USA). A third, independent investigator conducted the statistical analysis using Stata® Software. Results: The overall intraoberver and interobserver reliability were 0.99 ± 0.002 and 0.97 ± 0.02 respectively. In normal cases, mean value for FAO was 2.38% ± 2.96, whereas in varus and valgus cases mean was -11.67% ± 6.90 and 11.47% ± 5.79, respectively (p<0.001). The normal population had a Gaussian distribution with a Kolmogorov-Smirnov test > 0.8 Conclusion: This study reports excellent reliability and discriminative power of a semi-automatic 3D measurement tool for Hindfoot Alignment in WBCT.
Subchondral Bone Degradation Following Bone Marrow Stimulation -An MRI Analysis-
Authors: Shimozono Yoshiharu , Yasui Youichi , Megill Robin , Kennedy John 
Published: September 2017

Category: Ankle Introduction/Purpose: Microfracture is the most common operative procedure for the treatment of osteochondral lesions of the talus (OLT). The role of the subchondral bone (SCB)/plate (SCBP) is recognized as one of the most significant factors providing joint-loading support to the ankle. Greater attention has recently been paid to the SCBP and its effects on overlying hyaline and fibrocartilage function. However, damage to the SCB and SCBP during microfracture may irreversibly change the joint loading support of the ankle, leading to reparative cartilage degradation. The purpose of this study is to investigate the morphological change in the SCB and SCBP after microfracture for OLT by developing a novel magnetic resonance imaging (MRI) scoring system specifically for evaluating SCB and SCBP. Methods: Twenty patients who underwent microfracture for OLT and had at least a one year follow-up 3-Tesla MRI between 2008 and 2011 were selected. A SCB Health scoring system was developed to assess the condition of the SCB using 3-Tesla MRI. The SCB Health score is based on the amount of edema, subchondral cyst diameter, qualitative change in SCBP morphology and thickness change of the SCBP (Table 1). Nine of the twenty patients had two follow-up MRIs, and differences in their scores were calculated. The clinical evaluation was assessed using the Foot and Ankle Outcome Scores (FAOS) preoperatively and at final follow-up. Results: At first follow-up MRI, 65% of patients had mild or greater edema, 40% had subchondral cysts, 65% had irregularity or collapse of their SCBP and 85% had a >25% change in SCBP thickness. The overall SCB Health score of 90% of patients were abnormal. Of the nine patients who had a subsequent follow-up MRIs, the mean time between the first and second study was 22±6 months. The scores between the two time points were not statistically significant (p=0.347, p=0.559, p=0.169, p=0.347 p=0.154 for edema, subchondral cyst diameter, qualitative SCBP measurements, SCBP thickness change and overall SCB Health score, respectively). The mean FAOS score improved significantly from 55.5±16.8 preoperatively to 76.0±12.3 at final follow-up (p<0.05). Conclusion: The SCB and SCBP were not completely healed in 90% of patients at a mean 18 months follow-up following microfracture of the talus. Subsequently, morphological changes were not restored at a mean 43 months at second follow-up in a smaller subset of patients. Most previous studies have focused on the degeneration of the articular cartilage layer, and its effect on clinical outcomes. The authors of current study believe that looking at the changes in the SCB may provide additional information as to why BMS procedures fail in the long-term.
The Osteochondral Lesions of Talus in the Subtalar Joint following the Intra-articular Calcaneal Fractures
Authors: Angthong Chayanin , Nangnual Suebsagul 
Published: September 2017

Category: Hindfoot, Trauma Introduction/Purpose: The cartilage delamination was frequently associated at the posterior articular facet of calcaneus following displaced intra-articular calcaneus fractures. However, little is known about the osteochondral lesion of the posterior facet of talus (OLPT) following an intraarticular calcaneal fracture. This study is to report the prevalence and characteristics of these lesions. Methods: This study retrospectively reviewed 34 patients who had the intraarticular calcaneal fractures. The CT scan was used to preoperatively evaluate the fracture type, the presence, area of lesion, and severity of OLPT following the intraarticular calcaneal fracture. These data were recorded in accordance with Akiyama mapping system, Sanders, and Ferkel classification. Results: The OLPT was found as 94.1% from a total of 34 patients. The most common area of OLPT was anterocentral part (26.5%) of posterior facet of talar surface in accordance with Akiyama mapping system. The most common fracture type was Sanders IV (44.1%). The most common severity of OLPT was Ferkel grade I (82.4%). The OLPT was predominantly associated in Sanders type IV fractures (46.9%; p = 0.412). Conclusion: This study demonstrated the high prevalence of OLPT following the intra-articular calcaneal fracture. Most lesions were mild severity; however, there was a tendency of the association of lesion occurrence with higher grade of fracture severity. The OLPT may play an important role in the formation of post-traumatic osteoarthritis of subtalar joint which can be found following the intraarticular calcaneal fracture. The preoperative evaluation of this lesion is recommended via CT. The lesion treatment may be encouraged to be performed during calcaneal fracture fixation for the reduction of post-traumatic osteoarthritis formation.
The relationships between patient-reported outcome, quality of life, and gait characteristics using a wearable foot inertial-sensor assessment in patients with foot and ankle conditions
Authors: Angthong Chayanin 
Published: September 2017

Category: Gait analysis Introduction/Purpose: The purpose of this study was to report the relationships between validated patient-reported outcome, health-related quality of life, and gait characteristics using a wearable foot inertial-sensor assessment in patients with foot-ankle conditions. In addition, the inter-metrics correlations were analyzed to determine the relationships between each spatiotemporal or gait parameter. Methods: Fifty-three patients with foot-ankle conditions (38 female/15 male, aged 21–75 years) were collected for this study. Clinical assessments, including evaluations with validated patient-reported outcomes using the visual analogue scale foot and ankle (VAS-FA) score, health-related quality of life using the validated Short Form-36 (SF-36)9, and gait characteristics assessment using a wearable foot inertial-sensor device, were performed and recorded in each patient. Results: Negative correlation between physical component summary (PCS) and maximal cadence only showed a significant value at Pearson’s correlation coefficient (r) = –0.308, P = 0.025. Positive correlations (r) were found between mean walking speed and mean cadence (r = 0.776, P < 0.001) and between maximal walking speed and mean step length (r = 0.498, P < 0.001). Negative correlations (r) were found between mean cadence and mean step length (r = –0.491, P < 0.001) and between maximal cadence and mean step length (r = –0.355, P = 0.009). Conclusion: Regarding relationships among several spatiotemporal parameters and patient-reported outcome measures, cadence is the only parameter that was significantly negatively related with PCS in health-related quality of life. Based on inter-metrics relationships, increased cadence might be used to maintain walking speed as a compensatory mechanism in patients with foot- ankle conditions.
Radiography in in SER II - IV Ankle Fractures
Authors: Baecker Henrik 
Published: September 2017

Category: Ankle, Sports, Trauma Introduction/Purpose: SER lateral malleolar fractures are common. The assessment of the stability of the ankle fracture is crucial for decision making of treatment which is associated with the integrity of the deltoid ligament (SERII-III). Slight talar shift can lead to extensive decrease of tibio-talar contact area (Ramsey 1999). Several clinical tests have been proposed of which static weightbearing radiography is used to measure the lateral talar shift with the medial clear space to detect medial instability (SERIV). However, the correlation of a stable ankle joint under weightbearing load with the structural integrity of the deltoid ligament has not been shown yet which we want to investigate. Methods: 17 patients with lateral malleolar fractures were investigated who underwent an MRI and weightbearing radiography examination. In the MRI, the deep deltoid ligament was assessed as intact, partial und complete rupture. The medial clear space was measured - distance between the lateral border of the medial malleolus and the medial border of the talus at the level of the talar dome (millimeter). Results: 7 patients suffered from deep deltoid ligament rupture (4 partial; 3 complete).The medial clear space in patients with intact deep deltoid ligament was 2.96+0.41 mm in mean, in partial rupture 2.8+0.38 mm, in complete rupture 3.43+0.23 mm. When counting the complete and partial ruptures together the mean was 3.07+0.45 mm and in partial ruptures plus the intact ones 2.91+0.40 mm. Conclusion: Our results show no significant correlation between the medial clear space and the integrity of the deep deltoid ligament (figure1). A negative weightbearing radiograph does not exclude deep deltoid ligament rupture. This fact might indicate the importance of the intrinsic stability provided by the osseous contour of the highly congruent ankle joint. In our opinion, malleolar fracture with deep deltoid ligament rupture (SERIV) can therefore be treated conservatively as long as ankle stability is provided under physiological load.