bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective Controlled Trial of STAR Total Ankle Replacement versus Ankle Fusion: Initial Results
Authors: Saltzman Charles L. , Mann Roger A. , Ahrens Jeanette E. , Amendola Annunziato , Anderson Robert B. , Berlet Gregory C. , Brodsky James W. , Chou Loretta B. , Clanton Thomas O. , Deland Jonathan T. , DeOrio James K. , Horton Greg A. , Lee Thomas H. , Mann Jeffrey A. , Nunley James A. , Thordarson David B. , Walling Arthur K. , Wapner Keith L. , Coughlin Michael J. 
Published: July 2009

Background: Mobile-bearing ankle replacements have become popular outside of the United States over the past two decades. The goal of the present study was to perform a prospective evaluation of the safety and efficacy of a mobile-bearing prosthesis to treat end stage ankle arthritis. We report the results of three separate cohorts of patients: a group of Scandanavian Total Ankle Replacement (STAR) patients and a control group of ankle fusion patients (the Pivotal Study Groups) and another group of STAR total ankle patients (Continued Access Group) whose surgery was performed following the completion of enrollment in the Pivotal Study. Materials and Methods: The Pivotal Study design was a non-inferiority study using ankle fusion as the control. A non-randomized multi-centered design with concurrent fusion controls was used. We report the initial perioperative findings up to 24 months following surgery. For an individual patient to be considered an overall success, all of the following criteria needed to be met: a) a 40-point improvement in total Buechel-Pappas ankle score, b) no device failures, revisions, or removals, c) radiographic success, and d) no major complications. In the Pivotal Study (9/00 to 12/01), 158 ankle replacement and 66 arthrodesis procedures were performed; in the Continued Access Study (4/02 to 10/06), 448 ankle replacements were performed, of which 416 were at minimum 24 months post-surgery at time of the database closure. Results: Major complications and need for secondary surgical intervention were more common in the Pivotal Study arthroplasty group than the Pivotal Study ankle fusion group. In the Continued Access Group, secondary procedures performed on these arthroplasty patients decreased by half when compared with the Pivotal Arthroplasty Group. When the Pivotal Groups were compared, treatment efficacy was higher for the ankle replacement group due to improvement in functional scores. Pain relief was equivalent between fusion and replacement patients. The hypothesis of non-inferiority of ankle replacement was met for overall patient success. Conclusion: By 24 months, ankles treated with STAR ankle replacement (in both the Pivotal and Continued Access Groups) had better function and equivalent pain relief as ankles treated with fusion. Level of Evidence: II, Prospective Controlled Comparative Surgical Trial
Recombinant Bone Morphogenetic Protein-2 (rhBMP-2) in High-Risk Ankle and Hindfoot Fusions
Authors: Bibbo Christopher , Patel Dipak V. , Haskell Michelle D. 
Published: July 2009

Background: The purpose of this study was to evaluate the effect of rhBMP-2 on bone healing in patients who undergo high-risk ankle & hindfoot fusions. Materials & Methods: Patients who underwent high-risk, elective ankle and hindfoot fusions treated with rhBMP-2 augmentation were reviewed for clinical outcomes and complications. A total of 112 fusion sites (69 patients) were reviewed for analysis. The mean age of the patients was 52 years (range, 21 to 84 years). There were 37 males (53%) and 32 females (47%). Forty-four patients (64%) were smokers and 13 patients (19%) were diabetic. A history of high-energy trauma was present in 47 (68%) patients and avascular necrosis of the talus was present in 22 patients (32%). Forty-five patients (65%) had multiple risk-factors. The exclusion criteria were peripheral vascular disease, infection, and patients who were not available for the usual follow-up protocol. Internal and/or external fixation was utilized for ankle and hindfoot fusions. Bone graft was used only for patients who had defects or malalignment. Postoperatively, nonweightbearing radiographs were taken every 2 to 4 weeks (3 views per site). When plain radiographic union was evident, a confirmatory CT scan was obtained. Results: Overall, 108 fusion sites went on to union (96% union rate) at a mean time of 11 weeks (as assessed by a CT scan) [ankle joint at 10 weeks; subtalar joint at 12.3 weeks; talonavicular joint at 12.7 weeks and calcaneocuboid joint at 10.9 weeks]. Different union times between ankle, subtalar, talonavicular, and calcaneocuboid joint were not significant ( p = 0.2571, Kruskal-Wallis Test Nonparametric ANOVA). All sites: [No graft] vs. [Autograft] vs. [Allograft]: p = 0.2421 (Kruskal-Wallis Test Nonparametric ANOVA), were not statistically significant. Complications included nonunion in 5 of 112 joints in 3 patients (4% joint nonunion rate; 4% patient nonunion rate) [subtalar joint, n = 2; talonavicular joint, n = 1; and calcaneocuboid joint, n = 1]. Two patients had wound complications and one other patient had a deep infection; all were successfully treated with local wound care, negative-pressure dressings and antibiotics. Conclusion: We believe rhBMP-2 is an effective adjunct for bone healing in patients who undergo high-risk ankle and hindfoot fusions. Low complication rates were observed in this study. Level of Evidence: IV, Retrospective Case Series
Correlation of Harris Mats, Physical Exam, Pictures, and Radiographic Measurements in Adult Flatfoot Deformity
Authors: Coughlin Michael J. , Kaz Ari 
Published: July 2009

Introduction: In many reports describing flatfoot deformities, the abnormality is described using observations from physical examination, radiographs, or foot imprints. Correlation of these measurements is often lacking, making determination of the magnitude of the deformity or its surgical correction difficult to quantify. Material and Methods: Weightbearing AP and lateral radiographs were obtained on 25 patients (39 feet) with a clinically apparent flatfoot deformity and an asymptomatic control group of 28 subjects (56 feet). Radiographs were examined for the lateral talometatarsal angle, the lateral talocalcaneal angle, calcaneal pitch, first metatarsocuneiform height, medial cuneiform -fifth metatarsal height, metatarsus primus elevatus, plantar gapping at the first metatarsocuneiform joint, the AP talonavicular coverage angle, and the metatarsus adductus angle. Harris mat imprints were obtained on each foot and measured for the magnitude of the flatfoot deformity. Physical examination included the subjective appearance to the examiner of the degree of pes planus (none, mild, moderate, severe), hindfoot valgus, and ankle range of motion. Photographs of the hindfoot were obtained in a standardized manner, and hindfoot valgus was measured from these photos and compared to the measured hindfoot valgus on the physical exam. Results: Statistically significant differences between the two groups were found in the lateral talometatarsal angle, lateral talocalcaneal angle, calcaneal pitch, first metatarsocuneiform height, the AP talonavicular coverage angle, Harris mat imprint score, subjective pes planus score, hindfoot valgus measurement from both photographs and physical examination, ankle range of motion (all with a p value less than 0.01), and the metatarsus adductus angle ( p = 0.019). No patient in the control group and 14 (36%) in the flatfoot group had evidence of plantar gapping at the first metatarsocuneiform joint. In the flatfoot group, statistically significant correlations were demonstrated between the Harris mat score and heel valgus as measured by photographic and physical examination, subjective pes planus grading by physical exam, the lateral talometatarsal angle, and the first metatarsocuneiform height. Conclusion: This study validates the use of the Harris mat imprint as an effective method of quantifying the magnitude of a flatfoot deformity. We also found a statistically significant decrease in ankle range of motion in the flatfoot group, indicating that tightness of the gastrocsoleus complex is part of the pathophysiology of flatfoot deformity. Level of Evidence: III, Case Control Study
Hindfoot Motion following Reconstruction for Posterior Tibial Tendon Dysfunction
Authors: Brodsky James W. , Charlick Daniel A. , Coleman Scott C. , Pollo Fabian E. , Royer Christian T. 
Published: July 2009

Introduction: Due to advances in technology, segmental gait analysis of the foot is now possible and can elucidate hindfoot deformity in persons with posterior tibial tendon dysfunction (PTTD). This study evaluated the motion of the hindfoot and ankle power following surgical reconstruction for PTTD utilizing a segmental foot model during gait. Materials and Methods: Twenty patients who underwent posterior tibial tendon reconstruction for Stage 2 PTTD using transfer of the flexor digitorum longus tendon to the navicular tuberosity, reconstruction of the calcaneo-navicular ligament complex, and a medial displacement calcaneal osteotomy were evaluated at a minimum followup of 1 year. Three-dimensional gait analysis was performed utilizing a 4-segment foot model. Temporal-spatial parameters included walking velocity, cadence, step length, and single support time. Sagittal, coronal, and transverse hindfoot motion with respect to the tibia/fibula and ankle power was calculated throughout the gait cycle. Results: Walking velocity, cadence, and step length were not significantly different between the study subjects and the normal control group. Study patients did show a significantly smaller single support time on both the affected and unaffected limbs compared to controls. There was no statistical difference in plantarflexion-dorsiflexion, varus-valgus, or ankle push-off power between the affected and unaffected sides of the study subjects, or between the affected side and the controls. Conclusion: In this preliminary postoperative study, surgical reconstruction for PTTD effects quantifiable objective improvement in walking velocity, hindfoot motion and power. Level of Evidence: III, Case Control Series
Improvement in Surgical Consent with a Preoperative Multimedia Patient Education Tool: A Pilot Study
Authors: Beamond Ben M. , Beischer Andrew D. , Brodsky James W. , Leslie Hamish 
Published: July 2009

Background: Preoperative education and discussion is a crucial part of the surgeon-patient relationship. The purpose of this study was to assess the efficacy of a multimedia education tool to improve patients' understanding when used as an adjunct to the usual verbal consent process regarding first metatarsophalangeal joint (MTPJ) arthrodesis surgery. Materials and Methods: Thirty-one patients were prospectively recruited. There were 24 female and seven male patients with an average age of 56 years. Well-rehearsed, standardized and thorough information regarding the surgery, its risks, benefits, and usual post-operative course were supplied verbally to each patient. Patient understanding was then assessed with a condition specific questionnaire. Following this, each completed a multimedia educational program and repeated the questionnaire, including supplementary questions regarding ease of understanding and satisfaction with the two methods. Results: The patients answered 62% questions correctly before the multimedia presentation compared to 87% after it ( p < 0.001). Patients rated the ease of understanding of the multimedia module as a median 9.3 cm along a 10-cm visual analogue scale and 9.1 cm when asked whether it contained the appropriate amount of information to make a decision about surgery. Ninety percent of patients considered that the multimedia tool answered their questions about surgery as well or better than the treating surgeon. Conclusion: This study demonstrated that incorporation of a computer-based, multimedia education tool into to the surgical consent process improved patient understanding of the risks, benefits and usual postoperative course following first MTPJ arthrodesis surgery Level of Evidence: II, Prospective Cohort Study
Evaluation of the Hallux Morbidity of Single-Incision Flexor Hallucis Longus Tendon Transfer
Authors: Richardson David R. , Willers Jeffrey , Cohen Bruce E. , Davis W. Hodges , Jones Carroll P. , Anderson Robert B. 
Published: July 2009

Background: Achilles tendinosis and chronic Achilles tendon ruptures are relatively frequently encountered by orthopaedic surgeons. One treatment for patients who fail to respond to conservative management involves augmentation of the repair with transfer of the flexor hallucis longus (FHL), using either a single-incision or double-incision technique. Despite the frequency of this procedure, little is known about the associated donor morbidity. We report the effects of the single-incision technique on hallux function. Materials and Methods: We retrospectively reviewed 48 patients who underwent a single-incision FHL tendon transfer for chronic Achilles tendon rupture or Achilles tendinosis. Twenty-two patients (mean followup, 28 months) completed the study. The average age was 56 years. Outcome measures included the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal (MTP) joint and interphalangeal (IP) joint scores, the Health Related Quality of Life Measures Short Form (SF-36). Also, the average of two pedobarographic measurements of both feet and strength testing of the FHL of both feet were recorded. Results: Decreased distal phalangeal pressure and FHL weakness were demonstrated ( p < 0.05). No difference was noted in plantar pressure of the first or second metatarsal head. The high score on the AOFAS hallux MTP-IP scale demonstrated improved patient forefoot function after FHL transfer through a single-incision technique. Conclusion: Flexor hallucis longus tendon transfer using a single-incision technique results in decreased flexion power at the IP joint as demonstrated by decreased distal phalangeal pulp pressure; however, this appears to be a laboratory finding as patient function remains high. Level of Evidence: IV, Retrospective Case Series
Anterior Double Plating for Rigid Fixation of Isolated Tibiotalar Arthrodesis
Authors: Plaass Christian , Knupp Markus , Barg Alexej , Hintermann Beat 
Published: July 2009

Background: Arthrodesis is the most common procedure used to treat end-stage osteoarthritis of the ankle, particularly in patients with difficult conditions such as poor bone quality. While many techniques are available to fuse the ankle, current recommendations favor the use of internal fixation with screws and/or plates. Despite of progress, the complication rate remains a major concern. Non-union is one difficult problem especially with difficult bone conditions, particularly the loss of bone stock on the talar side. Therefore, fusion of the tibiotalar joint is often extended to the talocalcaneal joint to provide sufficient stability. To preserve the subtalar joint, an anterior double plate system for rigid fixation of isolated tibiotalar arthrodesis was developed. This is a preliminary report on the clinical and radiological outcome with this technique. Materials and Methods: Twenty-nine patients (15 men, 14 women; one ankle per patient) were treated from October 2006 to September 2007. We converted 16 ankles with osteoarthritis and difficult bone conditions, four non-united ankle arthrodeses, and nine failed total ankle replacements to an isolated tibiotalar arthrodesis using anterior double plating. If necessary, we used solid allograft to fill bony defects. Outcomes included bone union as assessed by radiographs, pain as indicated by the American Orthopaedic Foot and Ankle Society scores, and patient satisfaction. Results: Solid arthrodesis was achieved after an average of 12.3 (eight to 26) weeks in the 16 ankles without bone graft interposed between the tibia and talus, and 14.3 (range, 8 to 26) weeks in the 13 ankles with interpositional bone allograft. Radiographs showed that the position of arthrodesis obtained at the time of surgery did not change in any patient up to one year after surgery. The mean American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot Score increased from 37 (range, 20 to 63) preoperatively to 68 (range, 50 to 92) at the last followup. Twenty-seven patients (93%) were satisfied with their outcome and indicated they would have the operation again. No complications were noted. Conclusion: The anterior double plating system was shown be a reliable method to achieve solid isolated tibiotalar arthrodesis, even in ankles with difficult conditions such as loss of bone stock due to failed total ankle arthroplasty. Level of Evidence: IV, Retrospective Case Series
Total Sesamoidectomy for Painful Hallux Rigidus: A Medium-Term Outcome Study
Authors: Tagoe Mark , Brown Henry A. , Rees Sharon M. 
Published: July 2009

Background: The nature of the sesamoid complex in the development of hallux rigidus or limitus (HL) has been poorly characterized and the role of the sesamoids in the surgical management of this condition has not been explored. Previous surgical approaches in younger active patients unsuited to destructive procedures have been limited. Materials and Methods: Thirty-three patients (36 procedures) were reviewed between 2 and 4 years following total sesamoidectomy for the management of hallux rigidus/limitus. The American Orthopedic Foot & Ankle Society hallux (AOFAS) clinical rating system was used to compare pre and postoperative scores. The range and quality of motion and transfer metatarsalgia were noted. The three most important patient problems and the degree to which these had been addressed by the surgery and the time to maximal improvement were noted. Results: No significant functional impairment or malalignment were found. There were no instances of pain on metatarsal compression, or of transfer metatarsalgia with or without callus formation. A highly statistically significant improvement in AOFAS scores was found ( p < 0.001). Conclusion: High levels of clinical improvement and patient satisfaction were found following total sesamoidectomy. No deleterious consequences of sesamoid removal were observed. For symptomatic patients where a joint replacement/fusion is not indicated, total sesamoidectomy was beneficial as an interim procedure, for joints with a moderate (grades 2 to 3) degree of arthrosis. Level of Evidence: IV, Retrospective Case Study
Progressive Neuromuscular Planovalgus Foot Deformity Treated with a Modified Extra-articular Subtalar Fusion
Authors: Vlachou Maria , Dimitriadis Dimitris 
Published: July 2009

Background: Obtaining a successful subtalar fusion in the pediatric population can be challenging. We present our results with a modified extraarticular method. Materials and Methods:- We retrospectively evaluated 12 patients (17 feet) with progressive neuromuscular planovalgus foot deformity that underwent an extra-articular subtalar arthrodesis with the combined Batchelor-Grice procedure. All patients were ambulatory and were treated conservatively with braces prior to the operation. The average followup was 10 (range, 5 to 17) years. Postoperatively the feet were immobilized in short leg casts for 6 weeks. Preoperative and postoperative appearance of the feet, the clinical symptoms and radiographic measurements were recorded. Results: Sustained correction and solid fusion took place in all feet. Foot appearance and gait pattern of the patients were improved, while preoperative complaints were reduced. Radiographic healing was noted in all cases. Conclusion: This technique is an effective treatment for the correction of the deformity as it gives a greater assurance of solidarity than when either of the two procedures is used alone. Level of Evidence: IV, Retrospective Case Series
Results of Metallic Hemi-Great Toe Implant for Grade III and Early Grade IV Hallux Rigidus
Authors: Konkel Kurt F. , Menger Andrea G. , Retzlaff Sharon A. 
Published: July 2009

Introduction: The authors the short-term and mid-term results of patients with their preoperative status who were surgically treated for advanced Grade III and early Grade IV symptomatic hallux rigidus using the Futura Hemi-Great Toe Implant. Materials and Methods: The authors were able to contact 23 of 33 consecutive patients. They had a detailed evaluation preoperatively and came in for a detailed mid-term evaluation. Some of the patients were able to come in routinely for detailed periodic evaluations. Results: Periodic evaluations showed most patients had a gradual improvement of function over the first 2 years. Patients with early Grade IV disease had a greater propensity to develop early recurrence of their dorsal osteophyte at or before their mid-term followup (average 6 years). In this group of patients, the Futura Hemi-Great Toe Implants lead to 88% good to excellent mid-term results and 88% patient satisfaction over a 6-year average followup. Conclusion: Patients with early Grade IV hallux rigidus tend to develop progressive sesamoid arthritis and recurrent dorsal osteophyte formation more rapidly than advanced Grade III patients. Level of Evidence: IV, Retrospective Case Series
Glucocorticoid Injections in Lesions of the Achilles Tendon
Authors: Metcalfe David , Achten Juul , Costa Matthew L. 
Published: July 2009

Background: A number of non-operative interventions are used to manage Achilles tendinopathy. In particular, local glucocorticoid injections have generated controversy. Although a number of case reports indicate symptomatic relief following glucocorticoid injection, one systematic review found little evidence to support their efficacy. Furthermore, local glucocorticoid injections may be associated with rupture of the Achilles tendon. This systematic review considered all available clinical trials measuring the effect of local glucocorticoid injections on symptom relief in patients with Achilles tendinopathy. Materials and Methods: The search strategy encompassed five databases: Medline, EMBASE, CINAHL, AMED and the Cochrane Library. Only studies reporting the outcome of glucocorticoid injection for Achilles tendinopathy were included. Results: A total of 72 articles were identified, five of which met the inclusion criteria. These included one randomized controlled trial, three retrospective studies, and one prospective case series. Conclusion: There is no consensus as to whether local glucocorticoid injections have a therapeutic role in the treatment of Achilles tendinopathy However, they may incur a risk of tendon damage and therefore further research is required before glucocorticoid injections can be recommended for use in Achilles tendinopathy. Level of Evidence: III, Systematic Review of Level I-IV Studies