bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Outcomes and Complications of the Zadek Calcaneal Osteotomy in Insertional Achilles Tendinopathy: A Systematic Review and Meta-analysis
Authors: Poutoglidou Freideriki , Drummond Isabella , Patel Amit , Malagelada Francesc , Jeyaseelan Lucky , Parker Lee 
Published: December 2023

Category: Hindfoot; Ankle Introduction/Purpose: Insertional Achilles Tendinopathy (IAT) is a degenerative process at the insertion of Achilles tendon onto the calcaneal tuberosity that often coexists with retrocalcaneal bursitis and Haglund’s deformity. The Zadek osteotomy, a dorsal closing wedge osteotomy of the calcaneus, has been described as a treatment option in patients with IAT that have failed conservative management. The aim of this study was to evaluate the clinical outcomes and the complications of the Zadek for the management of IAT. Methods: PubMed, EMBASE and Cochrane Central Register of Controlled Trails (CENTRAL) were searched for all studies to November 2022. PRISMA guidelines were followed. The overall estimates of effect were presented as Weighted Mean Difference (WMD) and 95% confidence intervals (CIs). Meta-analysis was conducted using the Review Manager Software (RevMan, Version 5.4). Results: Ten studies with 232 patients were included. The AOFAS (American Orthopaedic Foot and Ankle Society) Ankle- Hindfoot Score and the VISA-A score (Victorian Institute of Sports of Australia-Achilles score) were significantly improved after the Zadek osteotomy (p < 0.00001). Pain levels were also significantly reduced (p < 0.00001). There were a total of 22 complications reported in the included studies and they were all considered minor. The most common complications were superficial wound infection and sural nerve paraesthesia. Conclusion: The Zadek osteotomy is a safe and effective procedure for patients with IAT. The osteotomy improves pain levels and functions and is associated only with minor complications and a low complication rate. There are no well-designed randomized controlled trials in the literature assessing the outcomes of a Zadek osteotomy against alternate surgical treatments and future research should focus on this.
Deformities Influencing Different Classes in Progressive Collapsing Foot
Authors: Fayed Aly M. , Mallavarapu Vineel , Schmidt Eli , Kim Ki Chun , Lalevee Matthieu , Ehret Amanda , Lintz François , Carvalho Kepler A.M. , Mansur Nacime Salomao Barbachan , de Cesar Netto Cesar 
Published: December 2023

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: The current classification system of progressive collapsing foot deformity (PCFD) is comprised of 5 possible classes. PCFD is understood to be a complex, three-dimensional deformity occurring in many regions along the foot and ankle. The question remains whether a deformity in one area impacts other areas. The objective of this study is to assess how each one of the classes is influenced by other classes by evaluating each associated angular measurement. We hypothesized that positive and linear correlations would occur for each class with at least one other class and that this influence would be high. Methods: We retrospectively assessed weight-bearing computed tomography (WBCT) measurements of 32 feet with PCFD diagnosis. The classes and their associated radiographic measurements were defined as follows: class A (hindfoot valgus) measured by the hindfoot moment arm (HMA), class B (midfoot abduction) measured by the talonavicular coverage angle (TNCA), class C (medial column instability) measured by Meary’s angle, class D (peritalar subluxation) measured by the medial facet uncoverage (MFU), and class E (ankle valgus) measured using the talar tilt angle (TTA). Multivariate analyses were completed comparing each class measurement to the other classes. A p-value < 0.05 was considered significant. Results: Class A showed a substantial positive correlation with class C (ρ=0.71; R2=0.576; p 0.001). Class B was substantially correlated with class D (ρ=0.74; R2=0.613; p 0.001). Class C showed a substantial positive correlation with class A (ρ=0.71; R2=0.576; p 0.001) and class D (ρ=0.75; R2=0.559; p 0.001). Class D showed a substantial positive correlation with class B and class C (ρ=0.74; R2=0.613; p 0.001), (ρ=0.75; R2=0.559; p 0.001) respectively. Class E did not show correlation with class B, C, or D (ρ=0.24; R2=0.074; p=0.059), (ρ=0.17; R2=0.071; p=0.179), and (ρ=0.22; R2=0.022; p=0.082) respectively. The average values of each class radiographic markers are listed in Figure 1. Conclusion: This study was able to find relations between components of PCFD deformity with exception of ankle valgus deformity (Class E). Measurements associated with each class were influenced by others, and in some instances, with pronounced strength such as between class A and C as well as between Class B and D. Surgical procedures to address certain class deformities could indirectly address other classes as well, which ultimately decreases surgical procedures numbers or complexity. The presented data may support the notion that PCFD is a three-dimensional complex deformity and suggests a possible relation among its ostensibly independent features.
Patient Reported Outcomes using PROMIS after Tarsal Tunnel Release Surgery
Authors: El-Zein Zein S. , Botros Mina , Florentino Samuel A. , Baumhauer Judy 
Published: December 2023

Category: Other Introduction/Purpose: Tarsal tunnel syndrome is an entrapment neuropathy of the tibial nerve and its branches in the tarsal tunnel. The literature on surgical release of the tarsal tunnel shows variable outcomes with no studies reporting validated patient reported outcomes. We aim to determine clinical response after tarsal tunnel release using the Patient-Reported Outcomes Measurement Information System (PROMIS). Methods: Under an IRB-approved protocol, CPT code 28035 was used to identify patients who underwent isolated tarsal tunnel release (TTR) between 1/1/2015 and 12/15/2022 at a single institution. Patient demographic data and PROMIS CAT physical function (PF), pain interference (PI), and depression scores were prospectively collected at the initial pre-operative clinic visit and in follow-up throughout the episode of care after TTR. The validated distribution-based method (1/2 sd) was used to assess minimal clinically important difference (MCID). Bivariate analysis was used to determine the postoperative recovery after TTR. Statistical significance was set at p< 0.05. Results: A total of 39 patients who underwent tarsal tunnel release were included. The mean age was 49.1 years (19.44-70.75 years) and mean follow-up was 280.9 days (23-1,459 days). The mean PROMIS PF score improved from 38.97 preoperatively to 46.17 postoperatively (p-value= 0.0024). The mean PROMIS PI score improved from 63.75 preoperatively to 57.65 postoperatively (p-value < 0.001). The mean PROMIS depression score improved from 49.78 preoperatively to 43.85 postoperatively (p-value < 0.001). The mean t-score change (pre to post-operation) was 7.2 for PF, -6.1 for PI, and -5.93 for depression. MCID thresholds were calculated as PF increase of 4.7; PI decrease of 3.9; and Depression decrease of 5.1. Fourteen (35%), 24 (62%), and 27 (69%) patients reached MCID for PF, PI, and depression, respectively. Conclusion: This study provides validated outcomes after TTR. Though there is improvement after surgery, the patients still experience some pain and physical limitations. Interestingly, the greatest gains were seen in depression symptoms supporting the idea that mental health is impacted in these chronic compressive neuropathy conditions.
The Burden of Revision Total Ankle Replacement Has Markedly Increased from 2010 to 2020
Authors: Ratnasamy Philip P. , Maloy Gwyneth , Oghenesume Oghenewoma , Peden Sean C. , Grauer Jonathan N. , Oh Irvin 
Published: December 2023

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) surgery has steadily increased in recent decades. The aim of the current study was to investigate the evolving burden of revision surgery and risk factors and timing of revision or implant removal. We hypothesized that there has been an increase in revision TAR and explant surgeries in the past decade and that younger age and higher comorbidity burden are risk factors for revision and explant. Methods: Using the 2010-2020 PearlDiver M151Ortho dataset, this retrospective cohort study identified primary TAR, TAR revision, and TAR explant patients. This is a large national database containing billing claims information on over 151 million patients in the United States across all payer types and sites of care. Patient factors investigated included age, sex, and Elixhauser Comorbidity Index (ECI, a longitudinal measure of patient comorbidity burden generated using ICD-9 and ICD-10 diagnosis codes). Annual incidence for primary and revision TAR, and explant were recorded. Multivariate logistic regression analyses were performed to determine independent risk factors for revision TAR or explant relative to primary TAR. For explants, the eventual intervention by two years was analyzed. Ten-year timing and survival to revision or explant surgery following patient-matched unilateral TAR were characterized. Results: Over the study period, there were 10,531 primary, 1,218 revision, and 1,735 explant TARs (increasing by 310%, 398%, and 9.6%, respectively). Independent predictors of revision TAR included: younger age (odds ratio [OR] 1.29 per decade decrease) and higher ECI (OR 1.23 per 2-point increase) (p < 0.0001 for both). Independent predictors of explant surgery included: younger age (OR 1.80 per decade decrease, p< 0.0001), female sex (OR 1.17, p=0.0011), and higher ECI (OR 1.35 per 2-point increase, p< 0.0001). Explanted patients went on to arthrodesis (37.7%), amputation (26.1%), revision TAR (14.7%), or no identified procedure/other procedures (21.5%) within the subsequent two years. The 10-year implant survival rate following primary TAR was 91.8%. 73% and 83% of revisions and explants occurred in the first three years following index TAR, respectively. Conclusion: The burden of TAR revision has grown substantially over the past decade. Younger age, female sex, and higher patient comorbidity burden were associated with increased risk of revision or explant surgery. If explant is pursued, most went on to arthrodesis or amputation. These results suggest that care should be taken in patient selection for TAR to minimize the occurrence of revision and explant surgery. Treatment algorithms should be modified to optimize outcomes among patients who undergo explant or revision surgery.
The Workers Compensation Burden: Does Compensation Status Lead to Increased Utilization of Healthcare Resources Following Foot and Ankle Surgery?
Authors: Goodwin Tyler , Wilson Andrew , Doty Jesse F. 
Published: December 2023

Category: Other Introduction/Purpose: The association between workers’ compensation (WC) patients and the increased risk of complications and poor outcomes following orthopaedic procedures has been well documented. Recent studies have shown that WC patients have a higher rate of subsequent pain or injury than non-WC patients following common foot and ankle procedures. Due to the increased risks of complications, poor outcomes, and chronic pain amongst WC patients following orthopaedic procedures, it is possible that these patients consume more healthcare resources than non-WC patients during the post-surgical period. This study aimed to investigate the amount of healthcare resources utilized by WC patients following a foot or ankle procedure compared with a procedure-matched control group. Methods: A retrospective review was conducted of all WC and non-WC patients who had undergone foot (CPT 28001-28899) or ankle (CPT 27600-27899) procedures by a single surgeon from October 2017 through January 2020. Patients were excluded based on age ( < 18 or >70), bilateral procedures, presence of neuropathy, disability, and insufficient follow-up. Data collection included demographic, social, surgical, perioperative follow-up, and complications. Measures of healthcare burden included patient communications, physical encounters, processed documents, overall total prescriptions, the total number of office visits, days to return to work, and days to discharge from the clinic. Data analysis was performed with SPSS version 28. Comparisons were conducted with Mann-Whitney U test, chi-square test, or Fisher’s exact test. Power analysis determined the sample size with a 0.05 alpha level, 0.80 power, and 0.5 effect size. Results: 142 patients met the inclusion criteria including 71 WC patients and 71 non-WC patients. Measures of healthcare burden were greater in WC patients. WC patients had more communication encounters (median 6 vs 3; P<.001), processed documents (median 6 vs 1; P<.001), total prescriptions (median 5 vs 3; P<.001), the total number of office visits (median 8 vs 6; P<.001), days to return to work (median 119 vs 74; P<.001), and days to discharge (median 267 vs 194; P<.001). WC patients were also more likely to have postoperative complications (OR 2.1; P=.045), secondary surgeries (OR 8.2; P<.001), and new complaints during follow-up (OR 1.9; P=.070). WC was less likely to cancel appointments (OR 0.4; P=.028). Conclusion: WC patients demonstrate increased healthcare resource utilization compared to the non-WC population. WC was associated with a higher burden on office staff requiring more time commitment to a single patient. Double the effort was evident on some measured parameters. WC patients also receive more medication prescriptions overall and are more likely to have complications, subsequent surgery, and new complaints remote to the inciting injury.
Transient Exposure of Tissue-Engineered Cartilage Analogs to Synovial Fluid Hematoma After Ankle Fracture Promotes Chondrocyte Death and Alters Gene Expression Toward an Osteoarthritic Phenotype
Authors: Allen Nicholas , Aitchison Alexandra Hunter , Bagheri Kian , Guardino Nicholas , Abar Bijan , Anastasio Albert T. , Adams Samuel 
Published: December 2023

Category: Basic Sciences/Biologics; Ankle Arthritis Introduction/Purpose: The first stage of fracture healing consists of hematoma formation with recruitment of proinflammatory cytokines and matrix metalloproteinases. Unfortunately, when there is an intra-articular fracture, these inflammatory mediators are not retained at the fracture site, but instead, bathe the healthy cartilage of the entire joint via the synovial fluid fracture hematoma (SFFH). These inflammatory cytokines and matrix metalloproteinases are known factors in the progression of osteoarthritis and rheumatoid arthritis. Despite the known inflammatory contents of the SFFH, little research has been done on the effects of the SFFH on healthy cartilage with regard to cell death and alteration in gene expression that could lead to post- traumatic osteoarthritis (PTOA). Methods: SFFH was collected from 12 patients with intraarticular ankle fracture at the time of surgery. Separately, human chondrocytes were three-dimensionally cultured to create scaffold -free cartilage tissue analogues (CTAs) to simulate articular cartilage. Experimental CTAs (n=12) were exposed to 100% SFFH for 3 days, washed, and transferred to complete media for 3 days. Control CTAs (n=12) were simultaneously cultured in complete medium. Subsequently, CTAs were harvested and underwent biochemical, histological, and gene expression analysis. Results: Exposure of CTAs to ankle SFFH 3 days significantly decreased chondrocyte viability by 34% (p = .027). Gene expression of both COL2A1 and SOX9 were significantly decreased after exposure to SFFH (p= .012 and p=.0013 respectively). COL1A1 expression trended upward in the SFFH exposure group while there was no difference in RUNX2 and MMP13 gene expression. Quantitative analysis of Picrosirius red staining demonstrated increased collagen I deposition with poor ultrastructural organization in SFFH exposed CTAs. Conclusion: Exposure of an organoid model of healthy cartilage tissue to SFFH after intraarticular ankle fracture resulted in decreased chondrocyte viability, decreased expression of genes regulating normal chondrocyte phenotype, and altered matrix ultrastructure indicating differentiation toward an osteoarthritis phenotype.
A Bibliometric Analysis of the 50 Most-cited Publications in Plantar Fascia Release
Authors: Arrington Derek , Markel Jacob F. , Anciano Victor 
Published: December 2023

Category: Hindfoot; Sports Introduction/Purpose: As scientific publications continue to increase across all medical specialties, comprehensive bibliometric analyses have been utilized to evaluate the significance and impact of certain articles. Plantar fasciitis is a complex condition with often debilitating symptoms for patients. There is controversy regarding optimal treatment for it. Furthermore, to add complexity to the topic is looking through the vast literature available. The objective of this study was to analyze publications on plantar fascia release to understand the relevancy of publications in the field and provide a framework to review the literature. Methods: Using Web of Science database and the search strategy plantar fascia release OR plantar fasciitis OR plantar fasciitis surgery OR plantar fasciotomy, we identified 965 total articles. The search results were then refined to include 931 publications filtered for “English.” Results were further refined to 657 publications filtered for “articles.” Papers were then exported from Web of Science in Microsoft Excel and analyzed for total citations, average number of citations, authorship, journal, institution, country of publication, and year of publication. We determined the 50 most-cited articles about plantar fascia release and analyzed the parameters of these studies. Results: The 657 analyzed articles were published between 1974 and 2023 with a plurality 57 published in each of 2020 and 2022. Elsevier was the most successful publisher with 136 of the publications. Of the authors, Langford authored 7 of the 657 publications. The top 50 most cited articles were cited on average 131.2 times, ranging from being cited 76 to 403 times. The United States was found to have the most publications with 30 of the top 50 regarding Plantar fascia release, followed by Australia with 5 publications. The top 50 articles in this analysis were published between 1983 and 2013, with the most cited being Riddle (2003). Conclusion: A vast array of publications regarding plantar fascia release exists within the field of Orthopaedics. With so much information available, it is difficult to navigate the intricacies of pertinent research. As research began in 1974 and has flourished over the last decade, both publications and the number of times articles are cited have been increasing. This growth indicates a growing relevance of researching plantar fascia release. The purpose of this article was to review the 50 most cited articles discussing plantar fascia release to help guide the reader and further research of this topic.
A Novel Treatment Protocol to Improve Outcomes with Transtibial Amputations
Authors: Duda Marcus V. 
Published: December 2023

Category: Diabetes; Other Introduction/Purpose: A retrospective case series study was performed to evaluate the outcomes and risk factors of transtibial amputations (TTA) using a novel post operative treatment protocol. The study hypothesis is that a novel post operative treatment protocol could improve outcomes for TTAs. All patients who underwent a TTA from July 2019 through December 2022 were treated with this protocol. Outcomes identified included time to prosthetic fitting after surgery and complications including wound dehiscence and mortality at 30 days. Risk factors were also identified for the patients in this case series study. Methods: The novel post operative protocol includes a circumferential incisional negative pressure wound therapy (CiNPWT) dressing that covered with a novel residual limb shrinker (nRLS) and a limb protector (LP) applied after incision closure. The CiNPWT and nRLS were removed at the first follow up visit. Then the nRLS was applied as the primary dressing directly against the incision covering the residual limb. The nRLS was changed for wound cleansing and was sequentially decreased in size to facilitate consolidation of the residual limb. Results: There were 433 surgeries performed on 304 patients. This included 222 (73%) men and 81 (27%) women with an average age of 67 years (41-90 years). There were 129 revision surgeries including 25 above-the-knee amputations (AKA). The average time to prosthetic fitting for TTA was 8 weeks. The average study group BMI was 32 kg/m2, A1c 8.7%, albumin 2.6 g/dL and neutrophil to lymphocyte ratio (NLR) 4.9. Traumatic wound dehiscence from falls represented 26% of revision surgeries. Mortality at 30 days was 3.2% for all study participants. The early death average age was 70 years (41-90 years), 73% with end stage renal disease (ESRD) and 82% with diabetes mellitus (DM). Conclusion: The novel protocol for transtibial amputations decreased the 30 day mortality to 3.2% from a national average of 13.5%. The average time to prosthetic fitting was 8 weeks for the study group compared to 16 weeks for US Department of Veterans Affairs amputations. The early death group’s average albumin of 2.15 g/dL with a NLR of 8.9. The study demonstrated that a novel postoperative protocol may improve outcomes in transtibial amputations and that a few simple blood values may provide an indication of the diminished overall physiologic health of this patient population.
Biomechanical Evaluation of Different Fixation Methods for a First Metatarsal Transverse Neck Osteotomy in a Hallux Valgus Sawbone Model
Authors: Wagner Pablo , Wagner Emilio , Pinochet Miguel I. , Lam Peter 
Published: December 2023

Category: Bunion Introduction/Purpose: There are no studies available that provide information about fixation methods for minimally invasive Hallux Valgus osteotomies. Our objective was to evaluate different fixation methods' strength for a first metatarsal transverse neck osteotomy in a sawbone model. Methods: 30 sawbone foot models were used. Transverse neck first metatasal osteotomies were performed and fixed in a standardized fashion in 6 different configurations. Group 1 used one 4.0 screw; Group 2 used two (one 4.0 and one 3.0) parallel screws; Group 3 used two (one 4.0 and one 3.0) divergent screws; Group 4 used two divergent screws, one 4.0 with lateral metatarsal head cortex purchase, and one 3.0 screw; Group 5 was like Group 4, but with two 4.0 screws. Group 6 was like Group 4 and 5, but with two 3.5 screws. Cyclic and load to failure testing were performed, measuring stiffness and force needed to create deformity, using a Zwick Roell Universal Testing Machine. Results: Group 1 failed due to rotational instability. Group 2 showed increased stiffness (p < 0.05) against group 1. Group 3 did not achieve difference to group 2. Group 4 was stronger (p < 0.05) in all variables than groups 1-3. Group 5 did not show differences against Group 4. Group 6 was only stronger than Group 1-2. Conclusion: In this study, better biomechanical behavior is seen using divergent screws with lateral head cortex purchase. This is the first study that provides biomechanical information on first metatarsal transverse neck osteotomy fixation methods. Clinical studies are needed to evaluate the clinical impact of these findings.