bluuebunny/crossref_metadata_2025_split huggingface dataset:
Superior Rates of Return to Sport following Anterior Talofibular Ligament Repair Augmented with Suture-Tape compared to Anterior Talofibular Ligament Repair Alone: A Retrospective Comparative Study
Authors: Randall Grace W. , Butler James J. , Azam Mohammad T. , Rettig Samantha , Kennedy John G. 
Published: December 2023

Category: Ankle; Sports Introduction/Purpose: Chronic ankle instability occurs in 15-20% of patients with ankle sprains who do not recover following conservative management and typically requires surgical intervention. There is recent interest in Anterior Talofibular Ligament (ATFL) Repair techniques that may improve outcomes and expedite recovery. Evidence for the use of suture-tape as an internal in ATFL Repair is limited in the literature. The purpose of this study was to retrospectively assess outcomes and return to sport following ATFL Repair with and without suture-tape (ST) augmentation at greater than 1-year follow-up. Methods: Chart review was conducted to identify patients who underwent Anterior Talofibular Ligament (ATFL) Repair with a minimum of 1-year follow-up. Data collected and assessed included: patient demographics, pathological characteristics, treatment characteristics, Foot and Ankle Outcome Score (FAOS), visual analog scale (VAS) scores, return to sport (RTS), complications, and failures. Linear regression was performed to identify potential predictors of outcomes. Results: Eighteen cases of ATFL repair augmented with suture-tape (ST) and 20 cases of ATFL repair alone were included. The mean follow-up in the ST cohort was 20.8 ± 7.9 months and the mean follow-up time in the ATFL repair alone cohort was 25.3 ± 13.2 months. Improvements in FAOS and VAS scores were observed in both cohorts at final follow-up (p < 0.01). No statistically significant difference in FAOS and VAS scores at final follow up was found between the 2 cohorts. The mean time to RTS was 8.6 ± 3.3 weeks in the ST cohort and 13.3 ± 2.7 weeks in the ATFL repair alone cohort (p < 0.01). No statistically significant difference in complication rates nor failure rates was observed between the 2 cohorts. Conclusion: This retrospective study found that ATFL Repair with and without suture-tape augmentation produced comparable subjective clinical outcomes, complication rates and failure rates at short-term follow-up. A superior mean time to RTS was found in the ST cohort. The early results of this surgical technique are promising, but further studies with larger patient cohorts and longer follow-up times are needed to determine the optimal role of suture-tape augmentation of ATFL repair.
The Arterial Risk Posed by the Posterolateral Approach to the Ankle: An Anatomical Cadaveric Observational Study
Authors: Mason Lyndon W. , Heeran Niamh L. , Bond Alistair P. , Gomaa Abdul-Rahman 
Published: December 2023

Category: Ankle; Trauma Introduction/Purpose: The most commonly used approach for posterior malleolar access is the posterolateral approach. This approach gives good access to the fibula and lateral aspect of the posterior tibia, however; there is little known on the vascular risks with this approach. Methods: The aim of this study was to assess and describe the anatomy of the peroneal artery and its branches at the ankle region. Methodology: Eleven cadaveric foot and ankle specimens were dissected in layers, preserving the peroneal artery, anterior tibial artery (ATA) and posterior tibial artery (PTA). Results: The peroneal artery was consistently found between the peroneal compartment and deep muscular compartment of the posterior leg. A wide range of anatomical variation was found in the peroneal artery, in its location, muscular branches, anastomosis and anterior perforating branch. The peroneal artery was the largest diameter artery in one specimen. There was great variation in number and location of muscular branches. The mean proximal distance between the medial malleolus and the posterior communicating branch of the peroneal artery was 37.93mm (range: 19.03- 85.43mm). The mean proximal distance from the medial malleolus to the anterior peroneal perforating artery was 44.23mm (range:35.44-62.32mm). Distal to the anterior perforating branch of the peroneal artery, the peroneal artery was immobile. Conclusion: Understanding the common variations within the ankle’s arterial anatomy can help surgeons protect these vessels from damage during the surgical approach. The posterolateral surgical approach, specifically puts the peroneal artery at risk and knowledge of its anatomy and variability is important when undertaking this approach.
The Efficacy of Hyaluronic Acid Injections in Soft Tissue Foot and Ankle Pathology: A Systematic Review
Authors: Butler James J. , Wingo Taylor , Joshi Shravani , Konar Kishore , Kennedy John G. 
Published: December 2023

Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: The purpose of this systematic review was to evaluate the clinical outcomes, complication rates and failure rates at short-term follow-up following hyaluronic acid (HA) injection for the management of various soft tissue foot and ankle pathologies. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following HA injection for the management of various soft tissue foot and ankle pathologies. Data regarding study characteristics, patient demographics, pathological characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. In addition, the level of evidence and quality of evidence for each individual study was also assessed. Results: Studies examining outcomes following HA injection included the following pathologies: Achilles tendinopathy (AT) (6 studies, 126 patients, weighted mean follow-up of 2.9 months), plantar fasciitis (PF) (2 studies, 54 patients, 4.3), lateral ankle sprains (LAS) (2 studies, 119 patients, follow-up of 11.4 months) and Morton's neuroma (MN) (1 study, 83 patients, follow-up of 12 months). Seven different HA formulations were utilised across 10 studies. Weighted mean pain and functional scores improved significantly in all 4 cohorts. The complication rates for the AT cohort, PF cohort, LAS cohort and MN include: 3.2%, 1.9%, 2.5% and 20.5%, respectively. The failure rates for the AT cohort, PF cohort, LAS cohort and MN include: 1.6%, 0%, 0% and 0%, respectively. Conclusion: This systematic review demonstrated improvements in subjective clinical outcomes together with low complication and failure rates following HA injections for various soft tissue foot and ankle pathologies at short term follow-up. However, the heterogeneity between the studies, low number of high quality studies and short-term follow-up limits the generation of any robust conclusions. Further research is warranted to assess the optimal role of HA in the management of foot and ankle soft tissue pathologies.
The Evaluation of Muller Weiss Diseased and Normal Feet on a Three-Dimensional Foot Model
Authors: Gu Wanjun , Zhu Mingjie , Sun Chengyi , Zhang Mingzhu , Myerson Mark , Li Shuyuan 
Published: December 2023

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: The deformities associated with Müller Weis Disease (MWD) have not been well understood which inevitably impacts clinical and surgical decision making. Despite most previous studies characterizing MWD as a paradoxical flatfoot deformity, ie, a flat arch and a varus heel, some studies have treated MWD as a flatfoot deformity by performing a medializing calcaneus osteotomy, and others as an arthritic disorder treated with hind foot arthrodesis but without correcting the deformity. This study used an automatic 3D segmentation program to create an average 3D foot model for both normal controls and a large group of MWD feet, to demonstrate the deformity pattern, and to provide surgeons with a foundation for detailed alignment evaluation and surgical planning. Methods: Weight bearing Scans of 55 health feet without deformities, trauma and surgical histories, and 69 MWD feet were included in this study. The Bonelogic program (Disior, Paragon 28,) was used to automatically segment the bones and 3D information of each foot in the same group was pooled to create an average foot model for both the controls and the MWD feet. Videos were created using all feet in both groups to demonstrate the deformity patterns ranging from normal feet transitioning to MWD feet. Since current axial and angular metrics for alignment evaluation using traditional 2D imaging cannot be extrapolated to 3D this study was kept as a descriptive paper, and no traditional metrics were analyzed and reported. Results: Compared to the average normal foot, the MWD foot model demonstrated the following features: narrowing on the lateral pole and dorsal side of the navicular, lateral rotation and slight dorsal lifting of the talar head and medial rotation of the navicular, a varus heel with more opening in the sinus tarsi, proximal shift of the calcaneal tuberosity, a flat medial arch with subsidence at the talonavicular joint, decreased adduction of the forefoot, medial translation of the cuboid at the calcaneocuboid articulation, and a shortened 1st metatarsal. All of the above changes were consistently demonstrated in video one (a comparison between the two foot models), and video two (a comparison of the peritalar joint alignment between the two groups). Conclusion: The foot models were built up with pixels, with each pixel carrying its own 3D information in space allowing exploration of real 3D alignment evaluation tools. The MWD foot model clearly demonstrated and validated the deformity patterns originally described by Maceira, and subsequently by other authors using both radiographs and WBCT scans. This model facilitates evaluation of alignment from the hindfoot to the forefoot, as well as advanced 3D analysis to assess the morphology of the bones and joints and can be the foundation for surgical planning and predication of outcomes.
The Variation Between Unilateral and Bilateral Weight Bearing in Hindfoot Alignment Evaluation. Part I: A Prospective In Vivo Radiographic Study
Authors: Zhu Mingjie , Far Munib D. , Pham Kenneth , Read Jake , Constantine Evangelia , Tyler Benjamin , Wittels Stephen , Myerson Mark , Li Shuyuan 
Published: December 2023

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: When weight bearing radiographs are taken, the patient is frequently asked to stand on the foot being examined with the other foot lifted off the floor. We have found however that alignments of the hind and midfoot change when bearing weight switches from bilateral to unilateral standing. This study investigated the possible differences in hindfoot alignments between unilateral and bilateral weight bearing using radiographical evaluation. Methods: Eight flexible feet without symptoms symptoms, nor significant trauma & surgical history in their lower limbs were recruited for this study. A portable fluoroscopy machine (Smart C, Turner Imaging, Salt Lake City, USA) was used to take weightbearing lateral views. The patient first stood on both feet with the non-examined foot standing outside of the collimator but bearing weight evenly (Figure 1), and then lifted the non-examined foot off the floor when the lateral XR image was taken for the examined foot. Hindfoot alignment in both positions was reflected by measuring the angle between the long axes of the proximal and distal portions of the Achilles tendon on the skin using the subtalar joint line as the intersection. On lateral XRs, various parameters were measured to reflect the subtalar joint alignment, the position of the calcaneus with inversion and eversion of the hindfoot, and the lateral and medial arch heights. Results: From bearing weight on two feet (bilaterally) to one foot (unilaterally), the Hindfoot Alignment Angle (Achilles) increased (6.23 to 11.21 degrees), the Calcaneal Pitch Angle decreased (22.06 to 19.22 degrees), the Middle vs Posterior Facets Angle decreased (166.46 to 160.74 degrees), and the 5th metatarsal/cuboid height decreased (0.73 to 0.67) all significant changes (p < 0.05). All of these represented a pronation movement in the mid and hindfoot, ie, valgus tilt/eversion of the calcaneus, decreased sinus tarsi opening, and reduced lateral arch height. In this small cohort, these differences were more obvious in the feet that were either slightly flat or cavus shaped (Figure 1, Table 1, and 2) than in feet with a more neutral alignment. Conclusion: The hindfoot and midfoot are more pronated in unilateral weightbearing than in bilateral weightbearing which may mask the severity of the deformity in a flexible cavovarus foot, but increase that in a flexible flatfoot. Modification of the traditionally used unilateral weightbearing position in obtaining clinical radiographs should be considered. Bilateral WBCT scans may be a better alternative, taking advantage of allowing both feet to stand in the most natural position without one foot blocking the other during the radiographic imaging.
Tibiotalocalcaneal Arthrodesis with Hybrid Nail-Plate Constructs: A Novel Technique for Treatment of Unstable Ankle & Hindfoot Deformities
Authors: Smith Carson J. , Boyer Braden , Bettin Clayton 
Published: December 2023

Category: Ankle; Hindfoot Introduction/Purpose: Tibiotalocalcaneal (TTC) arthrodesis is a treatment option for several pathologies of the hindfoot and ankle. Traditional fixation options include intramedullary nailing or plate-screw constructs. In certain patients, for example when bone quality or post-operative compliance are of concern, more robust fixation may be desired. Charcot neuroarthropathy (CN) patients in particular often have complex deformities, poor bone quality, and impaired sensation. New trauma literature shows hybrid nail-plate constructs (NPCs) may permit early weight bearing in osteoporotic distal femur fractures. We report early results of TTC arthrodesis using NPCs in patients with complex deformities of the ankle and hindfoot. Methods: Patients undergoing TTC arthrodesis via intramedullary nail fixation plus plating by a single surgeon from September 2020 to December 2022 were included in our study. Indications included CN, post-traumatic deformities, and advanced arthritis. Age, comorbidities, Hemoglobin A1c, presence of an ulcer, implants, bone graft used, and postoperative complications were retrospectively recorded. Results: Fifteen patients met inclusion criteria. Six patients had CN; eight patients had post-traumatic complications; and one patient had an arthritic cavovarus deformity. Average age was 55 years (range 31-72). Eleven patients were treated with a lateral TTC locking plate; three were treated with an anterior tibiotalar arthrodesis plate; and one was treated with a 3.5mm reconstruction plate. All patients were treated with a TTC arthrodesis nail. In all cases, cellular bone matrix was used; in fourteen cases, autograft was also used. Average follow-up was 35 weeks (min. 12). Three patients underwent below-knee amputation, two for infection and the other for hardware failure. Two others required postoperative debridements but subsequently cleared their infections. Twelve patients have a stable, non-infected, ulcer free foot at latest follow-up. Conclusion: TTC arthrodesis can be used for a variety of indications, and many of these patients present complex challenges. Patients with CN in particular often have severe deformities and poor bone quality. Hybrid fixation methods provide added stability in complex cases, possibly allowing for more powerful deformity correction and earlier weight-bearing. We report a 80% favorable outcome rate in our case series, with major complications confined to patients with significant medical comorbidities (poorly controlled diabetes, peripheral vascular disease). We believe that TTC arthrodesis with hybrid nail-plate constructs represents an attractive solution to complex ankle and hindfoot deformities.
Unsatisfactory Outcomes After Conservative Treatment for Proximal Migration of Acute Calcaneal- Side Calcaneofibular Ligament Rupture in Athletes: A Preliminary Report
Authors: Kim Jin Su , Kim Sangbum 
Published: December 2023

Category: Ankle; Sports Introduction/Purpose: Acute ankle ligament rupture is usually treated conservatively. However, it sometimes progresses to chronic ankle instability. We suspected that there is a tendency for calcaneal-side calcaneofibular ligament (CFL) ruptures to progress to chronic ankle instability. Methods: Fourteen athletes with calcaneal-side CFL ruptures who were treated conservatively and followed for a mean period of 35.2 months were included in the study. Proximal migration of the stump of CFL (mm) was evaluated using magnetic resonance imaging at a 45° oblique coronal plane. A Stener lesion was defined as severe migration outside the peroneal tendon. The results of manual anterior drawer, varus stress tests, and stress radiographs at the initial and final follow-up visits were compared. The time to return to running, team training, and sporting competitions were recorded. At the final follow-up, patient satisfaction and Cumberland Ankle Instability Tool (CAIT) were used to assess ankle function. Results: The mean proximal migration of CFL was 11.2 mm. Four Stener lesions were found. However, neither proximal migration nor Stener lesions were significantly related to CAIT scores (rho = 0.288 and rho = 0.082, respectively) instability significantly decreased after conservative treatment from a mean grade of 2.0 to 1.4 in the anterior drawer test (P = 0.032). The varus stress test results showed a decrease from grade 2.2 to 1.8 (P = 0.053) without significance. Radiologically, decreases in anterior translation from 6.1 mm to 5.4 mm (P = 0.205) and talar tilt angles from 7.2° to 6.5° (P = 0.500) were observed without significance. It took 12.2, 14.7, and 18.0 weeks to return to running, team training, and sporting competitions. Seven athletes (50%) reported unsatisfactory results. Conclusion: Conservative treatment for CFL rupture with proximal migration was associated with poor outcomes in athletes.
Venous Thromboembolism: Assessing Risk Factors in Elective Foot and Ankle Surgery Patients
Authors: Heo Kevin Yunhao , Karzon Anthony , Bariteau Jason T. , Labib Sameh A. , Kadakia Rishin J. , Coleman Michelle 
Published: December 2023

Category: Midfoot/Forefoot; Ankle Introduction/Purpose: Venous thromboembolism (VTE) after foot and ankle surgery is a significant concern for patients and surgeons. The absence of guidelines for thromboprophylaxis in elective procedures underscores the importance of understanding risk factors. This study aimed to identify key risk factors of VTE in patients who underwent elective foot and ankle surgery, analyzing the rates based on the anatomical location of the surgery and the post-operative period. Methods: Data was collected from IBM MarketScan Database (2009-2019) for patients >18y without prior VTE who underwent elective foot/ankle surgery. Patients were divided into three groups based on region of surgery (forefoot, mid/hindfoot, lower leg/ankle), and VTE incidence was recorded 30- and 90-days post-surgery. Risk factors for VTE were identified through multivariate logistical regression analysis. Results: Among the 301,256 patients who underwent elective foot and ankle surgeries, the overall incidence of VTE within 90 days was 0.95%. The findings revealed that 31.8% of VTE incidents occurred within the first two weeks after surgery, and 29.2% still occurred after 6 weeks. An analysis of the anatomical region of surgery demonstrated that the lowest rate of VTE was amongst patients undergoing forefoot surgery (0.70%). There was a higher incidence and risk for VTE in patients undergoing midfoot/hindfoot surgery (1.22%, OR = 1.75) and lower leg/ankle surgery (1.76%, OR= 2.53). Additional risk factors for VTE included thrombophilia (OR = 5.06), male sex (OR = 1.43), increasing age (OR > 1.25), and a high Charlson Comorbidity Index (OR < 0.82 for scores < 5). Conclusion: This study identifies the incidence and timing for VTE after elective foot and ankle surgery. Furthermore, this study defines the risk factors associated with increased odds of VTE after elective foot and ankle surgeries. These findings are helpful in educating patients about a continued risk for VTE throughout the 90-day postoperative period. These results can also be utilized to stratify patients who need thromboprophylaxis based on the individual risk level.
Weight-bearing CT Scan Analysis in Hallux Valgus Surgery: Comparison between Open (Scarf) and Minimally Invasive (MIBA) Techniques
Authors: Ahumada Ximena , Chaparro Felipe , Pellegrini Manuel J. , Carcuro Giovanni , Protasowicki Nicolas , Ortiz Cristian A. 
Published: December 2023

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Hallux valgus (HV) is one of the most prevalent foot deformities. Coronal metatarsal rotation (pronation) has been recognized as a key element in HV deformity and an important prognostic factor for recurrence. With the advent of weight-bearing CT (WBCT), accurate pronation measurement has improved. The Minimally Invasive Bosh Akin (MIBA) surgery has proven to be effective in treating HV deformity. Literature comparing MIBA radiological correction with traditional open techniques (scarf osteotomy) is lacking. Purpose: To compare the transverse and coronal plane deformity correction by WBCT in HV patients treated with open vs MIS technique. Methods: We retrospectively analyzed HV deformity in patients who underwent Scarf and MIBA surgery with preoperative and at least 3 months postoperative WBCT for comparison. Intermetatarsal angle (IMA), hallux valgus angle (HVA), and alpha angle (AA) for first metatarsal pronation was measured by 2 different observers. Pre and postoperative measurement changes were established by T-test for related samples. the p-value for statistical significance was set at < 0.05. Results: 40 feet included. The mean preop IMA in scarf was 13.1, and 13.6 in MIBA (p= 0.7). Mean postop IMA in scarf was 4.9, and 6.8 in MIBA (p < 0.05). The mean preop HVA in scarf was 25, 28.7 in MIBA (p=0.1). Mean postop HVA in scarf was 5.9, 13.1 in MIBA (p < 0.05). Mean preop AA in scarf was 8.9, 8.9 in MIBA (p= 0.6). Mean postop AA in scarf was 6.3, 6.9 in MIBA (p=0.7). All feet had a significant improvement of IMA and HVA pre and postop (p < 0,005). Scarf preop AA was 8.9 and 6.3 postop, which is a pronation change of -2.5 (p < 0.05). MIBA preop AA was 8.9 and 6.9 postop, which is a pronation change of -2 (p=0.054). Conclusion: To the best of our knowledge, this is the only study that compares WBCT correction between Scarf and MIBA surgery. Both osteotomies have a significant power to correct transverse deformity, scarf corrects significantly better than MIBA when analyzing HVA and IMA. The scarf has a significant power to correct pronation, whereas MIBA shows a strong tendency.