bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arthroscopic Treatment of Osteochondral Lesions of the Talus with Allograft Cartilage Matrix
Authors: Ahmad Jamal , Jones Kennis 
Published: October 2016

Category: Arthroscopy Introduction/Purpose: The purpose of this study is to prospectively evaluate the clinical and radiographic outcomes of using allograft cartilage extracellular matrix (ECM) as an adjuvant when arthroscopically treating osteochondral lesions of the talar dome (OLT). Methods: Between May 2012 and September 2014, 22 patients presented with an OLT amenable to arthroscopic surgery. All patients received an excision, micro-fracture, and injectable allograft cartilage ECM (BioCartilage, Arthrex, Naples, FL) at the OLT. Preoperative and postoperative function and pain was graded using the Foot and Ankle Ability Measures (FAAM) and a Visual Analog Scale (VAS) respectively. At 6 months from surgery, post-operative radiographs and computed tomography were assessed for osteochondral healing. Final radiographs were evaluated for OLT recurrence and ankle degenerative changes. Data regarding postoperative complications and revision surgeries were also recorded. Results: All 22 patients that received arthroscopic treatment of their OLT with allograft cartilage ECM were evaluated with a mean follow-up time of 20.2 months. The mean FAAM score increased from 51.4 of 100 preoperatively to 87.3 of 100 at the time of final follow-up. The mean VAS pain score decreased from 8.1 of 10 preoperatively to 1.9 of 10 at final follow-up. These differences between pre-surgical and post-surgical functional and pain scoring are statistically significant (P < 0.05). At 6 months from surgery, two patients (9.1%) received CT scans that revealed incomplete chondral formation at their OLT. One of these patients was symptomatic from this and ultimately required revision surgical treatment, involving an ankle arthrotomy and osteochondral autograft plugs from the ipsilateral lateral distal femoral condyle, to achieve full talar chondral healing. At final follow-up, one patient (4.5%) developed symptomatic and radiographic ankle degenerative changes at 1 year from surgery. Conclusion: Outcomes from arthroscopically treating OLTs with excision, micro-fracture, and application of allograft cartilage ECM has not been previously reported in the orthopaedic literature. This study demonstrates that using allograft cartilage ECM as an adjuvant to traditional ankle arthroscopic technique results in a high rate of improving ankle function and pain relief in patients with OLTs.
Comparison of Two Operative Techniques for Total Ankle Arthroplasty
Authors: Werner Shawn , Brage Michael 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Preoperative navigation and patient-specific instrumentation has many theoretical benefits in total ankle arthroplasty (TAA). Potential benefits over standard instrumentation include decreased surgical time, improved implant alignment, decreased surgical complexity, and decreased fluoroscopy exposure. The purpose of this study was to compare the differences of operative time and fluoroscopy exposure between two total ankle arthroplasty techniques utilizing the same implant, one using an intramedullary referencing system and the other a computed tomography (CT) scan-derived guide. Methods: Between 2011-2013, 74 TAA cases in 73 patients were retrospectively reviewed from a single foot and ankle fellowship-trained orthopaedic surgeon at a single center. TAA implants used included 65 intramedullary referencing implants (INBONE II, Wright Medical Technology) and 9 CT scan-derived patient-specific plans and guides (PROPHECY, Wright Medical Technology). Patients with the custom guide had a standardized preoperative CT scan before surgery that was used to create a custom surgical plan and 3-dimensional cutting guide. Patient demographics and the reason for TAA were recorded. Total anesthetic/surgical/tourniquet time and the number of fluoroscopy shots taken during the case were compared. This study also recorded additional procedures performed at the time of the TAA. Results: Average age for all patients was 62.7. This included 38 males and 35 females, most commonly having a TAA for osteoarthritis (N=34) closely followed by post-traumatic arthritis (N=33). When comparing all patients in the INBONE II to the PROPHECY group, surgical time was 151.6 vs 129 minutes (p-value 0.056) and fluoroscopy exposure was 38 vs 30 shots (p-value 0.01). There were 5 additional procedures (average 0.55 per case) in the PROPHECY group compared to 75 additional procedures (average 1.2 per case) in the INBONE II group. In a subset group of patients without additional bone work, comparing the INBONE II (N=25) and the PROPHECY group (N=8), fluoroscopy exposure was 31.3 vs 29 shots (p-value 0.2), respectively. In patients without any additional procedures, the average surgical time and fluoroscopy exposure of INBONE II (N=8) compared to PROPHECY (N=4) group was 125.3 vs 125.5 minutes and 32.8 vs 29.1 shots. Conclusion: Results from this study suggest that there are no statistically significant differences between surgical time and fluoroscopy exposure, when comparing the INBONE II and PROPHECY TAA techniques. In one instance there was a statistically significant difference between fluoroscopy exposure, however, this compared groups with additional bone procedures, more likely to occur in the INBONE II group. Future studies are warranted to investigate larger sample sizes without co-founding variables and whether increased surgeon experience with the PROPHECY system will affect surgical time and fluoroscopy exposure, as it is a newer implant and our data could reflect the learning curve.
Does a Patient’s Self-Reported Ability to Weightbear Immediately after Injury Predict Stability for Ankle Fractures
Authors: Kwon John , Ghorbanhoseini Mohammad , Chien Bonnie Y. , Hofmann Kurt J. 
Published: October 2016

Category: Trauma Introduction/Purpose: Determining the stability of ankle fractures, particularly for apparent isolated Weber B fibula fractures, can be difficult. While the ultimate goal remains achieving an anatomic mortise, different techniques to predict ankle stability such as stress and weightbearing radiographs have been utilized with variable results. History of injury and the ability to walk after sustaining ankle trauma may be predictive of stability. Therefore, this study seeks to determine whether a patient’s ability to fully weight bear immediately after injury is an effective indicator for ankle stability following ankle fracture. Methods: A prospective review was conducted of patients sustaining isolated, unilateral ankle fractures presenting to two level I trauma centers. Aside from demographic data and fracture characteristics, a patient’s ability or inability to fully weightbear immediately after injury was elicited by interview at their initial assessment. This information was correlated with their ankle radiographs, which were deemed stable or unstable fractures based on commonly used indices to assess ankle stability. Results: 102 consecutive patients sustaining ankle fractures were included. Mean age was 45. When analyzing the entire cohort, patients who were able to ambulate immediately after injury were 10 times more likely to have a stable ankle fracture than those who could not bear weight (odds ratio (OR) 9.9 (P < 0.001). The positive predictive value (PPV) for being able to fully weightbear as it relates to a stable ankle fracture was 77%. Additionally, inability to weightbear was 89% specific for an unstable fracture. When separately analyzing patients with apparent isolated fibula fractures (n=56), the PPV was 75%, specificity was 83%, while the OR was 5.8 (p=0.003) for those who could fully bear weight having a stable ankle fracture. Conclusion: This study demonstrates that patient’s self-reported ability to fully weightbear immediately after injury is a specific and convenient prognostic indicator for ankle stability across a range of ankle fracture subtypes. Future studies can analyze whether initial weightbearing accurately predicts ultimate management and good outcome.
Driving Reaction Time After Left Sided Foot and Ankle Procedures
Authors: Anthony Chris A. , Rungprai Chamnanni , Sittapairoj Tinnart , Phisitkul Phinit 
Published: October 2016

Category: Ankle Introduction/Purpose: Previous authors have considered braking times using computer simulators in a effort to evaluate patient safety in returning to drive. Authors have considered brake response times after first metatarsal osteotomy, ankle fusion, ankle fracture as well as anterior cruciate ligament reconstruction and hip and knee arthroplasty. Brake reaction time (BRT), a commonly used parameter, is defined as time from a “stop” stimulus until a brake is depressed. Previous work suggested that a BRT of 0.47 seconds (s) was average for a healthy population and that a BRT > 0.7 s is potentially hazardous. To our knowledge, there is no previous study of left sided foot and ankle procedures and how these procedures may affect BRT and driving safety. The present pilot study aimed to evaluate postoperative BRT in patients at our institution who had undergone left sided foot and ankle procedures. Methods: Seventeen patients were enrolled in the study: 7 underwent ankle arthroscopy, 4 flatfoot reconstruction, 3 ankle arthroplasty, 2 ankle fusion, and 1 cavovarus foot reconstruction. Participants had their surgical procedures performed at a range of 6 weeks to 6 months prior to study enrollment. We utilized a standard software and hardware setup which included a steering wheel, gas and brake pedal and desktop computer which displayed the driving simulation (The Stationary Simple Reaction Timer, Vericom Computers, Inc, Rogers, MN). All participants had left sided surgery and had their right lower extremity tested in the driving simulation. All participants completed 4 driving simulations which were then averaged. Data was analyzed in two groups, those who underwent only ankle arthroscopy and those who underwent an open procedure (Flatfoot reconstruction, ankle arthroplasty, ankle fusion, cavovarus foot reconstruction). BRT was defined as the time from stop stimulus until brake depression of 5%. Results: Average BRT in patients undergoing ankle arthroscopy was 0.66 s (SD 0.06 s). Average BRT in patients undergoing any open procedure was 0.65 s (SD 0.08 s). In patients undergoing ankle arthroscopy, average BRT at 6 weeks was 0.65 s (N=2), 0.64 s at 3 months (N=3), and 0.69 s at 6 months (N=2). In patients undergoing an open procedure, average BRT at 6 weeks was 0.62 s (N=3), 0.65 s at 3 months (N=5), and 0.69 s at 6 months (N=2). Conclusion: We present driving simulation brake reaction time on patients undergoing common, left sided foot and ankle procedures at our institution. In both arthroscopic and open procedure populations BRT is greater than previously described healthy patient populations and is slightly below a previously defined “hazardous” cutoff of 0.7 s.
How Knowledge Relates to Confidence in Orthopaedics and Emergency Medicine Regarding Rehabilitation in Foot and Ankle Trauma
Authors: Johnson-Lynn Sarah E. , Townshend David 
Published: October 2016

Category: Sports Introduction/Purpose: The aim of this study was to survey the knowledge of registrars in emergency medicine and orthopaedics on five common injuries to the foot and ankle and compare this knowledge, and self-reported confidence in giving it, with that of consultants and physiotherapists of various levels of experience. Methods: An online survey was used to gather the information using scenario based open and closed questions. A total of 102 healthcare professionals, who regularly deal with sports injuries, were recruited. This included consultant orthopaedic surgeons with a subspecialty interest in foot and ankle surgery,. orthopaedic surgeons in other specialties, extended scope physiotherapy practitioners (ESPs) in foot and ankle and general musculoskeletal practice, emergency medicine consultants, emergency medicine registrars, orthopaedic registrars, senior physiotherapists and junior physiotherapists. The participants were drawn from the various healthcare institutions in the North East of England. Results: Consultant foot and ankle surgeons and extended scope practitioners in foot and ankle both scored significantly on knowledge of rehabilitation programme design than either set of registrars. For two of the case scenarios there was a significant difference in scores between either orthopaedic consultants or ESPs and registrars (p < 0.05). For total score there was a trend for extended scope practitioners to score higher than both sets of registrars but this did not reach significance. Correlation coefficients for knowledge and self-reported confidence ranged between 0.009 and 0.33, demonstrating only weak positive linear correlation between scenario score and reported confidence in advice given. Conclusion: The most significant area of gaps in knowledge amongst the two groups of registrars was in the specifics of rehabilitation programmes. There was markedly higher confidence with greater seniority, which correlated poorly with differences in specific knowledge. Registrars in emergency medicine and orthopaedics are likely to benefit from case based teaching in sports injury rehabilitation.
Mid- to Long-Term Follow Up of the Salto Mobile Bearing Total Ankle Arthroplasty with Radio Graphic Analysis
Authors: Puna Rupesh , Tomlinson Matthew P. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) remains a relatively uncommon procedure in New Zealand compared to total hip arthroplasty (THA) and total knee arthroplasty (TKA). Survivorship and clinical results of TAA have been mixed and inferior to both THA and TKA. There is a relative paucity of large series with long-term follow-up. The Salto mobile bearing prosthesis is now the most common prosthesis for TAA in New Zealand. We analysed a large series from a single surgeon with the purpose of reporting mid- to long-term survivorship, and performing radiographic analysis for radiolucencies and cytic changes. Methods: The New Zealand joint registry (NZJR) was used to obtain all Salto mobile bearing ankle replacements performed by the senior author between November 2005 and June 2012. The NZJR is a nationwide register of all joint arthroplasties performed in New Zealand and data on TAA has been collected since January 2000. Individual notes on each patient were reviewed to verify revision rate and reasons for revision. Post-op radiographs were analysed for alignment, radiolucencies, cystic changes and subsidence. Results: Of the 165 Salto mobile bearing ankle replacements in 150 patients, 62% were performed in males and 38% in females. Mean age at TAA was 65 years. Follow-up ranged from 5 to 121 months. Indications for primary included primary osteoarthritis (85%), inflammatory arthritis (9%), and post-traumatic arthritis (6%). 8% of patients (12 ankles) deceased during the follow-up although none had undergone revision. Over the course of the study, 8 ankles were revised giving a revision rate of 4.8% with mean time till revision of 69 months. Reasons for revision included aseptic loosening (3 ankles), talar collapse/avascular necrosis (2 ankles), broken polyethylene spacer without exchange of either component (2 ankles) and infection (1 ankle). At the time of study completion, 145 ankle replacements were still implanted in 130 patients which represents 94.7% survivorship in those patients still living. Post-operative radiographs demonstrated mean tibial alignment 90.7°, talar alignment 90.1°, tibial slope 82.6°, and talocalcaneal angle 11.2°. 49.1% demonstrated radiolucencies and 27.6% demonstrated cystic changes at long term. 7.2% showed subsidence over time. Conclusion: Our data represents one of the longest follow-up studies of the Salto mobile bearing TAA in the world. Our results show acceptable mid- to long-term survivorship. There is a notable percentage with radiolucencies and cystic changes but this does not seem to correlate with early failure. Component migration is uncommon. Further long-term follow-up of this cohort is necessary to determine the significance of the radiolucencies and cystic changes.
Measurement of Nitinol Recovery Distance Using Pseudoelastic Intramedullary Nail in Tibiotalocalcaneal Arthrodesis
Authors: Parekh Selene G. , Gross Christopher E. , Easley Mark E. , Adams Samuel B. , Kildow Beau J. 
Published: October 2016

Category: Ankle Introduction/Purpose: Tibiotalocalcaneal(TTC) arthrodesis is a salvage procedure for patients with complex disease of the ankle and subtalar joints. Despite the clinical efficacy and mechanical advantage of intramedullary nails, complications, such as nonunion, are not uncommon. It may be possible to sustain compression in the face of bone resorption and implant loosening over the course of healing using a novel pseudoelastic intramedullary nail. Methods: We identified 15 patients (age+54.7+/-20.0 years) who had undergone a tibiotalocalcaneal arthrodesis using a pseudoelastic intramedullary nai. Serial radiographs were used to determine the amount and rate of Nitinol element migration over time. Results: Three months after surgery, there was at least 2.38mm of Nitinol element migration proximally with mean of 5.58mm(range: 2.38 to 8.11mm). Average follow up time was 195 days (range: 89 to 490 days). Conclusion: The Nitinol element recovers distance when stretched intra-operatively and maintains moderate compression in response to bone resorption. Further studies are needed to assess if this increased compression lends itself to higher fusion rates than traditional IMN’s.
Primary Open vs. Arthroscopic Ankle Arthrodesis
Authors: Barg Alexej , Lyman Mikayla , Morris S. Craig , Saltzman Charles L. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Ankle arthrodesis is the gold-standard treatment option for patients with end-stage ankle osteoarthritis resulting in measurable improvements in postoperative pain relief. Arthroscopic ankle arthrodesis has gained increasing popularity, however there remains a lack of comparative data with open ankle arthrodesis. The objectives of this retrospective study were to compare (1) demographics, (2) surgical technique, (3) postoperative fusion rates, and (4) postoperative complication rates in patients with primary open vs. arthroscopic tibiotalar arthrodesis. Methods: Between March 2002 and November 2014, 385 primary ankle arthrodeses were performed at our institution. There were 212 male and 173 female patients with a mean age of 56 ± 14.7 years (18.0-88.8). The mean weight, height, and body mass index (BMI) were 89.4 ± 19.7 kg (46-168), 172.9 ± 11.1 cm (147-208), and 29.9 ± 5.8 kg/m2 (18.9-54.9), respectively. There were 322, and 63 patients with primary open and arthroscopic arthrodesis, respectively. Both patient groups were compared with regard to demographics including gender, weight, height, BMI, ASA classification, smoking, alcohol use, and comorbidities. The surgical technique was analyzed in both groups including approach, main fixation type, and allograft/autograft use. Finally, fusion rates and time to complete union were analyzed. Complication rates including wound complications, deep vein thrombosis/pulmonary embolism, and any secondary procedures were described in both groups. The mean time to final follow-up was 37.9 ± 27.0 months (12.0-150.4). Results: Demographics and comorbidities were comparable in both groups. All but one arthroscopy were performed using anterior portals. All arthroscopic ankle arthrodeses were performed using screw fixation, while fixation types varied in open arthrodesis (P < 0.001). Autograft use was higher in open arthrodesis at 84.2% vs. 6.3% (P < 0.001), while allograft was favored for arthroscopic arthrodesis at 66.7% vs. 20.2% (P = 0.101).Osseous union was with 92.2% and 90.5% in patients with open and arthroscopic arthrodesis, respectively (P = 0.529). However, the time to complete osseous fusion was significantly shorter in patients with arthroscopic ankle fusion, at 4.3 vs. 5.1 months (P = 0.034). Wound and thrombembolic complications occurred significantly more often in patients with open ankle arthrodesis. Conclusion: Osseous union rates were comparable in both patient groups,however union time was significantly shorter in the arthroscopic group. Wound healing problems and thrombembolic complications were more common in patients who underwent open ankle arthrodesis.
The Arterial Anatomy of the Deltoid Ligament
Authors: Haynes Jacob A. , Gosselin Michelle , McCormick Jeremy J. , Johnson Jeffrey E. , Klein Sandra E. 
Published: October 2016

Category: Ankle Introduction/Purpose: Injuries to the deltoid ligament complex on the medial aspect of the ankle account for 10-15% of ankle sprains. Chronic deltoid insufficiency can lead to medial or multidirectional ankle instability, necessitating operative stabilization. Many studies have examined the anatomy of the deltoid ligament complex, with a focus on characterizing the various bands that comprise its structure. To our knowledge the vascular supply to the deltoid ligament has not been previously studied. This information may have implications in the progression of deltoid injuries to chronic insufficiency, and is an important consideration when performing operative reconstruction of the deltoid ligament. The purpose of our study was to describe the vascular supply to the deltoid ligament utilizing a method of chemical debridement with cadaveric specimens. Methods: Twenty-seven matched pairs of adult cadaver legs, fifty-four legs total, were studied. Specimens with any signs of prior trauma or surgical treatment were excluded. The legs were amputated below the knee and injected with India Ink, followed by Ward Blue Latex, in the anterior tibial, posterior tibial and peroneal arteries. Specimens were chemically debrided utilizing 6.0% sodium hypochlorite, leaving vascular casts, ligaments and bones. The vascular supply to the deltoid ligament was evaluated, photographed, and recorded. Results: The vascular supply to the deltoid ligament complex was clearly visualized in 50 of the specimens. The deltoid ligament in all 50 specimens was supplied by arterial branches from the dorsalis pedis, specifically the medial tarsal arteries. Thirty-two of the specimens (64.0%) had an additional contribution from the anterior tibial artery, while the medial tarsal arteries were the only anterior vascular supply in the remaining eighteen specimens (36.0%). Thirty-nine specimens (78.0%) had additional arterial supply to the deltoid ligament from the posterior tibial artery. In thirteen (30.0%) of these specimens, the posterior tibial artery provided the dominant arterial supply, as determined by vessel diameter. Conclusion: Deltoid injuries can become chronic, leading to recurrent ankle instability. Our study shows that the deltoid ligament complex receives a consistent arterial supply from the dorsalis pedis and anterior tibial arteries, and that this anterior vasculature is the dominant supply in the majority of specimens. A large portion of our specimens also had additional arterial supply from the posterior tibial artery. Knowledge of the arterial anatomy of the deltoid ligament complex is valuable when planning operative treatment of medial ankle, and may also provide information for future studies examining the progression of medial ankle sprains to chronic deltoid insufficiency.