bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arthroscopic Broström-Gould Repair Has Comparable Radiological and Clinical Outcomes Compared to Traditional Open Broström-Gould Repair in High-Demand Patients
Authors: Jeong Bi O , Jung Cheol Hyun 
Published: December 2023

Category: Arthroscopy; Sports Introduction/Purpose: This study sought to confirm whether traditional open Broström–Gould repair and arthroscopic Broström–Gould repair for chronic ankle instability (CAI) would produce comparable radiological and clinical outcomes in high- demand patients. Methods: This retrospective case–cohort study included high-demand patients, as determined by a pre-injury Tegner Activity Level ≥ 6, who underwent Broström–Gould repair and were followed up for ≥ 2 years. Patients were divided into the arthroscopic Broström–Gould repair group (AS Group) and the open Broström–Gould repair group (Open Group). Perioperative radiological assessments were performed. The Tegner Activity Levels, Foot and Ankle Outcome Scores (FAOSs), Karlsson and Peterson (K– P) scores, and American Orthopaedic Foot and Ankle Society ankle–hindfoot (AOFAS) scores were evaluated clinically. Results: A total of 65 patients (31 from the AS Group and 34 from the Open Group) were included in the study. There were no differences in age, sex, body mass index, preoperative anterior talar translation, talar tilt, signal-to-noise ratio, FAOS, K–P score, or AOFAS score between the two groups (n.s.). The preinjury median Tegner Activity Level was 7 and unchanged at the final follow-up in both groups. Postoperative stress radiographs showed improvement; however, the groups did not differ significantly. The FAOS, K–P scores, and AOFAS scores improved in each group (P < 0.001). However, the clinical scores did not differ between the groups (all n.s.). Conclusion: Traditional open and arthroscopic Broström–Gould repair for CAI in high-demand patients had comparable radiological and clinical outcomes. Clinically, arthroscopic Broström–Gould repair may represent a viable surgical alternative to open Broström–Gould repair in high-demand patients.
Comparison of Intraoperative Radiation Exposure Between Minimally Invasive Chevron Akin (MICA) and Open Procedures for Hallux Valgus Correction
Authors: Kim C. James , Tsai Justin , Pedowitz David I. , Moncman Tara G. 
Published: December 2023

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: The minimally-invasive Chevron-Akin (MICA) procedure for hallux valgus correction is an increasingly popular technique that has yielded comparable radiographic and clinical outcomes to open procedures3–5. Intraoperative radiation dosages for certain foot and ankle surgeries have been reported relative to the international occupational radioprotection thresholds6. In particular, the mean intraoperative radiation exposure during the MIS Scarf osteotomy has been reported to be 14-times greater than open osteotomy7. However, no study to date has reported on the intraoperative radiation exposure during MICA procedures in relation to that of open procedures. Methods: This is a retrospective comparative study from a single institution. Patients underwent a MICA (n=25) or open (n=40) hallux valgus correction by a single foot and ankle fellowship trained surgeon. To account for the learning curve8, the number of intraoperative fluoroscopy shots for the first 50 consecutive MICA procedures were analyzed, and the first 25 procedures were excluded. Four data points were retrieved from the mini C-arm, including 1) number of fluoroscopy shots taken; 2) total fluoroscopy time (s); 3) total radiation dose (mGy); and 4) total dose area product (DAP; mGy*cm2). Preoperative and postoperative radiographs were referenced to measure the hallux valgus (HVA) and intermetatarsal angles (IMA) as previously described.9 Categorical variables were compared using the chi-square test, and continuous variables were compared using Student’s t-test or the Mann-Whitney U test. Analysis of variance was used to determine the statistical significance of differences in the fluoroscopy data between groups. Results: The average total dose absorbed (4.00 vs. 1.34 mGy, p< 0.001), total fluoroscopy time (226 vs. 48.5 s, p< 0.001), and number of fluoroscopy shots (125 vs. 22.3, p< 0.001) were 2.9, 4.6, and 5.6 times greater in the MICA versus the open group, respectively. The total DAP (4.22 vs. 2.56 mGy*cm2, p=0.175) was 1.6 times greater in the MICA group but the difference was not statistically significant. The mean preoperative and postoperative HVA and IMA were greater in the MICA cohort compared to the open cohort. However, there was no statistical difference in change in HVA (MICA -17.43 vs. Open -20.05, p=0.125) or IMA (MICA -8.08 vs. open -9.31, p=0.11) between the two cohorts, with each resulting in normal postoperative angles. Conclusion: In this single surgeon series, the MICA procedure demonstrated significantly greater dose absorbed, total fluoroscopy time, and number of fluoroscopy shots compared to the open procedure. The extent of radiation exposure to the surgeon and the patient in relation to the radioprotection thresholds must be closely monitored to specify the health risks involved with this procedure.
Does Shoe Type Impact Ankle Injury Risk or Outcomes in Professional Basketball Players?
Authors: Tansey Patrick J. , Robbins Jordan , Saucedo Levi , Chen Jie 
Published: December 2023

Category: Sports; Ankle Introduction/Purpose: Ankle injuries are common in professional basketball. Despite their significance to the sport, little is known about the impact of basketball shoe type on ankle injury risk and severity. The purpose of this study is to describe the frequency and impact of ankle injuries in National Basketball Association players wearing low, mid, or high-top shoes. Methods: Players appearing in ≥1 NBA game during the 2020-2021 season were included. Shoewear data per-player per-game was collected. Low, mid, or high-top shoes were defined as ending below the ankle, at, or above the ankle. Significant injuries were defined as those occurring in-game that required ≥1 missed games. Shoewear, performance statistics and injury data were obtained from open access databases. The risk of ankle injury per group was calculated using chi-squared tests. Baseline anthropometric demographics and in-game performance statistics including points, rebounds, assists, steals, blocks, turnovers, field goal shooting percentage, three-point shooting percentage and net scoring per game were compared between groups with analysis of variance (ANOVA) testing. Two-sided t-tests were performed to analyze performance within individual shoe groups before and after injury. Subgroup analysis was performed for primary vs repeatedly injured players Results: There were 25,009 player appearances during the 2020-2021 NBA season. The overall prevalence of low, mid, and high top wear was 61%, 33% and 6%, respectively. 77 significant ankle injuries among 66 players caused a total of 713 days missed during the 2020-2021 NBA season. 48% of injured players had a reported ankle injury prior to the 2020-2021 season. The average injured player was 1.1 years older than uninjured players. Shoe choice did not have a significant impact on baseline player production. There was no difference in first time or repeat injury rate between shoe groups. There was no difference in days missed or individual productivity statistics between groups. There was no difference in performance amongst players with primary vs repeat injury. Conclusion: Ankle injuries are a common cause of missed playing time. There was no difference in injury rate, post-injury performance, or recovery time by shoe type. As shoe category appears to have negligible impact on healthy performance, injury risk or injury outcomes, team physicians and trainers should advocate for athletes to use shoes they feel most comfortable in.
Patient Reported Outcome Measures and Complication Rates after Minimally Invasive vs Open Calcaneal Osteotomy
Authors: Phillips Tammy , Hall SarahRose , Encinas Rodrigo , Edelman David , Jackson J. Benjamin , Gonzalez Tyler 
Published: December 2023

Category: Hindfoot; Other Introduction/Purpose: Minimally invasive (MIS) percutaneous calcaneal osteotomy has been increasingly investigated as a potentially safe alternative to open calcaneal osteotomy due to reduced postoperative complication and decreased pain compared to an open procedure. This retrospective chart review aims to evaluate the postoperative outcomes and complication rates of patients undergoing MIS vs. open calcaneal osteotomy. Methods: IRB approval was obtained. The study was performed by 2 fellowship-trained orthopaedic foot and ankle surgeons. 20 patients underwent MIS percutaneous calcaneal osteotomy, and 33 patients underwent open calcaneal osteotomy. All cases were completed between March 2021 and February 2023. Patient charts were reviewed for outcome data including complication rate, union rate, revision rate, and Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Results: Average follow up for the MIS group was 130.4 days and 258.2 days for the open group. The MIS group was found to have a lower rate of revision, infection, and sural neuritis (0%, 5%, and 10%) compared to the open group (3%, 13.3%, and 16.7%). All participants achieved union. Average preoperative PROMIS scores in the domains of physical function, pain interference, and mobility for the MIS group were 36.8 (28.6-46), 67.1 (54.3-78), and 34.6 (25-40). Average postoperative PROMIS scores for the MIS group were 35.7 (21-76), 62.3 (39-76), and 33.4 (16-75). In the open group, preoperative PROMIS scores in these same domains were 37.0 (22.4-49.8), 65.2 (54.3-77.8), and 35.0 (19-56), whereas they were 39.6 (19-56), 60.0 (39-72), and 37.4 (16-53) postoperatively. Conclusion: MIS percutaneous calcaneal osteotomy appears to be an efficacious and safe treatment with lower rates of revision, infection, and nerve injury compared to an open procedure. Early outcome measures show comparable PROMIS scores in all three domains of physical function, pain interference, and mobility following MIS percutaneous calcaneal osteotomy when compared to standard open calcaneal osteotomy. Surgeons may consider MIS percutaneous calcaneal osteotomy as an alternative to open calcaneal osteotomy when treating hindfoot deformities.
The 10-Year Patient-Reported and Clinical Outcomes of a Series of 156 Mobile-Bearing Total Ankle Replacements and the Effects of Patient Age
Authors: Nicolas Andrea Pujol , Hakeem Samir , Ramaskandhan Jayasree R. , Harris-Douglas Matthew , Abdul Nicole , Siddique Malik 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total Ankle Replacement (TAR) is an established treatment option for end-stage ankle arthritis. We analysed at minimum, 10-year patient-reported and clinical outcomes of 156 TARs from a single centre. We specifically compared outcomes between patients under 60 and over 60 at time of surgery. Methods: Data was collected retrospectively from our departmental patient database. It included all patients who underwent a TAR by a single surgeon between 2006 and 2010 and patients were divided into those under 60 and those over 60 at the time of surgery. Patient reported outcomes (PROMs), including WOMAC, SF-36 and patient satisfaction scores and complications were analysed preoperatively and at one, two, five and over 10 years postoperatively. Results: There were 156 patients included in this analysis, 61 were under 60 (mean age 50.29) and 95 were over 60 (mean age 69.12). A total of 12 patients had revision surgery, (nine in the under 60 group) and 52 patients were deceased at the time of analysis (10 in the under 60 group). At one year the over 60 group had less pain and better functional scores (p=0.02, p=0.017). At two, five and ten years there was no statistical difference in pain and function between groups. At two years the over 60s reported less stiffness and quicker return to activities of daily living (p=0.007, p=0.001). However, at five and 10 years there was no statistical difference in any domain. Conclusion: This study demonstrates that age does not correlate with a significant difference in pain or functional outcomes in patients who have TAR, at over 10 years follow up. The higher revision rates in the younger group may correlate with higher functional demand and lower mortality rate.
The Density-Weighted Foot Center Is Different to the Geometric Foot Center
Authors: Lintz François , Bernasconi Alessio , de Cesar Netto Cesar , Fernando Céline , Chabrand Patrick R. 
Published: December 2023

Category: Basic Sciences/Biologics; Hindfoot Introduction/Purpose: It has become a reality with the advent of weight bearing CT (WBCT) that weight bearing (WB) is a significant element to be considered when analyzing foot and ankle images. Some knowledge has begun to accumulate on the effect of WB on bone positioning, but the effect of WB on bone mineral density (BMD) distribution, apart from being a long for accepted truth since the works of Julius Wolff, could not until now be visualized other than on the biological level. Now, Hounsfield Units allow for bone density analysis on WBCT. The objective of the study was to compare the relative positions of the geometric foot center (GC) and the density-weighted foot center (DC). We hypothesized those to be different. Methods: Ethics approval was obtained. Thrity two feet from our WBCT database were retrospectively randomly selected (Curvebeam Pedcat, Hatfield PA, USA). Datasets were analyzed using Bonelogics software (Disior, Paragon 28, USA). Bone segmentation was performed to obtain all bone orientations and volumes excluding tibia and fibula and all phalanges. The data was computed to obtain the geometric centers (from bone surface coordinates), which were considered as reference and were given a value of 0. Therefore density-weighted centers (from all bone data including density) were calculated. The difference between the two centers represented the shift which was assessed along the sagittal axis (anterior shift), transversal axis (lateral shift) and craniocaudal axis (upward shift). Statistical analysis was conducted using STATA package. Results: The mean age and Body Mass Index of the cohort were 57.2 ± 9.6 years and 22.2 ± 2.8 kg/m2, respectively. The 3D displacement vector between GC and DC had a norm of 10.01 mm. We found that DC was significantly shifted anteriorly by 8.9 ± 0.3 mm (range, 5.6 mm to 13.4 mm), medially by 0.4 ± 0.8 mm (range, -1.3 mm to 0.3 mm) and upwardly by 4.2 ± 0.14 mm (range, 2.8 mm to 5.9 mm) (p < 0.001 in all cases). Conclusion: Our hypothesis was confirmed: the geometric and weighed foot centers were different. DC was more anteriorly and slightly medially situated. Both centers were situated at the interface between the talus and cuboid. The more anterior position may be explained by the fact that human foot is responsible for anteriorly orientated longitudinal movement on average. We deem that BMD is a significant dimension in WBCT datasets that cannot be ignored in the development of new measurement tools that are not currently standardized. Alignment based purely on bone outer shape without considering BMD may not be representative of their true biomechanical state.
A Novel Application of Neural Networks to Identify Potentially Effective Combinations of Biologic Factors for Enhancement of Bone Fusion/Repair
Authors: Anastasio Albert T. , Zinger Bailey S. , Anastasio Thomas J. 
Published: December 2023

Category: Basic Sciences/Biologics; Other Introduction/Purpose: The use of biologic adjuvants (orthobiologics) is becoming commonplace in orthopaedic surgery. Amongst other applications, biologics are often added to enhance fusion rates in spinal surgery and to promote bone healing in complex fracture patterns. Generally, orthopaedic surgeons use only one biomolecular agent (ie allograft with embedded bone morphogenic protein-2) rather than several agents acting in concert. Bone fusion, however, is a highly multifactorial process and it likely could be more effectively enhanced using biologic factors in combination, acting synergistically. We used artificial neural networks to identify combinations of orthobiologic factors that potentially would be more effective than single agents. Methods: Available data on the outcomes associated with various orthopaedic biologic agents, electrical stimulation, and pulsed ultrasound were curated from the literature and assembled into a form suitable for machine learning. The best among many different types of neural networks was chosen for its ability to generalize over this dataset, and that network was used to make predictions concerning the expected efficacy of 2400 medically feasible combinations of 9 different agents and treatments. Results: The most effective combinations were high in the bone-morphogenic proteins (BMP) 2 and 7 (BMP2, 15mg; BMP7, 5mg), and in osteogenin (150ug). Some of the most effective combinations included bone marrow aspirate concentrate. In some others, electrical stimulation could substitute for osteogenin. BMP2 and BMP7 appear to have the strongest pairwise linkage of the factors analyzed in this study. Conclusion: Artificial neural networks are powerful forms of artificial intelligence that can be applied readily in the orthopeadic domain, but neural network predictions improve along with the amount of data available to train them. This study provides a starting point from which networks trained on future, expanded datasets can be developed. Yet even this initial model makes specific predictions concerning potentially effective combinatorial therapeutics that should be verified experimentally. Furthermore, our analysis provides an avenue for further research into the basic science of bone healing by demonstrating agents that appear to be linked in function.
Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in Chondral Defects of the First Metatarsophalangeal Joint: 5-Year Follow-up
Authors: Richter Martinus , Zech Stefan , Meissner Stefan A. , Naef Issam 
Published: December 2023

Category: Other Introduction/Purpose: The aim of the study was to assess the 5-year-follow-up (5FU) after Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in chondral defects at the first metatarsophalangeal joint (MTP1). Methods: In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral lesion at MTP1 that were treated with AMIC+PBC from July 17, 2016 to May 31, 2017 were included. Size and location of the chondral lesions, the Visual- Analogue-Scale Foot and Ankle (VAS FA) and the EFAS Score before treatment and at 5FU were analysed and compared with previous 2-year-follow-up (2FU). Peripheral Blood Concentrate (PBC) was used to impregnate a collagen I/III matrix (Chondro- Gide, Wolhusen, Switzerland) that was fixed into the chondral lesion with fibrin glue. Results: One hundred and ninety-eight patients with 238 chondral defects were included. In 21% of patients no deformities in the forefoot were registered. The average degree of osteoarthritis was 2.2. The chondral defect size was 1.0 cm2 on average. The most common location was metatarsal dorsal (33%), and in most patients one defect was registered (74%). Corrective osteotomy of the first metatarsal was performed in 79%. 176 (89%)/164 (83%) patients completed 2FU/5FU. VAS FA/EFAS Score were preoperatively 46.8/11.9 and improved to 74.1/17.1 at 2FU and 75.0/17.3 at 5FU on average. No parameter significantly differed between 2FU and 5FU. Conclusion: AMIC+PBC as treatment for chondral defects at MTP1 as part of joint preserving surgery led to improved and high validated outcome scores at 2FU and 5FU. The results between 2FU and 5FU did not differ.
Early Osteolysis and Component Revision of CADENCE Total Ankle Arthroplasty at Midterm Follow Up
Authors: Mendez Gabriella , Hyer Christopher , Vacketta Vincent G. , Perkins Jacob 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle arthroplasty (TAA) for the treatment of end-stage ankle arthritis has continued to grow in popularity as a favorable alternative to ankle arthrodesis. Amongst the fourth-generation implants released over the past decade is the CADENCE Total Ankle System (CTAS) which became available for clinical use in 2016. Our previous publication revealed a concerning incidence of radiographic osteolysis of the CADENCE tibial component interface at short-term follow-up of 24 months. Though there were limited cases of symptomatic loosening or component revision in this report, there was concern this trend may worsen with longer follow-up. The purpose of this study was to evaluate the radiographic and clinical outcomes of TAA with the CTAS, with a minimum of 1-year follow-up. Methods: This single-center retrospective study evaluated 63 consecutive patients who underwent TAA with the CTAS between August 2016 and October 2021 by a single fellowship-trained foot and ankle surgeon and co-design surgeon. Patients were included in our study on the basis of at least one year of clinical and radiographic follow-up; there were no other exclusion criteria. Results: Fifty-four TAA cases utilizing the CTAS in 50 patients were included in the current study. Preoperatively, eleven ankles had neutral alignment, 18 ankles demonstrated varus alignment, and 25 ankles demonstrated valgus alignment. Twelve patients underwent staged procedures for management of severe coronal plane deformity. Radiographic parameters changed significantly preoperatively to postoperatively. At final follow-up, PPL was demonstrated in 39 (72.2%) ankles in this cohort. Symptomatic PPL was present in 13.0% of ankles in this cohort. Talar subsidence was observed in 7 ankles within our cohort. Nine ankles underwent subsequent operations related to TAA complications. Seven ankles underwent revision procedures, resulting in a final implant survivorship of 87.0%. Four ankles, 7.4% underwent non-revision reoperations. No additional complications were encountered within this cohort. Conclusion: In this study of 54 CADENCE TAA, we observed a high rate of component loosening and bone interface osteolysis over time. This ultimately led to poorer implant survivorship over time and a higher than acceptable revision rate. Though the lead author is a co-designer of the CADENCE implant, we believe it prudent to share our clinical findings and experience as we all gain further knowledge and understanding about implant design and TAA. Based upon our results, we have abandoned use of this prosthesis as the midterm results fail to achieve parity with other TAA systems available on the market.