bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biomechanical Evaluation of 4th Generation Minimally Invasive Distal First Metatarsal Osteotomy-Akin Osteotomy Technique on First Ray Articular Contact Properties
Authors: Reddy Sudheer C. , Schipper Oliver , Li Jihui 
Published: December 2023

Category: Bunion; Basic Sciences/Biologics Introduction/Purpose: Hallux valgus is a common deformity encountered, but remains a complex clinical entity. Fourth generation minimally invasive (MIS) techniques consisting of a percutaneous distal metatarsal transverse osteotomy combined with an Akin osteotomy have been utilized to address mild to severe hallux valgus deformities. Benefits of a MIS approach include improved cosmesis, faster recovery, lower opiate requirement, immediate weightbearing, and favorable outcomes relative to a traditional, open procedure. An understudied area with respect to hallux valgus correction is the effect that osteotomies can have on the articular contact properties of the first ray following correction. Methods: Sixteen paired cadaveric specimens were dissected to include the first ray and tested in a customized apparatus. Specimens were randomized to receive a distal transverse osteotomy translated either 50% or 100% of the width of the first metatarsal shaft. The osteotomy was performed with either a 00or 200 distal angulation of the burr relative to the shaft in the axial plane. Specimens were tested in the intact state and following the distal first metatarsal osteotomy for peak pressure, contact area, contact force and center of pressure at the first metarsophalangeal joint (MTP) and first tarsometatarsal joint (TMT). An Akin osteotomy was then performed on each specimen and peak pressure, contact area, contact force and center of pressure were recalculated. Results: There was a notable decrease in peak pressure, contact area, and contact force across the TMT joint with greater shifts of the capital fragment. However, at 100% translation of the capital fragment, distal angulation of the osteotomy by 200 appears to improve loading across the TMT joint. Addition of the Akin osteotomy at 100% translation also aids in increasing the contact force across the TMT joint. The MTP joint is less sensitive to changes in shifts and angulation of the capital fragment. The Akin osteotomy also leads to increased contact force across the MTP joint when the capital fragment is translated 100%. Conclusion: While the clinical significance is unknown, larger shifts of the capital fragment lead to greater load alterations at the level of the TMT joint than the MTP joint. Distal angulation of the capital fragment and the addition of an Akin osteotomy can aid in reducing the size of those changes. The Akin can lead to increased contact forces at the MTP joint with 100% translation of the capital fragment.
Biomechanics and Injury Prevention for Barefoot/Minimalist Running
Authors: Connors Gregory , Mathew Justin , Freeland Erik 
Published: December 2023

Category: Sports; Midfoot/Forefoot Introduction/Purpose: Running-related injuries are common despite technological advances in running shoes. Recently, there has been a movement towards barefoot/minimalist running. Proponents of barefoot running state that this style of running provides beneficial modifications to the gait cycle and prevents running-related injuries. The purpose of this review is to analyze the biomechanical consequences of barefoot/minimalist running and determine if barefoot/minimal style running prevents running- related injuries. Methods: A literature search was done on PUBMED using the keywords: Barefoot running, minimalist running, injury prevention, injury rate, foot-strike pattern, vertical loading rate, biomechanics, and clinical outcomes. Studies were then grouped into biomechanical studies and clinical outcome studies. Biomechanical studies were included if they analyzed outcomes such as: foot strike index/pattern, vertical loading rates, vertical ground reaction forces, joint angles, cadence, step length, or joint energy absorption. Clinical outcome studies were included if they analyzed injury rates and pain. Results: Biomechanical studies indicated that barefoot/minimalist running coincided with a transition to an anterior foot strike, lower vertical loading rates, higher cadences, less energy absorption at the knee joint, and higher energy absorption at the ankle joint. The clinical outcome studies indicated improvement of prior injuries and equivocal injury rates in the barefoot/minimal style running groups. Conclusion: Foot strike pattern is more important than footwear in regard to injury prevention and vertical loading rate. Switching to minimalist footwear improves running biomechanics with a more anterior foot strike, higher cadence, lower vertical loading rate, less knee energy absorption, and a shorter stride length. However, minimalist footwear places higher degrees of stress on the ankle joints and an increased injury rate when abruptly transitioning to barefoot running. Runners must weigh the risks and benefits and take caution to properly strengthen their feet and safely transition to minimalist running.
Clinical and Radiographic Outcomes of Supramalleolar Osteotomy for the Old Age Patients with Medial Compartment Ankle Osteoarthritis
Authors: Lim Jung-Won , Jung Hong-Geun , Im Je-Min 
Published: December 2023

Category: Ankle Arthritis Introduction/Purpose: Supramalleolar osteotomy (SMO) has recently been accepted as the major surgical option for treating painful asymmetric ankle arthritis. However, in many literatures, old age is regarded as relative contraindication for SMO. This study aimed to evaluate clinical and radiographic outcomes of medial compartment ankle osteoarthritis (OA) treated with SMO for the patients of relatively old age. Also, the study is aimed to compare the outcomes between old age group (≥ 65 years) and the group younger than 65 years. Methods: The study is based on consecutive 60 ankles of medial compartment ankle arthritis (60 patients) with moderate to severe medial ankle pain (at least 1-year follow-up). SMO and fibular valgization oblique osteotomy were performed. As for the functional evaluation, visual analogue scale (VAS) pain scores, American Orthopaedic Foot and Ankle Society (AOFAS) ankle- hindfoot scores and ankle range of motion (ROM) were evaluated. On radiographs, tibial anterior surface angles (TAS), tibial lateral surface angles (TLS), and talar tilt angles (TT) were measured and the severity of ankle OA was classified by the Takakura stage. To evaluate how the age affects the outcomes of SMO procedures, the subjects were classified as two groups (Group 1: ≥ 65 years, 14 ankles, Group 2: < 65 years, 46 ankles) and the comparison between the groups were made. Using second look arthroscopy, regeneration of articular cartilage was evaluated and compared between the groups. Results: The postoperative VAS pain score and ROM in group 1 were not inferior to those in group 2 (2.0 ± 2.0 vs 1.0 ± 1.4, p=0.949 / 50.7 ± 12.8 vs 52.0 ± 13.5, p=0.764). Also, the postoperative TLS angle and TT angle showed no significant difference between two groups. However, the postoperative AOFAS score was significantly higher in group 2 (79.0 ± 12.6 vs 88.0 ± 9.4, p< 0.05). In terms of delayed union, there was no significant difference between two groups (3/14, 21.4% vs 9/46, 19.6%, p=0.818). As to complication rate, there was also no significant difference between two groups (1/14, 7.1% vs 6/46, 13.0%, p=0.899). There were no significant difference according to articular cartilage regeneration after SMO between two groups. Conclusion: SMO for the relatively older patients with painful medial compartment ankle OA achieved favorable clinical and radiological outcomes. In terms of osteotomy site union and complications, older age group (≥ 65 years) showed the results not inferior to those of younger age group ( < 65 years). Even in the older age group, SMO could be one of the surgical options for the medial ankle OA.
Clinical Outcomes Following Tibiotalocalcaneal Arthrodesis with Intramedullary Nailing Combined with Partial Fibulectomy and Onlay Bone Graft
Authors: Kyung Min Gyu , Yoon Youngsik , Kang Ho Won , Kim Dae-Yoo , Choi Yoon Hyo , Lee Kyoung Min , Lee Doo Jae , Lee Dong Yeon 
Published: December 2023

Category: Hindfoot; Ankle Arthritis Introduction/Purpose: Although intramedullary nailing is a popular method for tibiotalocalcaneal (TTC) arthrodesis, nonunion is one of the most commonly reported complications. The purpose of this study was to evaluate the fusion rate, improvement in functional outcomes, and occurrence of complications in TTC arthrodesis using retrograde intramedullary nailing with partial fibulectomy and onlay bone graft technique. Methods: We retrospectively reviewed 26 consecutive patients who underwent TTC arthrodesis using the proposed technique. For radiographic outcomes, the union rate, alignment, and any related complications were assessed. Functional outcomes were evaluated using the American Orthopedic Foot and Ankle Society hindfoot scale, Foot and Ankle Outcome Score, and visual analog scale, preoperatively and at the final follow-up. Results: The mean follow-up period was 38.2 months. For the tibiotalar joint, the union rate was 80.8% six months postoperatively, while all the cases achieved complete bony union at twelve months postoperatively and at the final follow-up. However, for the subtalar joint, the union rate was 26.9% at six months postoperatively, which gradually increased to 73.1% at 12 months postoperatively, and 80.8% at the final follow-up without revision surgery. A subgroup analysis showed there was a trend of higher subtalar fusion rate when an additional screw for the subtalar joint fixation was placed (86.7% vs. 54.5%). The functional outcomes significantly improved at the final follow-up. A few minor complications occurred, including surgical site infection, irritational symptoms, and metal failure; however, these eventually resolved. Conclusion: Our technique of TTC arthrodesis with partial fibulectomy and onlay bone grafting demonstrated reliable radiographic and satisfactory functional outcomes including patients with previous failed hindfoot surgery. In addition, it is considered safe, as minimal complications occur postoperatively. We believe that our method of TTC arthrodesis provides a good option where both the tibiotalar and subtalar joints need to be fused.
Combined Deltoid and Spring Ligament Reconstruction Using Quadrangular Construct
Authors: Moonot Pradeep , Dakhode Shubham , Karwande Nikhil , Pawar Prashant 
Published: December 2023

Category: Trauma; Hindfoot Introduction/Purpose: Combined reconstruction of chronic deltoid and spring ligament insufficiency is pretty uncommon and literature surrounding that is rare. The purpose of our study was discuss our experience in treating post-traumatic, chronic deltoid and spring ligament insufficiency utilising a technique called the “Quadrangular Construct” (combined deltoid and spring ligament reconstruction), which uses fibertape together with suture anchor fixation which anatomically resembles the ligament complex. Methods: A total of five patients were included in the study who had post traumatic combined deltoid and spring ligament insufficiency. All patients had a “giving away sensation”. Preoperatively, every patient had underwent weight-bearing radiographs of ankle and foot. Talo 1st Metatarsal angle & hind-foot alignment angle using Saltzman view were noted. Ankle arthroscopy was performed for diagnosis and removal of intra-articular fibrous tissue. Superficial deltoid ligament was repaired using suture anchor. This was augmented with Internal Brace TM (Arthrex, Naples, USA) fibertape forming a quadrangular construct which anatomically mimics tibio-navicular, anterior tibio-talar, tibio-calcaneal and spring ligament components of the deltoid-spring complex. Due to associated excessive heel valgus, three patients also underwent medial displacement calcaneum osteotomy. Additionally, one patient required lateral ligament repair and one patient required syndesmotic stabilisation. American Orthopaedic Foot & Ankle Society (AOFAS) hind foot score was used to evaluate pre and post operative ankle function. Results: All five patients were followed up for a mean of 20 months (12–24 months). The mean angle between the long axes of the talus and first metatarsal bone on preoperative weight-bearing radiographs improved from 8.46° to 4.84°. Preoperative mean angle of hind-foot alignment in the Saltzman view was reduced from 10.9° to 5.76° post operatively. Pain was relieved postoperatively in all patients. One patient has irritation due to metal anchor which needed removal after one year. Postoperatively, none of the patients had re-experienced “feeling of giving way” sensation. AOFAS scores showed, two patients being considered excellent, two good, and one fair. All the patients could perform their ADL & recreational activities independently, and returned to their pre injury work. Conclusion: It is uncommon and challenging to treat post-traumatic chronic deltoid and spring ligament insufficiency. Our technique of combined deltoid and spring ligament reconstruction using a quadrangular construct aids in anatomical restoration of stability, is safe, cost effective, and easily reproducible, and has a positive short-term follow-up.
Comparative Study between Semitendinous Autograft Tendon Length Harvested in Ventral vs Dorsal Decubitus
Authors: Nery Caio , de Britto Costa Lucas Plens , Mann Tania Szejnfeld , Lima Ricardo Luiz Gave , Raduan Fernando , Mansur Nacime Salomao Barbachan , Maffulli Nicola 
Published: December 2023

Category: Sports; Ankle Introduction/Purpose: Chronic Achilles tendon ruptures is challenging because the tendon ends are usually retracted, and if the gap between the proximal and distal stumps are of more than 6 cms with the ankle in plantarflexion the currently literature shows that semitendinous tendon (ST) autograft reconstruction has satisfactory funcional outcome. The usual anteromedial approach for ST harvest might be more demanding with the patient in ventral decubitus, requiring knee flexion and a change of perspective. The posterior approach offers direct access to the ST but some questions might be raised about the tendon length obtained, once the incision is made 5 to 8 cm proximal to its insertion. The objetive of this study is to compare the ST length obtained from posterior and anteromedial approach. Methods: Prospective comparative study, level III of evidence, authorized by Ethics Committee of our institution, assessed the ST length obtained by anteromedial and posterior approach (image 1) in patients submitted to anterior cruzade ligament (ACL) reconstruction and achilles tendon reconstruction, respectively, between March 2021 and June 2022. The patients with chronic achilles tendon rupture were diagnosed by 2 orthopaedic foot and ankle surgeons board certificated and were subjected to the following inclusion criteria: age between 18-60 years, agreeing to participate, with chronic achilles tendon rupture (> 12 weeks) and gap between proximal and distal stump larger than 6cm confirmed by ultrasound with the ankle in plantarflexion position. Demographic data was obtained, including gender, BMI and height and the full tendon length intraoperatively and Visual Analog Scale (VAS) 6 weeks was applied postoperatively. Results: In the Achilles group 20 patients were included, with medium age of 45 years old and medium gap of 6.3 cm. In ACL group 20 patients were included, with medium age of 30.9 years old. The medium BMI was 27.9 and 26.2 in posterior and anterior approach, respectively. The medium lenght of the ST from the posterior approach was 26.3 cm and the from the anteromedial approach was 26.9 cm, with no statistic difference between groups. The VAS for pain after six weeks had no statistic difference between approachs but the anteromedial approach had 15% of numbness on the correspondent area of the safenous nerve. There were no complications reported in the posterior approach. Conclusion: There was no difference in the ST length between posterior and anteromedial approach, with more complications in the anteromedial approach. During achilles tendon reconstruction, the use of the posterior approach is a safe, more direct and easy approach and non inferior in terms of tendon length extraction, and should be consider the first option for tendon harvest in this procedure.
Correlation between Level of Evidence and Citations in Top 100 Cited Hallux Valgus Articles
Authors: Panchbhavi Vishank V. 
Published: December 2023

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: An article's scientific impact has often been measured by the number of citations it receives. A citation analysis can help determine impactful works in medical specialties. The objective of this study is to describe the metrics and levels of evidence of articles on Hallux valgus. Methods: This study reviewed the top 100 most cited articles available when searching for articles in an electronic database using the keywords “hallux valgus”, and “bunion”. Each article was examined for the number of citations, publication type, journal specialty, authorship, country of origin, year of publication, level of evidence, and total sample size. Results: The number of citations ranged from 68 to 424. The 100 most cited articles were published in 24 journals, spanning from general to more specific subspecialty journals. 45% of articles were published by Foot and Ankle International. The most common level of evidence was V (34 out of 100 articles), and most articles were case series (n = 28) and expert opinion (n = 19). The median sample size in experimental studies was 44. Out of 100 articles, only 3 were randomized controlled trials. Conclusion: The median year of most cited publications, 2003, suggests a need for newer studies reviewing Hallux valgus. The paucity of articles with an evidence level of 1 or 2 and a small median sample size suggests a lack of scientifically rigorous studies reviewing Hallux valgus. There is a weak positive correlation between strength of evidence and number of citations in the top 100 articles cited on Hallux valgus (r= 0.149).
Decreased Reoperation Rate with ABMP in Foot and Ankle Fusions
Authors: Bennfors Grace , Cutrone Joseph , Nadeau Elizabeth K. , Morningstar Joshua L. , Scott Daniel , Gross Christopher E. 
Published: December 2023

Category: Ankle; Hindfoot Introduction/Purpose: A nonunion is a challenging clinic problem following foot and ankle arthrodeses. There is great interest in orthobiologics as surgical adjuvants. The purpose of this study is to compare three orthobiologics (PDGF-B agonist [PDGF-B], allograft bone morphogenetic protein [ABMP], crushed cancellous allograft [CC]) to determine if there is a difference in union rates following foot and ankle arthrodeses. Methods: A retrospective review was conducted of 258 feet (255 patients) with minimum 3-month follow-up, undergoing arthrodesis by a single fellowship-trained foot and ankle orthopaedic surgeon from 2016-2022. Patients underwent ankle, pantalar, triple, subtalar (ST), midfoot, or talonavicular fusion. Data collected included demographics, medical history, orthobiologics used, postoperative complications, readmission and reoperation rates. 83 (34.0%) cases used PDGF-B with CC, 32 (13.1%) used solely ABMP, 66 (27.0%) used ABMP with CC, and 63 (25.8%) used solely CC. Union was defined as bridging bone on three joint quadrants on AP and lateral radiographs, or greater than 50% bridging bone of the joint space on computed tomography (CT). Results: Of the 258 cases, the ST joint was most commonly fused (53.7%). Cases using ABMP had statistically significantly shorter mean time to fusion (ABMP=120.81 days, no ABMP=162.04 days). Patients treated with ABMP were also significantly less likely to undergo reoperation or removal of hardware. Between PDGF-B+CC and ABMP+CC groups, only reoperation rates differed significantly (PDGF-B+CC=26.5%, ABMP+CC=7.6%,). Multivariate regression modeling for time to fusion found ABMP usage to be the only statistically significant predictor of time to fusion, predicting patients will achieve fusion nearly 40.7 days quicker with the use of ABMP. Conclusion: Joints treated with PDGF-B and ABMP demonstrated equivalent fusion rates. Treatments using ABMP and CC achieved quicker time to fusion and lower rates of reoperation when compared to treatments using PDGF-B and CC.
Distance Mapping of the Ankle Joint Before and After Corrective Anterolateral Arthroscopic Subtalar Arthrodesis (ALAPSTA)
Authors: Bernasconi Alessio , Fernando Céline , Izzo Antonio , Lintz François 
Published: December 2023

Category: Hindfoot; Arthroscopy Introduction/Purpose: Supramalleolar osteotomies have been proposed as surgical option to realign the ankle joint in case of altered intra-articular loading. Little is known about the changes occurring at the tibiotalar joint after inframalleolar procedures, such as the corrective arthroscopic anterolateral subtalar arthrodesis (ALAPSTA). We set out to investigate changes in terms of joint interaction between the articular surfaces at the tibiotalar joint after corrective anterolateral arthroscopic subtalar arthrodesis (ALAPSTA) to treat Progressive Collapsing Foot Deformity (PCFD) with sinus tarsi impingement and subtalar joint degeneration. We hypothesized that ALAPSTA would improve hindfoot malalignment and that the distances between articular surfaces at the ankle would change significantly. Methods: In this retrospective study, we evaluated a consecutive series of 33 feet from 33 patients (mean age 60 years, SD 16.2; 16 right and 17 left) diagnosed with PCFD undergone ALAPSTA and reassessed at a mean follow-up of 7 months (range, 2 to 50). Weightbearing computed-tomography (WBCT) images were retrieved and the Foot and Ankle Offset (FAO) was calculated to assess the hindfoot alignment. Distance Mapping (DM) at the ankle joint (divided in 9 regions) allowed to assess changes in terms of joint interaction at this level between pre and postoperative images. Results: Hindfoot alignment significantly improved with a pre-operative FAO at 10.7 points (SD 4.7) and a post-operative FAO at 4.8 (SD 4.9) (p < 0.001). The mean improvement was 5.6 points. We found a significant increase in mean distances occurring posterolaterally at the ankle (from 4.5 mm (SD 1.2) to 5.4 mm (SD 1.5), p< 0.001) along with a significant decrease occurring anteromedially (from 9.1 mm (SD 1.2) to 8.3 mm (SD 1.4), p< 0.001). Conclusion: In this series, ALAPSTA was effective at correcting hindfoot malalignment in PCFD. After the procedure, the interaction at the ankle joint significantly changed with a reduction of anteromedial distance and an increase of posterolateral distance. Inframalleolar procedures seem to alter significantly the interaction between the tibia and the talus at the ankle. Further studies are warranted to ascertain whether changes in distances between surfaces correspond to changes in intra-articular pressures.