bluuebunny/crossref_metadata_2025_split huggingface dataset:
Objective Analysis of Regional Tibiotalar Joint Changes in Ankle Osteoarthritis Assessed by Semi- Automated 3D Distance Mapping
Authors: Behrens Andrew , Dibbern Kevin , Anderson Donald D. , Talaski Grayson M. , Carvalho Kepler A.M. , Mansur Nacime Salomao Barbachan , de Cesar Netto Cesar 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: Ankle osteoarthritis is a degenerative joint disease characterized by the narrowing of the tibiotalar joint space and in late stages, eventual tibiotalar contact and subchondral bone loss. Traditional methods of assessing changes in the joint space (such as assessment on 2D radiographs) are subjective and do not fully consider the three-dimensional nature of articular surfaces. Weight-bearing CT (WBCT) provides a unique perspective by placing the joints of the lower extremity in a loaded, functional position, and may help to better quantify changes in joint space. Determining the presence and progression of ankle arthritis is difficult. It is our hope that novel 3D distance mapping technologies using images acquired from WBCT may assist with the detection and characterization of progression of ankle osteoarthritis. Methods: In this IRB-approved, retrospective case-control study, we analyzed WBCT data of 9 ankle osteoarthritis patients and 20 healthy controls. Patients included in this study had no identifiable talar tilt. Segmentations were created using an automated segmentation software package (DISIOR Bonelogic 2.0) Principal component analysis was used to divide the talar dome into nine subregions. The articular facet of the medial malleolus was also analyzed. We used 3D distance mapping to objectively measure joint space width across the tibiotalar joint and assessed changes in distance in each of the nine subregions of the talar dome articular surface. Overall mean distances for each subregion analyzed were calculated. Comparisons between the control and ankle arthritis cases were performed with independent t-tests, assuming unequal variances. P-values < 0.05 were considered significant. Results: Changes in the mean distances are reported in the attached figure. The medial side of the talar experienced significant decreases in mean joint space width. The middle medial subregion experienced the largest decrease in mean joint space width with a reduction of 35% when compared to controls (p = 0.017). Increases in joint space width were observed on the lateral aspect of the talar dome, However, these increases were not found to be significant. Conclusion: The purpose of this study is twofold: to quantify changes in joint space using 3D distance mapping technique and to evaluate the utility of a commercial automated segmentation software package. In this cohort, there was a significant decrease on the medial side of the talar dome – this change can be attributed to cartilage degeneration. To our knowledge, this is the first study to analyze changes in ankle osteoarthritis using a fully automated segmentation method. Automated segmentation and 3D distance mapping provide a useful tool for the quantification of osteoarthritis-associated joint space changes.
One Year Outcomes of the H-AMIC Procedure for Osteochondral Lesions of the Talus
Authors: Haldar Anil , Ardakani Amir Hossain Gahanbani , Patel Shelain , Welck Matthew J. , Malhotra Karan , Cullen Nicholas 
Published: December 2023

Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: Osteochondral lesions of the talus (OLTs) present a challenging clinical problem. Hyaluronic acid assisted autologous membrane-induced chondrogenesis (H-AMIC) is a technique where a polyglycolic acid and hyaluronin membrane scaffold (Chondrotissue®) is affixed over an area of talar bone marrow stimulation. Our study aims to assess the efficacy of this technique. Methods: We undertook a prospective study on consecutive adult patients at our unit who had H-AMIC procedures between January 2020 and November 2021 to treat single, symptomatic OLTs, >1.5cm2, refractory to previous management. Data was collected on patient reported outcomes (MOxFQ, EQ5D, satisfaction), ankle range of movement, and complications at 1-year post-surgery. Fifteen patients were included in this study with a mean age of 33.8±20.9 years. Mean duration of symptoms was 7.9±5.2 years, with a mean of 1.5 previous procedures (range 0 to 3). All patients had osteotomies to gain access to the OLT (13 medial malleolar, 2 fibular). Results: Mean improvements greater than the minimum clinically important difference (MCID) were seen in MOxFQ-Pain (61.7±26.1 to 48.3±21.8, p=0.112), MOxFQ-Walking (64.6±21.8 to 46.6±23.9, p=0.067), MOxFQ-Social (63.67±22.5 to 41.8±29.2, p=0.055), although none reached statistical significance. No difference was seen in EQ5D. Overall improvements were seen in MOxFQ-Pain in 58.3%, MOxFQ-Walking in 75%, and MOxFQ-Social in 83.3% of patients. Overall, 11 patients (73.3%) were satisfied with the procedure. Patients displayed improvement in plantarflexion from 33.1±5.5 to 42.0±7.9 degrees (p=0.002) and no change to dorsiflexion. There were no complications. Conclusion: The H-AMIC procedure is a promising and safe option for larger osteochondral lesions of the talus. Early results suggest improved range of motion despite osteotomy and clinically (but not statistically) significant improvement in function in a group of patients with longstanding symptoms and previous failed surgery. Larger, adequately powered cohorts may establish statistical efficacy of this technique compared with alternative techniques.
Outcomes following Peroneal Tendoscopy for Peroneal Tendon Disorders: A Systematic Review
Authors: Butler James J. , Nair Akshay A. , Campbell Hilary T. , Azam Mohammad T. , Kennedy John G. 
Published: December 2023

Category: Other; Ankle Introduction/Purpose: The purpose of this systematic review was to evaluate the clinical and radiological outcomes at short-term follow-up following peroneal tendoscopy for the treatment of peroneal tendon disorders. Methods: During October 2022, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following peroneal tendoscopy for the treatment of peroneal tendon disorders. Data regarding patient demographics, pathological characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. Results: Nine studies were included. In total, 264 patients (269 tendons) underwent peroneal tendoscopy for the treatment of peroneal tendon disorders at a weighted mean follow-up of 30.5±11.4 months. The peroneal tendon disorders included: peroneal tendon tear (89 patients), peroneal tenosynovitis (85 patients), low lying muscle belly (54 patients) and peroneal tendon subluxation (17 patients). The weighted mean AOFAS score improved from a pre-operative score of 76.0 to a weighted mean post-operative score of 96.0. The complication rate was 3.8%, the most common of which was persistent lateral ankle pain (1.1%). Two failures (0.007%) were reported, both of which underwent repeat peroneal tendoscopy, tenosynovectomy and low lying muscle belly resection. Conclusion: This systematic review demonstrated improvement in subjective clinical outcomes together with a low complication rate and low failure rate at short-term follow-up following peroneal tendoscopy for the treatment of peroneal tendon disorders. However, the level of evidence was low and the quality of evidence was poor. In addition, there was significant heterogeneity between the included studies. Further higher quality studies are warranted to determine the optimal role of peroneal tendoscopy for the management of peroneal tendon disorders.
Predictors of Intraoperative and Early Complications in Total Ankle Replacement
Authors: Cornelius Canon C. , Greaser Michael , Gauvain Taggart , Beaver Richard , Duncan Leslie A. , McGarvey William 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: Predictors of intra operative and early complications following total ankle replacement (TAR) become more important as the incidence and indications for TAR continue to expand. Talar bone loss whether from avascular necrosis, osteoarthritis, or post traumatic arthritis can be a challenging problem to deal with in TAR. The aim of this study is to report predictors of complications in TAR with talar bone loss. Methods: A retrospective review using CPT codes for four surgeons over a three-year period at an academic institution was performed. A single surgeon reviewed the immediate preoperative plain radiographs for 200 consecutive patients for talar bone loss. The mortise and lateral views were used to calculate talar bone loss and then averaged (Fig 1). 37 patients were identified as having talar bone defects of greater than 20 percent when the two measurements were averaged. Our preoperative variables we looked at were size of talar defect, location, and cause of talar defect and postoperatively, the implant choice. Our primary outcomes were intraoperative fracture, reoperation, subsidence, and revision surgery. Results: The average follow up was 23 months. The average defect size was 54 percent with a range of 20 to 100 percent. Mann U Whitney tests were performed that showed a relationship between the lateral and overall percentage of talar bone loss being predictive of subsidence of the talar component. A Fischer exact test showed a that a chamfered talus cut was protective against subsidence. The mean of the talar bone loss for the chamfered components were 40% versus 58% in flat cut. There were no other significant differences when comparing complications, fracture, reoperation, or wound complications. Conclusion: While TAR for patients with talar bone loss can be a good option for the patient and surgeon it does have a higher complication rate than standard TARs. Careful attention should be given to the percentage of talar bone loss. Flat cut and revision style components were more likely to be used in worse situations, so it is not the authors belief that they are more prone to subsidence. All patients over 20% bone loss need extensive discussion regarding potential complications and additional procedures. Talar bone loss is a difficult problem to deal with but TAR is a viable option.
Retrograde Drilling for Hepple-V Subchondral Lesion of Talus using 3D Image-based Navigation Assisted Endoscopic Technique
Authors: Shijun Wei 
Published: December 2023

Category: Ankle; Arthroscopy Introduction/Purpose: Retrograde drilling remains technically challenging, due to the difficulty of identifying the accurate location of cysts on fluoroscopic images or matching the tip of the drill guide under arthroscopic visualization. This studies aim was to evaluate the 3-dimentional(3D) image-based surgical navigation system assisted endoscopic retrograde drilling technique for subchondral lesions of the talus. Methods: From Mar 2018 to Jun 2020, 21 cases with Hepple-V type subchondral lesions of the talus were treated with 3D image- based surgical navigation system assisted endoscopic retrograde drilling technique. Arthroscopic views were categorized per Pritsch’s classifications. The American Orthopaedic Foot and Ankle Society (AOFAS) scores and Visual Analog Scale (VAS) scores were evaluated at the preoperative and final follow-up appointments. All complications were also recorded. Results: The average follow-up time was 29.2 ± 9.4 months (range, 24 – 48). Only 9 cases (42.9%) showed intact and normal cartilage surfaces (grade 0, group A), 12 cases (57.1%) had intact, soft cartilage surfaces (grade I, group B). At the final follow-up, the average of the AOFAS scores and VAS scores were 89.0 ± 2.1 vs 88.3 ± 2.0 and 0.8 ± 0.2 vs 0.8 ± 0.3, respectively. There were no significant differences between both groups. In group B, however, two patients were documented with signs of recurrence after 2 years postoperative. Also, an additional overlying cartilage lesion was noticed in another patient. Finally, two patients were given revised surgery. Conclusion: The 3D image-based surgical navigation system assisted endoscopic retrograde drilling technique is accurate, effective and safe for the subchondral lesions of the talus. The ideal indication is subchondral cysts with intact and normal cartilage surfaces. However, these patients are uncommon.
Revision Total Ankle Arthroplasty Outcomes in a Large Single-Center Series: Evaluation of Coronal Plane Deformity Correction and Patient Reported Measures
Authors: Kim Billy I. , Anastasio Albert T. , Valan Bruno N. , Krez Alexandra , DeOrio James K. , Nunley James A. , Easley Mark , Adams Samuel 
Published: December 2023

Category: Ankle Arthritis Introduction/Purpose: As total ankle arthroplasty (TAA) rises in popularity nationwide, the incidence of major complications and need for revision TAA will continue to increase. A better understanding of the ability to durably correct deformity and improve patient reported outcomes (PROs) in the TAA revision setting is paramount for surgeons facing the impending wave of failed TAA. Thus, the purpose of this study was to present the largest single-center case series of revision TAA to date and to evaluate improvement in PROs and maintenance of correction of coronal plane deformity in patients undergoing this procedure. Methods: This was a single-center, retrospective review of 87 revision TAAs performed between 2007 and 2022. Reoperations for cyst formations only or without metallic component exchange were excluded. The two most common implants used for revision TAA were Inbone II (n=65) and Inbone I (n=14). Mean follow-up was 2.8 ± 2.9 years. Data on patient preoperative characteristics, concurrent procedures, and postoperative complications were collected. The primary outcome measures were time to major complication, reoperation, and infection. Secondary outcomes included PROs and correction of coronal plane deformity measured from both the tibial plafond and talar articulating surface from pre- to post-operatively. Cox regression analyses were performed to compute survivorship. Results: The most common concurrent procedures performed concomitantly with revision TAA were gastrocnemius recession (n=31, 35.6%), subtalar arthrodesis (n=18, 20.7%), and talonavicular arthrodesis (n=5, 5.7%). Mean preoperative coronal plane deformity measured off both the tibial plafond and talar articular surface improved after revision TAA. 1- and 5-year survivorship from major complication, reoperation, and infection is shown in Table 2. Fourteen patients underwent subsequent revision, including TAA (n= 6, 6.9%), arthrodesis (n= 4, 4.6%), below-the-knee amputation (n= 2, 2.3%), or implantation of an antibiotic spacer (n= 2, 2.3%). At one-year postoperatively, mean VAS pain score, SF36, and AOFAS Hindfoot score was 18.2 ± 16.0, 73.0 ± 13.3, and 68.8 ±:9.3, respectively, representing an improvement in PROs after revision TAA. Conclusion: In the largest single-center series of patients undergoing single or double component exchange revision TAA, we demonstrate durable improvements in coronal plane deformity measured off both the tibial plafond and talar articular surface. We also noted 63.0% survivorship with regards to reoperation and improvements in average PROs across the cohort. Overall, revision TAA is a successful procedure, but is associated with higher failure rates at 5 years than primary TAA.
Safe Zones Analysis for Lateral Column Lengthening Using Weightbearing CT and Distance Mapping
Authors: Barbero Agustin , Efrima Ben , Indino Cristian , Ramalingam Kuharajan , Maccario Camilla , Usuelli Federico Giuseppe 
Published: December 2023

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: Lateral column lengthening (LCL) is the cornerstone for flexible, progressive collapsing foot correction. Evans LCL (ELCL) and Hinterman LCL (HLCL) are the most used surgical techniques. ELCL is performed between the anterior and medial facets and endangers specific os-calcis subtypes (OSCT). HLCL passes in a safe zone between the posterior and medial facets and should be suitable for all OSCTs. However, both osteotomies are associated with increased subtalar osteoarthritis, indicating iatrogenic damage. Distance mapping (DM) enables visualization of the relative distance between two articular surfaces using color patterns. This study aims to measure the safe zones for LCL using DM. Methods: Using the Bruckner et al. classification, two raters categorized 134 patients and 200 feet into the four OSCTs. Four angles were measured. The proximal posterior safe zone (PSZ) and distal PSZ angles defined the safe zone for HLCLO; it was measured for all OSCTs. The proximal anterior safe zone (ASF) angle and the distal ASF defined the safe zone for ELCLO. They were measured only in cases where a discontinuity between the two facets exists or in the absence of anterior facet. A statistical comparison between the groups was made Results: The mean proximal PSZ angle was 68+/-7 degrees, the distal PSZ angle was 75+/-5, the Proximal ASZ angle was 89+/-6 degrees, and the distal ASZ angle was 95+/- 5 degrees. There were no statistically significant differences between the OSCTs. In five patients, the PSZ morphology did not allow planning for HLCLO.in 13 cases; the ASZ left insufficient bone stock between the ELCLO and the calcaneal cuboid joint. Conclusion: In this study, we used DM to determine the safe zone for LCL. The high OSCT and morphology variability call for patient-specific LCL preoperative planning. DM could be reliably used to tailor the optimal surgical solution.
Supramalleolar Osteotomy Combined with Medial Malleolar Osteotomy for Varus Ankle Osteoarthritis with Varus Medial Malleolar Deformity
Authors: Hio Naohiro , Taki Masanori 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: In some cases of varus ankle osteoarthritis (VAO), the varus medial malleolar deformity causes widening of the mortise and reduced conformity. In such cases, the angles of the medial distal tibial platform and the angle of the talar medial shoulder are different, so it is necessary to match the angles of both to improve the compatibility of the mortise. We performed lateral closing wedge supramalleolar osteotomy (LCWSMO) with opening wedge medial malleolar osteotomy (OWMMO) to achieve lateral shift of the load-bearing axis and mortise-plasty at the same time. The purpose of this study was to evaluate the therapeutic outcomes of this technique for VAO with the varus medial malleolar deformity. Methods: The subjects were 12 joints in 12 cases, two males and ten females, the mean age at the surgery was 58.2 years (36-76 years), and the mean follow-up period was 9 years and 1 month (1-20 years and 4 months). After LCWSMO was performed, OWMMO was made to fit the mortise, and autogenous bone grafting was performed in the gap. Additional surgery included two lateral ligament reconstructions, one osteochondral graft, and one high tibial osteotomy. Clinical evaluation was performed using the score of Takakura et al. For arthroscopic evaluation, we used our five grades classification, which is based on the percentage of eburnation areas on the articular surface. The radiographic assessments were the Takakura-Tanaka staging system, the tibial articular surface angle, the tibial lateral surface angle, the talar tilting angle, and the ratio of the medial distal tibial platform angle to the medial talar shoulder angle. Results: The clinical score improved from a preoperative average of 65.0±9.3 points to 82.8±9.8 points at the final follow-up. All arthroscopic grade improved at one year after surgery except one each of grade 2 and grade 3 joints which remained unchanged. According to the postoperative radiographic staging, 6 joints had improved, 3 had not changed, and 3 had progressed. The tibial articular surface angle increased from an average of 84.4 ± 2.1° preoperatively to 97.4 ± 3.6° at the last observation, the tibial lateral surface angle from 80.5 ± 2.5° to 83.7 ± 5.9°, the talar tilting angle increased 11.3 ± 4.7° to 7.9 ± 4.3°, and the ratio of the medial distal tibial platform angle to the medial talar shoulder angle from 112.3±4.9% to 103.6±5.8%. Conclusion: For VAO with varus medial malleolar deformity and large mortise opening, good results can be obtained by lateral shift the load-bearing axis with LCWSMO and improving the fit of the mortise with OWMMO.
Systematic Review of Intra-Articular Use of Antibiotics and Antiseptic Irrigation and their Association with Chondrolysis
Authors: Post Hunter K. , Blankespoor Michael , Ierulli Victoria K. , Morey Tucker , Schroeppel J. Paul , Mulcahey Mary K. , Vopat Bryan , Vopat Matthew L. 
Published: December 2023

Category: Arthroscopy; Other Introduction/Purpose: Intra-articular antibiotics have been proposed as a treatment for septic arthritis to allow for high local concentrations without subjecting a patient to systemic therapy and its associated toxicity/side effects. However, there is concern for chondrotoxicity with intra-articular use of antimicrobials and antiseptic solutions in high concentrations. The purpose of this systematic review was to evaluate the intra-articular use of antibiotics and antiseptic solutions, determine their association with chondrolysis following in vitro or in vivo administration, and identify the dosages at which they become chondrotoxic. Methods: A systematic review was conducted following the PRISMA guidelines through PubMed, Clinical Key, OVID, and Google Scholar. Studies were included if they were written in the English language and evaluated for chondrotoxicity following in vitro or in vivo intra-articular exposure to an antibiotic and antiseptic solutions. All agents, study characteristics, and conclusions were extracted and summarized. Results: The initial search resulted in 228 studies, with 36 meeting full inclusion criteria. Overall, chondrotoxicity was not associated with 7 out of 24 (29%) included agents: minocycline, tetracycline, chloramphenicol, teicoplanin, pefloxacin, linezolid, polymyxin-bacitracin. Inconsistent results were noted with 8 (33%) agents: doxycycline, ceftriaxone, gentamicin, vancomycin, ciprofloxacin, ofloxacin, chlorhexidine, and povidone iodine. Chondrotoxicity was evident with 9 (38%) agents, all of which were also dose-dependently chondrotoxic based on reported estimated half maximal inhibitory concentrations (est.IC50): amikacin (est. IC50 = 0.31-2.74 mg/mL), neomycin (0.82 mg/mL), cefazolin (1.67-3.95 mg/mL), ceftazidime (3.16-3.59 mg/mL), ampicillin- sulbactam (8.64 - >25 mg/mL), penicillin (11.61 mg/mL), amoxicillin (14.01 mg/mL), imipenem (>25 mg/mL), and tobramycin (>25 mg/mL). Additionally, certain studies reported chondroprotective effects of doxycycline and minocycline. Conclusion: This systematic review identified antimicrobial and antiseptic agents that may be used in the treatment of septic arthritis. The following agents should be avoided due to their dose-dependent chondrotoxic effects: amikacin, neomycin, cefazolin, ceftazidime, ampicillin-sulbactam, penicillin, amoxicillin, imipenem, and tobramycin. Further studies, especially in human models, are needed to clarify the safety of these medications for human intra-articular use.