bluuebunny/crossref_metadata_2025_split huggingface dataset:
Posterior Hindfoot Endoscopy Using 1.9-mm Diameter Needle Arthroscopy: A Cadaveric Study
Authors: Shimozono Yoshiharu , Ito Yoshiharu , Ryoki Hayato , Sakai Sayako , Ishie Shinichiro , Arai Ryuzo , Kuroda Yutaka , Matsuda Shuichi 
Published: January 2022

Category: Ankle; Arthroscopy; Hindfoot; Sports Introduction/Purpose: Posterior hindfoot endoscopy is a safe and effective treatment for posterior ankle impingement syndrome (PAIS) and flexor hallucis longus (FHL) tendon disorders. As frequent coexistence of PAIS and FHL tenosynovitis has been reported, it is important to investigate FHL tendon pathology concomitantly when treating PAIS. However, the visualization of FHL tendon distal to the retinaculum is limited when using conventional rigid arthroscopy. Additionally, wound-healing problems following hindfoot endoscopy have been still reported. Recently, a novel 1.9-mm diameter needle-arthroscopic system has been introduced. Its small and semirigid features can help reduce the risk of wound complications and can make it easier to perform FHL tendoscopy. The purpose of this study was to assess whether 1.9-mm diameter needle-arthroscopy was useful for hindfoot endoscopy in a cadaveric model. Methods: A 1.9-mm diameter arthroscopic system (NanoScopeTM, Arthrex) was used to perform a hindfoot endoscopy in 6 human donor ankles (3 pairs). The arthroscope tube is 9.5-cm long and semi-rigid, and has a 1.9-mm outer diameter. The scope's direction of view is 0°, with a 120° field of view. Posteromedial and posterolateral portals were established. Visualization and operative reach with tailored arthroscopic instruments were recorded, including posterolateral talar process, posterior talofibular ligament, intermalleolar ligament, subtalar joint, ankle joint, and flexor hallucis longus (FHL) tendon. Finally, a conventional 4.0-mm diameter arthroscope with a 30° angle was used to compare the visualization of FHL tendon. Results: All significant structures were successfully visualized and reached in all specimens. In ankle joint, all of the tibial surface was visualized, but visualization of talar surface was limited. Due to its wide 120° field of view, there was no difficulty obtaining sufficient visualization in any structures. As this needle-arthroscopic system has the semirigid frame, FHL tendoscopy was easily performed via the posterolateral portal. In all specimens, the FHL tendon was visualized from the level of ankle joint to the Knot of Henry (Zone 1 and 2), and the flexor digitorum longus tendon crossing obliquely over the FHL tendon was observed (Figure). The conventional arthroscope could not be inserted into the tunnel underneath the sustentaculum tali in any specimens. Conclusion: Posterior hindfoot endoscopy using a 1.9-mm diameter needle-arthroscopy provides effective visualization and surgical reach of all significant structures for the treatment of PAIS. Its small and semirigid features also make the FHL tendoscopy less invasive and more accessible than conventional rigid arthroscope.
Quantification and Comparison of Talar Exposure Utilizing A Posteromedial Approach and Medial Malleolar Osteotomy
Authors: Shofoluwe Ademola I. 
Published: January 2022

Category: Ankle; Hindfoot; Trauma Introduction/Purpose: Fractures of the talus contain a variety of morphologies including the head, neck, body, dome, lateral process, posterior process, and medial/lateral tubercles. Specifically, the posterior medial approach is useful for surgical fixation of posterior process fractures. The use of the medial malleolar osteotomy is beneficial in more extensive medial and distal exposure for neck or neck/body fractures. The purpose of this study was to quantify the area of osseous exposure afforded by a posteromedial approach to the talus and medial malleolar osteotomy. We believe this can be potentially useful for preoperative planning. To the authors' knowledge, a quantitative comparison of the talar access afforded by these two distinct approaches has yet to be described in the literature. Methods: Five fresh frozen cadaveric lower extremities were dissected using a posteromedial approach and medial malleolar osteotomy respectively. Following exposure, the talar surfaces directedly visualized and demarcated along its boarders using a 2.0 mm drill bit orthogonal to the talar surface. The surface visualized was labeled and captured using a calibrated digital image. The digital images were then analyzed using ImageJ software (National Institutes of Health, Bethesda, MD) to calculate the surface area of the exposure. Results: The average square area of talus exposed using the posteromedial approach was 9.70 (SD = 2.20, range 7.20 - 12.46) cm2. The average quantity of talar exposure expressed as a percentage was 9% (SD = 1.58, range 7.03 - 10.40). The average square area of talus exposed using a medial malleolar osteotomy was 14.32 (SD 2.00, range 11.26 - 16.66) cm2. The average quantity of talar exposure expressed as a percentage was 12.94% (SD = 1.79, range 9.97 - 14.73). The posteromedial approach provided superior visualization of the posterior talus, while the medial malleolar osteotomy offered greater access to the medial body. Conclusion: The posteromedial approach and medial malleolar osteotomy allow for significant exposure of the talus, yielding 9.70 cm2 and 14.32 cm2, respectively. Given the differing portions of the talus exposed, surgeons may prefer to utilize the posteromedial approach for surgical fixation of posterior process fractures and elect to use a medial malleolar osteotomy in cases requiring more extensive medial and distal exposure for neck or neck/body fractures.
Efficacy of Fluoroscopically Guided Corticosteroid Injections for Foot and Ankle Pain
Authors: Slone Tyler , Ciesa Michael , Bartholomew Ania , Cheney Nicholas A , Clark Brian C. 
Published: January 2022

Category: Midfoot/Forefoot; Ankle; Ankle Arthritis; Hindfoot; Lesser Toes Introduction/Purpose: Arthritis of the foot and ankle can severely hamper quality of life resulting in decreased mobility and functionality. Conservative treatment can involve corticosteroid injections into affected joint spaces. Fluoroscopic guided injections provide confirmation that the injection was successfully applied within the appropriate joint space. Due to this, they can be of diagnostic value and result in more accurate injection placement. Current literature focuses on ultrasound guided injections and does not fully address the efficacy of fluoroscopic injections. Objective: Assess and determine overall efficacy of fluoroscopically guided corticosteroid injections including the degree and period of relief provided. Methods: We retrospectively reviewed patient charts from 2016 through 2020 of patients that received fluoroscopically guided corticosteroid injections in foot or ankle joints. 224 injections were reviewed, gathering responses to percent relief, days of relief, pre-/post-injection VAS pain score and efficacy of repeat injections. Additionally, Kellgren-Lawrence arthritis scale vs pain relief were analyzed. Results: Analysis limited by incomplete patient response. 24/83 (28.9%) injections provided less than 2 weeks of relief while 59/83 (71.1%) injections averaged 109.49 +- 72.03 days of pain relief. Of 127 responses, post-injection relief at first follow up had an average VAS reduction of 2.87 +- 3.17 with 70.38 +- 30.8 % improvement. 40 subjects with repeat injections had 109.41 +- 64.96 days of relief per injection. No significant correlation was found between joint injected or degree of arthritis and percent improvement. Conclusion: Fluoroscopic guided injections are an effective conservative option providing prolonged but varying relief of 3-4 months irrespective of the specific joint or degree of arthritis. Repeat injections show similar efficacy. In contrast to ultrasound guided injections, fluoroscopy provides additional diagnostic and therapeutic value. This can be beneficial if the injections fail and the patient must progress to surgery. Future prospective studies could directly compare different injections modalities and further analyze efficacy for specific diagnoses.
Percutaneous Correction Surgery of Hammer Toes with Biodegradable Pins
Authors: Sotelano Pablo , Villena Daniel S. , Parise Ana C. , Conti Leonardo A. , Carrasco Nelly M. , Verbner Jonathan M. , Araujo Maria Gala Santini 
Published: January 2022

Category: Lesser Toes; Midfoot/Forefoot Introduction/Purpose: The standard treatment for deformities in lesser toes is proximal interphalangeal arthrodesis with Kirschner wires. It is relatively inexpensive but complications have been described such as infection, recurrences and misalignment. New devices were developed, among them biodegradable pins avoid the need for withdrawal and exposure to the outside. The objective of this study was to describe the clinical and radiological results one year after surgery in a group of patients with a diagnosis of rigid hammer toes, who underwent percutaneous surgical correction with a biodegradable pin. Methods: Methods: We present a retrospective study in a consecutive series of cases with a diagnosis of hammer toe operated between January 2016 and December 2018. Patients older than 18 years of age who underwent a percutaneous proximal interphalangeal arthrodesis, with a biodegradable pin, were included. The patients were asked through a survey to rate the results obtained with the intervention (excellent, very good, good, fair and bad). loss of contact with the ground was evaluated with podobarography. The patients were evaluated with weightbearing X rays to assess interphalangeal alignment and consolidation. We used the AOFAS scale to assess clinical results, preoperatively and one year after surgery. Postoperative complications, infection, wound dehiscence, rupture of osteosynthesis material, loss of correction were also evaluated. Results: 117 patients were identified, 23 (16%) underwent bilateral surgery (140 feet), with a total of 220 lesser toes who underwent proximal interphalangeal arthrodesis stabilized with percutaneously biodegradable pin. 50% had a minimum follow-up of 1 year. The pre-surgical AOFAS of 52 improved to 95 points in the postoperative period. In 96 (43.63%) fingers, an F1 base osteotomy was performed to correct the alignment in the coronal plane. We observed pseudo osteoarthritis in 5% of the toes but with good alignment. We observed 6% of floating fingers, the pin was removed in 5 fingers; without loss of correction. In 1.36% cases it migrated early, causing a recurrence of the lesion. Patient satisfaction was excellent or very good in 79 %. Conclusion: According to our serie results, we consider that percutaneous technique with biodegradable pins manages to maintain adequate alignment and a consolidation rate both in radiological and clinical results with good patient satisfaction. No infection case was reported. We found a low rate of biodegradable pin removal. For its part, the biodegradable plug allows osteotomies to be performed with the implant already in place, it does not require routine removal of the implant, reducing the need for a second intervention.
Preoperative Depression is Associated with Increased Complications Following Ankle Fracture Surgery
Authors: Tahmid Syed , Broggi Matthew S. , Hurt John , Kadakia Rishin J. , Bariteau Jason T. , Coleman Michelle M. 
Published: January 2022

Category: Ankle; Trauma Introduction/Purpose: Ankle fractures are a common injury treated by orthopaedic surgeons with a rising incidence. Preoperative depression is a known risk factor for postoperative complications in joint replacement surgery, however its effects on outcomes following ankle fracture surgery is unknown. The purpose of this study was to investigate the relationship between preoperative depression and outcomes following ankle fracture surgery. Methods: In this retrospective study, the Truven MarketScan claims database was used to identify patients who underwent outpatient ankle fracture surgery from January 2009 to December 2018 using Common Procedure Terminology (CPT) codes. Patient characteristics, and medical comorbidities were collected. Patients with and without a diagnosis of preoperative depression were identified based on International Classification of Diseases (ICD) codes. Chi-squared and multivariate analyses were performed to investigate the association between preoperative depression and common postoperative complications following ankle fracture surgery. Results: In total, 107,897 patients were identified for analysis, 13,981 of whom were diagnosed with depression (13%). Preoperative depression was associated with the increased odds for postoperative infection (OR 1.33, CI 1.20-1.46), wound complications (OR 1.13, CI 1.00-1.28), pain-related postoperative emergency department visits (OR 1.58, CI 1.30-19.1), 30-day and 90-day readmissions (OR 1.08, CI 1.03-1.21 and OR 1.13, CI 1.07-1.18), sepsis (OR 1.39, CI 1.12-1.72) and postoperative development of complex regional pain syndrome (OR 1.46, CI 1.18-1.81). Conclusion: Preoperative depression in patients undergoing ankle fracture surgery is common and associated with increased complications following surgery. An understanding of patients' preoperative depression diagnosis can allow providers to modify perioperative and postoperative protocols for these higher risk patients. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor.
Quantitative Evaluation of Ankle Instability Using a Capacitance-Type Strain Sensor
Authors: Teramoto Atsushi , Murahashi Yasutaka , Shoji Hiroaki , Kamiya Tomoaki , Watanabe Kota , Yamashita Toshihiko 
Published: January 2022

Category: Basic Sciences/Biologics; Ankle; Sports Introduction/Purpose: Manual evaluation is an important method for assessing ankle instability, but it is not quantitative. Capacitance-type sensors can be used to measure the distance on the basis of the capacitance value. We applied the sensor to the noninvasive device for measuring ankle instability and showed its utility. Methods: First, five ankles embalmed by Thiel's method were used in an experiment using a cadaver. The capacitance-type sensor was fixed alongside the anterior talofibular ligament (ATFL) of a specially made brace, and the anterior drawer test was performed. The test had been performed for the intact ankle, with the ATFL transected, and with both the ATFL and calcaneofibular ligament (CFL) transected. The anterior drawer distance was calculated by the sensor. Intra and interinvestigator reliability were also analyzed. Next, as a clinical study, a brace with a sensor was fitted to 22 ankles of 20 patients with a history of ankle sprain. An anterior drawer test at a load of 150 N was conducted using a Telos stress device. The anterior drawer distances measured by the sensor and based on X-ray images were then compared. Results: The mean anterior drawer distance for the intact cadavers was 3.7 +- 1.0 mm, 6.1 +- 1.6 mm with the ATFL transected (P < 0.001), and 7.9 +- 1.8 mm with the ATFL and CFL transected (P < 0.001). The intrainvestigator intraclass correlation coefficients (ICC) were 0.862-0.939, and the interinvestigator ICC was 0.815. In the experiments on patients, the mean anterior drawer distance measured by the sensor was 2.9 +- 0.9 mm and 2.7 +- 0.9 mm from the X-ray images. The correlation coefficient between the sensor and the X-ray images was 0.843. Conclusion: We carried out a quantitative evaluation of anterior drawer laxity using a capacitance-type sensor and found it had high reproducibility. It was also very strongly correlated with stress radiography measurements in patients with ankle instability. Capacitance-type sensors can be used for the safe, simple, and accurate evaluation of ankle instability.
Lateral Extensile Approach to the Calcaneus is Safe after Sinus Tarsi Incision: A Report of Two Cases
Authors: Udawatta Thiran , Goodnough Lawrence H. , Benirschke Stephen K. 
Published: January 2022

Category: Trauma; Hindfoot Introduction/Purpose: While the optimal surgical approach for operative treatment of calcaneus fractures is controversial. Regardless of index approach, post-injury sequelae such as malunion may require subsequent extensile exposures for reconstruction. In the tenuous soft tissues overlying the Whether a lateral extensile approach is safe following a previous sinus tarsi exposure has yet to be demonstrated. Methods: In this case report, two individuals underwent an initial sinus tarsi approach for reduction and fixation of calcaneus fractures, but went on to malunion or subtalar arthritis. A 'sham' surgery consisting of skin incision and initial flap elevation was performed to evaluate the efficacy of a lateral extensile approach to the calcaneus after previous sinus tarsi incision. Results: In each instance, the patients experienced uneventful skin incision healing, and subsequently had successful reconstruction with distraction subtalar arthrodesis via lateral extensile exposures. Conclusion: The lateral extensile approach to the calcaneus may be safely performed following sinus tarsi exposure.
Comparison of a Simple Anatomic Landmark-Based Achilles Tendon Measurement with Ultrasound and MRI Measurements
Authors: Urness Daniel , Thompson Austin R. , Sodders Emelia , Ensrud Erik , Meeker James E. 
Published: January 2022

Category: Ankle; Trauma Introduction/Purpose: Achilles tendon ruptures (ATRs) occurred with an incidence of 2.5 per 100,000 person-years in 2016. This rate has been increasing over the last decade and it has been postulated that this is due to the increasing activity level of an aging population. With a high and increasing incidence of this significant injury, further investigation must be done to optimize the treatment of ATRs. The degree of tendon lengthening has been correlated with clinical outcomes, with greater elongation being associated with worse outcomes. MRI and ultrasound (US) techniques have been validated in Achilles tendon measurements. We sought to develop a reliable, reproducible, and accurate measurement technique utilizing the manual palpation of anatomic landmarks that will be cost effective as well as convenient to perform, particularly intraoperatively. Methods: Both lower legs of 10 healthy subjects without history of Achilles tendon injury were examined. For US and anatomic landmark-based (ALB) measurements, subjects' ankles were held at 90o with the lateral aspect of the lower leg resting on the exam table. The length from the medial head of the gastrocnemius to the bottom of the non-compressed heal pad was measured by three raters using the US and ALB techniques. Two of those raters repeated the measurements one week later. MRI studies were obtained with ankles held at 90o. Using imaging software, the above measurements were made in sagittal and coronal series. A repeated measures mixed model method was utilized to model the measurement type and the length of the Achilles tendon. The length of the Achilles tendon measured by each measurement type was estimated with least square means. All pairwise comparisons were considered. Results: The Achilles tendon length was similar on the left [23.4 cm (95% CL: 22.3 cm, 24.5 cm)] and right [23.5 cm (95% CL: 22.4 cm, 24.6 cm)] legs. The average Achilles tendon length measured with the ALB technique was 23.2 cm (95% CL: 21.9 cm, 24.6 cm). The average Achilles tendon length measured with the US technique was 22.4 cm (95% CL: 21.0, 23.8). The average Achilles tendon length measured on the sagittal view of MRI was 24.1 cm (95% CL: 22.7, 25.4). The average Achilles tendon length measured on the coronal view of MRI was 24.2 cm (95% CL: 22.8, 25.5). Pairwise comparisons of the measurement types were not significantly different from 0. Conclusion: The ALB measurements were not statistically different from MRI or US. With orthopaedic surgeons in need of simple, noninvasive, and cost-effective methods to assess tendon length, the authors propose this ALB technique or US as valid ways to monitor that variable both during and after repair. These results set the stage for further evaluation of this measurement technique in the operating room in subjects undergoing ATR repair.
Valgus Drift after Total Ankle Arthroplasty
Authors: Vier David , Hamid Rasikh N. , Odum Susan M. , Jones Carroll P. , Cohen Bruce E. , Irwin Todd A. , Davis W. Hodges. 
Published: January 2022

Category: Ankle; Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is a common treatment for ankle arthritis, but many challenges exist when attempting to correct and balance coronal plane deformity. Varus ankle arthritis tends to be stiffer and often leads to a more stable TAA, but valgus ankle arthritis tends to have more laxity especially in the setting of a progressive collapsing foot deformity. Failure to achieve appropriate deformity correction and soft tissue balance can result in recurrence of the deformity with valgus drift. The purpose of this study was to evaluate the longitudinal coronal plane alignment as well as outcomes in patients treated with TAA with resultant valgus drift. Methods: 98 patients who underwent TAA for valgus ankle arthritis were identified through a prospectively collected database. All patients had a minimum of 2 year follow-up. The tibiotalar angle was measured on preoperative radiographs to include patients with valgus ankle arthritis five degrees or greater. Radiographic alignment in the postoperative period was compared to the alignment at final follow-up. Complications, failures, revisions, and reoperations were recorded. Patients were categorized by severity of preoperative valgus deformity into 3 groups: 5-10 degrees, 11-20 degrees, and greater than 20 degrees. Valgus drift was defined as greater than 5 degrees of valgus shift at final follow-up when compared to the postoperative alignment. Median follow- up was 49.2 (37.2-68.3 inner quartile) months. Results: Patients with greater than 20 degrees of preoperative valgus deformity had an initial postoperative alignment of 2 degrees of valgus and ended with an average of 5.5 degrees of valgus at final follow-up. The groups of patients with 5-10 degrees as well as 11-20 degrees of valgus were corrected to neutral (0 degrees) in the initial post-op period and ended with a final postoperative valgus alignment of 2.5 degrees and 2 degrees, respectively. Overall, 16 patients (18%) had greater than 5 degrees of valgus drift after their surgery, of which 2 failed and were revised (13%) and 5 had reoperations (31%). Conclusion: All groups of preoperative valgus deformity severity had some valgus shift overall at final follow-up. The most severe preoperative valgus deformities were least likely to be corrected to neutral with the index procedure and also on average drifted back to over 5 degrees of valgus. Patients with valgus drift after TAA can still have a good result but should be monitored closely. Overall, they did not have a high failure rate. This study emphasizes the necessity of correcting both the ankle and foot deformity when performing TAA for valgus ankle arthritis in order to maintain deformity correction.