bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Arthroscopic Anterior Talofibular Ligament Repair with and without Inferior Extensor Retinaculum Augmentation for Chronic Ankle Instability: A Prospective Randomized Study
Authors: Lee Sung Hyun , Jo Yang Hun 
Published: December 2023

Category: Sports; Arthroscopy Introduction/Purpose: Although Modified Broström Technique is still gold standard procedure for chronic ankle instability (CAI), the effect of inferior extensor retinaculum (IER) augmentation remains unclear. Recently, as several arthroscopic surgical techniques for CAI have been introduced, the issue on additional IER augmentation has been controversial in the arthroscopic field as well. The purpose of this study was to compare the clinical and radiological outcomes between all-inside arthroscopic anterior talofibular ligament (ATFL) repair with and without IER augmentation. Methods: We prospectively randomized 59 patients who underwent arthroscopic surgery for CAI into 2 groups: arthroscopic ATFL repair with IER augmentation (group W, 29 patients) and without IER augmentation (group WO, 30 patients). The pain visual analog scale, American Orthopaedic Foot & Ankle Society score, Foot and Ankle Outcome Score, and the Karlsson Ankle Function Score were measured as subjective outcomes, and posturographic analysis was performed using a Tetrax device as an objective outcome. Radiologic outcome evaluations were performed preoperatively and at 2 years postoperatively using stress radiographs and axial view magnetic resonance imaging. Results: All clinical scores, objective posturography, and stress radiographs improved significantly at 2 years postoperatively in both groups (all, p< 0.05), with no significant differences between the groups with respect to the preoperative and postoperative values (all, p>0.05). In addition, we identified 3 retear (5.1%) based on postoperative MRI evaluation (3.4% [1/29] in group W and 6.7% [2/30] in group WO). However, there was no significant differences between 2 groups (p>0.05). One patient in group WO had neuralgia of the superficial peroneal nerve; 2 patients in group W had knot irritation causing mild discomfort. Conclusion: Arthroscopic ATFL repair represent good postoperative functional and radiologic outcomes, regardless IER augmentation. Additional IER augmentation after arthroscopic ATFL repair is not promise better clinical outcomes.
Outpatient Total Ankle Arthroplasty (TAA) as a Safe and Lower Cost Alternative to Inpatient TAA
Authors: Wolfe Isabel , Conti Matthew S. , Demetracopoulos Constantine , Ellis Scott J. 
Published: December 2023

Category: Ankle; Other Introduction/Purpose: Joint replacement procedures have traditionally been performed in an inpatient setting to minimize complication rates. While the Centers for Medicare and Medicaid Services (CMS) have made provisions for outpatient total hip and knee arthroplasty, Medicare patients undergoing total ankle arthroplasty (TAA), until recently, required inpatient admission. There is growing evidence that TAA can safely be performed as an outpatient procedure, with the benefit of decreased healthcare expenses and improved patient satisfaction. Studies have largely investigated direct costs associated with TAA. The purpose of our study was to compare payer costs and complication rates between inpatient and outpatient TAA using a large publicly available for-fee database. Methods: The PearlDiver Database was queried to identify TAA-associated claims for all payer types from January 2010 to April 2021. The claims were identified by the following ICD and CPT codes and analyzed based on service location: CPT-27700, CPT- 27702, ICD-9-P-8156, ICD-10-P-0SRF07Z, ICD-10-P-0SRF0JZ, ICD-10-P-0SRF0KZ, ICD-10-P-0SRG07Z, ICD-10-P-0SRG0JZ, ICD-10-P-0SRG07Z. Baseline comparisons of age, Charleston Comorbidity Index (CCI), geographic region, and payer type were performed. Total reimbursement amount for all associated claims was summed and divided by the number of patients assigned to those claims for the average amount paid per patient. Total cost over a 90-day period was calculated by summing the cost of all claims assigned to patients who underwent TAA within this time frame. The data were analyzed for postoperative infections and readmissions within 90 days as well as failure of TAA defined as conversion to ankle arthrodesis, revision ankle arthroplasty, and/or infection requiring postoperative irrigation and debridement. Results: A total of 7,520 patients who underwent outpatient TAA and 10,772 patients who underwent inpatient TAA were identified. The average age was 54.3 years for outpatients and 63.9 years for inpatients (p Conclusion: In patients undergoing TAA, both average paid per patient and total cost within 90 days were significantly lower in the outpatient setting. Patients who underwent TAA in the outpatient setting as compared to the inpatient setting were younger, with a lower comorbidity index and a different distribution by geographic region and payer type. Complication rates including postoperative infections, readmissions, and arthroplasty failures were significantly lower in the outpatient setting, perhaps due to differences in baseline patient characteristics. These data suggest that outpatient TAA is a safe and lower cost alternative to inpatient TAA.
Diagnostic Accuracy of Conventional Ankle CT Scan With External Rotation and Dorsiflexion in Patients With Acute Isolated Syndesmotic Instability
Authors: Rodrigues Joao Carlos , do Amaral e Castro Adham , Rosemberg Laercio Alberto , de Cesar Netto Cesar , Godoy-Santos Alexandre Leme 
Published: December 2023

Category: Ankle; Sports Introduction/Purpose: Syndesmotic injury in an athletic population is associated with a prolonged ankle disability after an ankle sprain and often requires a longer recovery than a lateral collateral ligament injury. Although several imaging tests are available, diagnosing syndesmotic instability remains challenging. The main objective was to determine the diagnostic accuracy of conventional ankle computed tomography (CT) scans with the joint in external rotation and dorsiflexion and compare it with that of conventional ankle CT scans in a neutral position. Methods: Between September 2018 and April 2021, this prospective study consecutively included adults visiting the foot and ankle outpatient clinic with a positive orthopedic examination for acute syndesmotic injury. Participants underwent 3 CT scan tests. First, ankles were scanned in a neutral position. Second, ankles were scanned with 45° of external rotation, dorsiflexion, and extended knees. Third, ankles were scanned with 45° of external rotation, dorsiflexion, and flexed knees. Three measurements, comprising rotation (measurement a), lateral translation (measurement c), and anteroposterior translation (measurement f) of the fibula concerning the tibia, were used to diagnose syndesmotic instability in the 3 CT scans. Magnetic resonance imaging was used as a reference standard. The area under the curve (AUC) was used to compare the diagnostic accuracy, and Youden’s J index was calculated to determine the ideal cutoff point. Results: Images obtained in 68 participants (mean age, 36.5 years; range, 18-69 years) were analyzed, comprising 36 syndesmotic injuries and 32 lateral collateral ligament injuries. The best diagnostic accuracy occurred with the rotational measurement a, in which the second and third CT scans with stress maneuvers presented greater AUCs (0.97 and 0.99) than the first CT scan in a neutral position (0.62). The ideal cutoff point for the stress maneuvers was 1.0 mm in the rotational measurement and reached a sensitivity and specificity of 83% and 97% for the second CT scan with extended knees and 86% and 100% for the third CT scan with flexed knees, respectively. Conclusion: Conventional ankle CT with stress maneuvers has excellent performance for diagnosing subtle syndesmotic rotational instability, as it shows a greater AUC and enhanced sensitivity at the ideal cutoff point compared with ankle CT in the neutral position.
The Effect of Diabetes Mellitus on Total Ankle Arthroplasty Outcomes
Authors: Helbing Jordan A. , Farley Benjamin , Gu Alex , Siram Gautam , Stein Benjamin , Chodos Marc David 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: The utility of total ankle arthroplasty (TAA) for management of end-stage ankle arthritis continues to increase. Postoperative infection after TAA is a devastating complication leading to additional surgeries, hospitalizations, long term antibiotics, arthrodesis, and sometimes amputation. Diabetes has been shown to be associated with postoperative infections following other orthopedic procedures. While the majority of literature demonstrates an association between diabetes and post- operative complications following TAA, other studies have demonstrated no such association. The goal of this study was to determine if diabetes influences the outcomes following TAA. Methods: An insurance database was utilized to identify patients undergoing TAA for end-stage ankle arthritis with a concurrent diagnosis of diabetes based on CPT, ICD-9, and ICD-10 diagnosis and procedure codes from 2010 to 2021. The postoperative outcomes of all cause revision, periprosthetic joint infection, periprosthetic joint infection with revision, and aseptic revision were compared between diabetic and nondiabetic patients with a minimum 2-year follow up using Kaplan-Meier and Cox proportional hazards analyses. Patient demographics, comorbidities, and Charlson Comorbidity Index was queried and analyzed via univariate and multivariate analysis, along with 90-day postoperative outcomes. Results: The study population included 8,317 patients who underwent TAA, 345 of which had a concurrent diagnosis of diabetes, with a minimum of 2-year follow up from 2010 to 2021. After multivariate Cox proportional hazards analysis, the 5-year cumulative incidence of PJI was 7.3% in diabetic patients compared to 3.9% in nondiabetic patients, with a 95% increased risk of revision (HR 1.95, 95% CI: 1.15-3.30, P=0.01). Diabetic patients also demonstrated a 5-year cumulative incidence of septic revision rate of 1.4% compared to 0.4% in nondiabetic patients, with a 363% increased risk (HR 4.63, 95% CI: 1.22-17.52, P=0.02). After controlling for differences in demographics and comorbidities through multivariate analysis, diabetes was independently associated with an increased risk for stroke (OR 10.12, P=0.007). Conclusion: The incidence of post-operative complications, including increased risk of 5-year risk of periprosthetic joint infection and septic revision was higher among diabetic patients compared to nondiabetic patients.
The Role of Computed Tomography with External Rotation and Dorsiflexion in Decision Making for Acute Isolated Posterior Malleolar Fractures Bartoníček and Rammelt Type II: A Cross-Sectional Study
Authors: Godoy-Santos Alexandre Leme , Rodrigues Joao Carlos , de Cesar Netto Cesar , Carvalho Kepler A.M. , Mansur Nacime Salomao Barbachan , Sposeto Rafael Barban , Giordano Vincenzo 
Published: December 2023

Category: Ankle; Sports Introduction/Purpose: A ligament-centered analysis is currently incorporated in the assessment of joint stability in malleolar fractures. Although several imaging tests are available, in the setting of acute isolated non-displaced posterior malleolar fractures Bartoníček/Rammelt types II and IV diagnosing syndesmotic instability remains challenging. The objective of this multi-center cross- sectional study was to evaluate the syndesmotic and fracture instability using conventional ankle CT with external rotation and dorsiflexion in the setting of acute, isolated non-displaced Bartoníček and Rammelt type II posterior malleolar fractures. Methods: Between March 2018 and September 2022, a consecutive sample of 123 individuals with an ankle sprain were assessed for eligibility. In total, 33 participants met the inclusion criteria. All participants underwent a CT scan (CTSM), comprising a first phase with the ankles in a neutral position, then a stress phase with the ankles in external rotation and dorsiflexion and semiflexed knees. Investigators used the patterns of ligament tear found at MRI and instability at CTSM to classify all participants into West Point grades I, IIA, IIB, or III. Mann-Whitney test was used to test the differences in the numerical variables between injured and uninjured syndesmoses. The Spearman correlation tested the strength of the association between the tibial joint surface involved in posterior malleolus fracture and syndesmotic instability. Results: In MRI reading parameters two patterns of syndesmotic ligament injury predominated. A completely torn AITF and IO ligaments and a completely torn AITF was combined with a partially torn IO. Regarding the deep layer of the deltoid ligament, participants were classified as normal, strained and partially torn. In CT scan reading parameters in the neutral phase, the median difference of 0.2 mm in d measurements between injured and uninjured syndesmoses was not statistically significant (P = 0.057). During the stress phase, the injured and uninjured syndesmoses had distinct behavior, and the 2.3 mm median difference for d measurement was statistically significant (P < 0.0001). Conclusion: The conventional computed tomography with external rotation and dorsiflexion represent a reproducible and accurate diagnostic option for the detection of syndesmosis instability and fracture instability in acute isolated posterior malleolar fractures Bartonícek and Rammelt type II.
Total Ankle Arthroplasty is Associated with Decreased Risk of Postoperative Total Knee Arthroplasty Compared to Ankle Arthrodesis
Authors: Coden Gloria , Brzezinski Andrzej , Hofmann Kurt 
Published: December 2023

Category: Ankle Arthritis Introduction/Purpose: There is a known association between ankle arthritis and ipsilateral knee arthritis. However, it is unknown if the increased range of motion and improved gait mechanics provided by total ankle arthroplasty (TAA) may delay the progression of knee arthritis compared to ankle arthrodesis (AA). We hypothesized that patients treated with TAA would have a lower incidence and longer time to total knee arthroplasty (TKA) compared to AA. Methods: We retrospectively reviewed a matched cohort of 5726 AA and 5726 TAA performed between 1/1/2007 and 12/31/2021 using a commercial claims database. Patients with a history of preoperative ipsilateral or unknown laterality TKA were excluded. Records were reviewed for demographics, comorbidities, diagnosis, documented history of an ankle deformity, and postoperative ipsilateral or unknown laterality TKA. Mahalanobis nearest neighbor matching was performed based on age, gender, year of surgery, geographical region, and diagnosis was used to determine the cohorts from 13,679 AAs and 5726 TAAs. Mean follow-up was 2.2 years. Univariate and multivariate analyses were performed to assess for risk factors. Significance was set at p< 0.05. Results: Patients who underwent TAA were older (p < 0.001), female (p < 0.001), had earlier ankle surgery (p < 0.001), and increased ankle deformity (p < 0.001) than AA, but rates of rheumatoid arthritis (p=0.54) and posttraumatic arthritis (p=0.53) compared to osteoarthritis were similar. Patients who underwent AA were 2.77 times more likely to undergo a postoperative TKA compared to TAA (p < 0.001). However, for those who underwent a TKA, patients with an AA (mean=3.48 years) tended to wait longer before proceeding with TKA than patients who underwent TAA (mean=2.62 years, p< 0.001). Risk factors for undergoing postoperative TKA included having AA (p < 0.001), earlier year of ankle surgery (p < 0.001), older age (p < 0.001), lack of ankle deformity (p < 0.005), lack of obesity (p < 0.047), and posttraumatic arthritis (p < 0.001), while gender (p=0.55) and rheumatoid arthritis (p=0.75) were not. Conclusion: Our results showed that there is a significantly higher incidence of patients undergoing TKA after AA compared to TAA (p < 0.001). Therefore, we recommend that surgeons consider TAA over AA, especially in young, active patients with minimal knee arthritis as a strategy to help delay the progression of knee arthritis. Patients who underwent AA tended to have a longer time interval to TKA (p < 0.001), which may be related to the longer expected recovery from an AA compared to TAA. With improved rehabilitation protocols for TAA, patients may recover faster so that they can proceed with their ipsilateral TKA earlier.
Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty using a Revision Ankle System
Authors: Ray Justin J. , Graham George Dillon , Irwin Todd A. , Jones Carroll , Cohen Bruce , Davis Hodges 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: With the growing popularity of total ankle arthroplasty (TAA), revision surgeries are inevitable and expected to significantly increase over the next decade. Revision TAA remains a significant challenge with high complication rates. No previous study has reported on outcomes following revision TAA using an implant designed specifically for revisions. Theoretical benefits of a revision-specific ankle system include tibial and talar fixation/stability, restoration of joint height, coverage of bone loss/defects, and maximal talar coverage. The purpose of this study was to investigate radiographic and clinical outcomes at a minimum of 2 years following revision TAA using a revision-specific ankle system. Methods: Patients who underwent a revision TAA using a revision-specific ankle system (Invision, Stryker, Kalamazoo, MI) between January 2016 and December 2020 were eligible to be included in this study. Patients with less than 2-year follow-up and unwilling to return to clinic were excluded. Overall, 25 patients met inclusion criteria. Indications for revision TAA (Table 1) included talar loosening (n = 6), tibial loosening (n = 7), talar subsidence (n = 6), re-implant after infection (n = 4), instability (n = 3), periprosthetic fracture (n = 2), and severe osteolysis (n = 2). Medians and interquartile ranges (IQRs) were reported since the data was not normally distributed. Clinical and radiographic outcomes, complications, reoperations, and implant survival was recorded. Results: Implant survival was noted in 80% of patients (20/25) at a median of 3.8 years following revision TAA. Index revision was most commonly performed for implant loosening (tibia 28%, talus 24%), talar subsidence (24%), or re-implant after infection (16%). Foot and Ankle Ability Measure (FAAM) Activities of Daily Living and Sports scores were 53.9 (IQR 46.4, 71.4) and 37.5 (IQR 21.9, 46.9), respectively at final follow-up. There was evidence of talar loosening in 3 patients (12%) and talar subsidence in 5 patients (20%) on final radiographs. Reoperation rate at final follow-up was 48%, most commonly for talar loosening/subsidence (n= 2), tibial loosening (n = 3), septic TAA (n = 1), medial/lateral gutter impingement (n = 2), and instability (n = 2). Conclusion: At a minimum follow-up of 2 years, 80% of patients retained their metal revision TAA, but reoperation rates were high with 48% of patients requiring an additional procedure most commonly for implant loosening, talar subsidence, gutter impingement, or instability. Revision TAA using a revision-specific ankle system is a viable option for patients with a failed TAA. Physicians and patients should be aware that revision TAA remains a significant challenge with a high risk of complication and reoperation rates.
Does Patient-Reported Outcome Measures Use at New Foot and Ankle Patient Clinic Visits Improve Patient Activation, Experience, and Satisfaction?
Authors: Bernstein David N. , Jones Courtney Marie Cora , Flemister A. Samuel S. , DiGiovanni Benedict F. , Baumhauer Judy 
Published: December 2023

Category: Other; Ankle Introduction/Purpose: Patient-reported outcome measures (PROMs) can help predict clinical outcomes and improve shared clinical decision-making discussions. There remains a paucity of research assessing how the use of PROMs may drive improved patient experience and patient activation. This randomized, controlled trial study objectives: 1) Determine if the active use and discussion of PROMs during new patient visits are associated with patient satisfaction and experience 2) Determine if the active use and discussion of PROMs during new patient clinic visits are associated with patient activation; and 3) To determine if the objectives (1) and (2) differ based on surgeon or sociodemographic factors. Methods: This Institutional Review Board (IRB) approved singled-blinded RCT was registered prior to data collection on ClinicalTrials.gov (NCT04654910). As a standard of care, new foot and ankle patients completed PROMIS Physical Function (PF), Pain Interference (PI), and Depression assessments. Patients were then randomized to viewing and discussing their PROMIS scores with their surgeon or not. Following the clinic visit, patients completed a series of Clinician & Group Survey-Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) questions and the Patient Activation Measure (PAM). CG-CAHPS findings and PAM responses were compared between the two groups and after clustering on surgeon. Potential interaction effects by social deprivation were also explored. Results: After enrolling patients but removing those lost to follow-up or with missing data, 97 and 116 patients remained in the intervention control cohorts, respectively. No difference was found in CG-CAHPS responses, nor PAM scores between the two groups (p>0.05). All surgeons were highly rated by all patients. When clustered by surgeon, intervention subjects were less likely to indicate “top box” scores for the understanding domain of the CG-CAHPS question (OR:0.51;p < 0.001) and had decreased odds of high patient activation compared to control subjects (OR:0.67;p=0.005). Among the most socially disadvantaged patients, there was no difference in control and intervention subjects in their likelihood of having high patient activation (p=0.09). Conclusion: Well perceived foot and ankle surgeons who show and discuss PROMs results may not improve the patient experience or activation and may, in fact, decrease understanding or patient activation in select populations. Future work is needed to determine when PROMs discussions are most beneficial and how best to present PROMs data. Health literacy tools and/or communication training may better engage different patient groups regarding PROMs.