bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Weight-Bearing Computed Tomography in the Evaluation of Abnormal Hindfoot Morphology in Charcot-Marie-Tooth Patients
Authors: Michalski Max , An Tonya W. , Haupt Edward T. , Yeshoua Brandon , Salo Jari , Pfeffer Glenn B. 
Published: January 2022

Category: Hindfoot; Other Introduction/Purpose: The hindfoot deformity seen in Charcot-Marie-Tooth disease (CMT) is poorly understood, and the contribution of abnormal bone morphology has never been conclusively demonstrated. The purpose of this study was to compare the three-dimensional (3D) bone morphology of the talus, calcaneus and navicular in a cohort of CMT patients versus a control population. We used the data obtained from weight-bearing computed tomography (WBCT) to reconstruct the geometric shape of each bone using 3D surface meshing techniques. Surface mesh analysis of this type is commonly used in engineering to evaluate and optimize 3D geometries and structures. Methods: A total of 17 WBCTs from 15 patients (average age 24) with CMT who underwent WBCT without previous surgeries, degenerative changes or open physes were included. These were compared to 20 healthy control WBCTs. Calcaneal measurements included the radius of curvature and the angle between the posterior tuberosity and posterior facet in the sagittal plane. Talar measurements include axial and sagittal declination between the body and neck as well as coronal rotation of the talar head relative to the body. Surface-mesh model analysis was performed comparing the average of the CMT cohort to the controls using CT analysis software (Disior Bonelogic). Means were compared with a t test (p<0.05). Results: CMT patients had significantly less sagittal declination (plantarflexion) versus controls (14.9 versus 25.1 degrees respectively) (p<0.01). Similarly, CMT patients had less talar head coronal rotation versus controls (30.2 versus 42.5 degrees respectively) (p<0.001). There was no difference in axial rotation of the talar neck versus body between the groups (p=0.88). The calcaneal radius of curvature in CMT patients was significantly smaller than the control population (716.6 versus 2143.5 mm respectively) (p<0.05). Angular differences were also significant between the posterior tuberosity and posterior facet of the subtalar joint in the sagittal plane (CMT 57.7 degrees, control 67.9 degrees) (p<0.001). Additionally, surface-mesh model analysis demonstrated the largest differences in morphology at the navicular tuberosity, medial talar head, sustentaculum tali and anterior process of the calcaneus (Figure 1). Conclusion: This is the first study to quantify the morphologic differences in osteology seen in CMT patients. The decreased sagittal declination of the talar neck is seen with a reciprocal decreased slope of the posterior facet of the calcaneus. The coronal rotation of the talar head and abnormal navicular tuberosity morphology shows changes seen in patients with CMT and may be attributed to unbalanced pull of the posterior tibial tendon during development. These findings will help refine, and potentially revolutionize the surgical reconstruction of cavovarus deformity in CMT patients.
Declining Trends in Medicare Reimbursement in Orthopaedic Foot and Ankle Surgery
Authors: Miskiel Sandra , Bye Matthew , Freeland Erik C. , Pagliaro Andre J. 
Published: January 2022

Category: Ankle; Ankle Arthritis; Arthroscopy; Bunion; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports; Trauma; Other Introduction/Purpose: With the increasing complexity of physician reimbursement models, understanding reimbursement trends is crucial to the financial sustainability of orthopaedic practices nationwide. Inflation-adjusted Medicare physician reimbursement for total joint arthroplasty has decreased by approximately 33% from 2000 to 2019. Recent trends in orthopaedic foot and ankle reimbursement are unknown. Thus, our study sought to analyze trends in Medicare reimbursement rates from 2000 to 2020 for common orthopaedic foot and ankle surgical procedures. Methods: The financial database of a single academic tertiary care center was queried to identify the CPT codes most frequently utilized in orthopaedic foot and ankle care. Next, the Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried for the top 30 CPT codes utilized, and physician reimbursement data extracted. Monetary data was subsequently adjusted for inflation utilizing the consumer price index and reported in 2020 US dollars (USD). Average annual and the total percent change in reimbursement were calculated for included procedures. Results: After adjusting for inflation, the average physician reimbursement decreased by 31.6% for all included foot and ankle procedures from 2000 to 2020, with 23/30 codes decreasing by more than 30%. The greatest decrease in reimbursement observed from 2000 to 2020 was for open treatment of calcaneal fracture at 48.3% ($2,254.17 to $1,164.97), followed by flexor tendon repair at 48.2% ($741.02 to $357.39), and open treatment of pilon fracture at 43.9% ($2,451.37 to $1,076.36). Conclusion: Over the past two decades, physician reimbursement for foot and ankle procedures has dramatically decreased by up to 48.3%. Continued downward trends in orthopaedic foot and ankle physician reimbursement may lead to decreased access to quality foot and ankle care.
The Intercalary Fragment in Posterior Malleolus Fractures: Characterization and Significance
Authors: Umbel Benjamin D. , Myers Devon , Taylor Benjamin C. , Buchan John A. , Melaragno Anthony J. 
Published: January 2022

Category: Trauma Introduction/Purpose: Methods of fixation in ankle fractures involving the posterior malleolus have become increasingly scrutinized. With the increase in computed tomography (CT), an intercalary fracture fragment (ICF) adjacent to the posterior malleolus has often been described. Treatment of this intercalary comminution remains controversial. The primary goal of this study was to compare clinical and radiographic outcomes in patients who had direct reduction and fixation of this fragment compared to those where the ICF was removed or not reduced prior to posterior malleolus fixation. Methods: This retrospective study included 249 trimalleolar and posterior pilon ankle fractures grouped into those who had the ICF reduced and fixed (n=74) and those where the ICF was not directly addressed or excised (n=175). CT scans were evaluated for size and location of the ICF. Demographic, radiographic and intraoperative variables were collected and analyzed. The Kellgren and Lawrence classification system was utilized to grade severity of post-traumatic arthritis during the follow up period. Chart review was performed assessing time to weightbearing, repeat surgeries and post-operative complications. Results: For the group which had the ICF reduced and fixed, follow up radiographs demonstrated significantly worse Kellgren- Lawrence scores compared to the group that did not specifically reduce the ICF (p< 0.05). There was also a higher rate of repeat surgery in the group which had the ICF fixed, although not meeting statistical significance. There were no differences in size or location of the ICF fragment between groups. The average overall time to weightbearing amongst all patients was 9.7 +- 3.8 weeks. There was no significant difference between time to weightbearing between groups (p = 0.6). There was no significant difference in need for secondary surgeries or post-operative deep and superfical infections. Conclusion: With the widespread utilization of CT-scans for preoperative planning of ankle fractures involving the posterior malleolus, there has been greater discussion surrounding the optimal management of the ICF when present. In our study, the primary aim was to explore radiographic changes in patients after direct reduction and fixation of this ICF compared to those without ICF fixation. We demonstrated significantly worse radiographic outcomes following attempted direct reduction and fixation of the ICF. Our results suggest that while concentric joint reduction and syndesmosis stabilization are of utmost importance, attempting to reduce and fix the ICF may lead to worse radiographic outcomes.
Suture Tape Reinforcement Device as an Independent Fixation Solution for Partial Syndesmosis Injuries
Authors: Waryasz Gregory R. , Ogawa Takahisa , Lubberts Bart , DiGiovanni Christopher W. , Guss Daniel 
Published: January 2022

Category: Ankle; Arthroscopy; Basic Sciences/Biologics; Sports Introduction/Purpose: A suture tape reinforcement device is designed for repair of syndesmotic injury. Its insertion in the fibular and tibial footprints of the anterior inferior tibiofibular ligament (AITFL) promises a dynamic constraint to external rotation, antero-posterior translation of fibula and diastasis of the syndesmosis in the coronal plane.We hypothesized that following fixation of transected syndesmosis with suture tape reinforcement, syndesmotic stability becomes similar to that of an intact syndesmosis. Methods: Fifteen non-paired fresh frozen cadaveric specimens amputated above the knee were included in this study. Assessment of the ankle syndesmosis was performed in six stages; 1) with all syndesmosis ligaments intact; 2) after transection of the AITFL, 3) the interosseous ligament, 4) subsequent fixation with suture tape reinforcement device, 5) transection of the posterior inferior syndesmotic ligament, and 6) after removal of the suture tape reinforcement device (complete ligament transection stage). Instability measurements included anterior and posterior tibiofibular spaces measured arthroscopically under 100N lateral stress using a bone hook, tibiofibular anteroposterior and posteroanterior translation in sagittal plane measured arthroscopically under sagittal stress of 100N, and anterior tibiofibular space measured directly with a caliper under external rotation torque of 7.5 Nm. Instability measurements taken after each fixation method were compared with the intact stage and to the complete ligament transection stage using the Wilcoxon signed-rank test. Results: The suture tape reinforcement device was able to stabilize an AITFL- and the interosseous ligament-transected stage, similar to the intact stage, with respect to all measures of instability. As for the complete ligament transection stage, after suture tape reinforcement it remained unstable in the coronal plane, compared to the intact stage: there was an increase in anterior tibiofibular space without stress (1.7 mm vs 1.1 mm, p=0.005) and with stress (1.8 mm vs 1.1 mm, p=0.007), as well as in posterior tibiofibular space with stress (2.8 mm vs 1.6 mm, p=0.002). Conclusion: Our findings suggest that suture tape reinforcement device might be effective for fixation of partial syndesmotic injury, but not for complete syndesmotic injury. Future clinical research is needed to confirm this.
Adolescents with Lisfranc Injury Frequently Have Different Pathology with Higher Incidence of Proximal Extension of the Ligamentous Disruption
Authors: Abdelgawad Amr , Thabet Ahmed 
Published: January 2022

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Lisfranc injuries are rare injuries in the adolescent age group and can be easily missed. Ligamentous Lisfranc injuries have been classically descried as disruption of the Lisfranc ligament (between medial cuneiform and second metatarsus) and ligamentous disruption of the first metatarso-phalangeal joint. The study aimed to report pathological pattern of Lisfranc injury in adolescent patient and if it was different from the common adult forms. Methods: This is a retrospective study of patients with Lisfranc injury treated at a Level 1 trauma center between 2012 and 2019. This study has been IRB approved. The inclusion criteria were of adolescents with isolated Lisfranc injuries and treated via surgical intervention. The surgical intervention helped to identify the exact pathology. The study excluded patients over the age of 18, patient with high energy injuries and patients treated non-operatively. Patients' demographics including age and gender, were recorded. Other variables included the mechanism of injury, side of injury, fracture type, the intraoperative findings of the ligamentous injury and follow-up data. Follow up radiographs were reviewed for time to bony union and any post-traumatic complications. Outcomes include wound healing status, the union status of the fracture, and complications that may arise along with treatment and follow-up. Results: A total of 9 patients met the study inclusion criteria. Mean age was 15.4 years old, male to female ratio of 5:4, mean follow-up time was 9.5 months. All patients achieved full union at the final follow-up. The postoperative course went without complications except one for patient. The patient had prominent screw under the skin. The screw removed in the office under local anesthesia. Intraoperative findings in 6/9 (66.6 %) cases demonstrated a Lisfranc injury pattern with proximal extension through the inter-cuneiform ligament. Operative treatment in cases of proximal extension included added fixation between the middle cuneiform and middle cuneiform (screws or plates). Also noted in 2 cases, that the 1st tarso-metatrsal joint was not affected (in contrast to classic Lisfranc injury in adults). In these cases, no fixation was need for the 1st TMT joint. Conclusion: Lisfranc injury in adolescent has frequently different pathology compared to adults' counterparts. It commonly involves proximal extension with the ligament disruption. It also sometimes spares the ligaments of the 1st TMT joint. Orthopedic surgeons should be aware of these changes as it implies changes in the treatment strategy and fixation construct.
Performance Outcomes after Surgical Repair of Achilles Tendon Rupture in the Women’s National Basketball Association
Authors: Aiyer Amiethab A. , Hodgens Blake H. , Geller Joseph S. , Rizzo Michael G. , Munoz Julianne , Kaplan Jonathan R. 
Published: January 2022

Category: Sports; Ankle Introduction/Purpose: Achilles tendon ruptures are devastating injuries in elite athletes. Current literature shows poor prognosis following Achilles tendon rupture in professional male basketball players, however there are currently no studies examining the effects of Achilles tendon rupture on performance outcomes in the Women's National Basketball Association (WNBA). Understanding the impact Achilles tendon rupture has on return to play and performance metrics in the WNBA will provide valuable information to players, team personnel, and medical professionals on post-injury expectations. Methods: 17 WNBA players who sustained an Achilles tendon rupture from 2000-2019 were identified from publicly available injury reports and player profiles. Demographic information collected included age, body mass index (BMI), position, and service in the WNBA when the tear occurred. Statistics were collected for the season before the injury, and two seasons after the injury, and the Player Efficiency Rating (PER) was calculated. PER is defined as ([points + rebounds + assists + steals + blocks] - [(field goals attempted - field goals made) + (free throws attempted - free throws made) + turnovers]) / games. Controls were matched by service in the WNBA, position, and PER. Results: Following Achilles tendon rupture, four players never returned to play in the WNBA, while seven players failed to play >1 season. Players who returned saw a significant decrease in the number of minutes played per game in both their first and second seasons post-injury (mean differences -6.11 and -6.54, respectively, p<0.01). Players also suffered a significant decrease in PER during their second season after injury compared with their pre-injury PER (mean difference -2.53, p=0.024). Compared to healthy controls, players who returned to play were significantly more likely to experience a decrease in minutes played per game at both one and two seasons postoperatively (-6.11 mpg vs +1.05 mpg, p<0.01 and -6.54 mpg vs +0.53 mpg, p= 0.018, respectively), while also experiencing significant per-game decreases in field goals (-0.85 vs + 0.20, p=0.47), free throws (-1.04 vs +0.12, p<0.01), steals (-0.48 vs +0.24, p=0.018), and points scored (-2.89 vs +0.58, p=0.014). Conclusion: Achilles tendon rupture and subsequent surgical repair in the Women's National Basketball Association (WNBA) accounted for significantly decreased minutes played and performance outcomes in athletes at one and two years post-operatively compared to both their pre-injury year and healthy matched controls. 23.5% of players failed to return to the WNBA, while 41.2% failed to play >1 season after returning from injury.
Clinical and Radiological Results after Use of A Human Bone Graft (Shark Screw®) in TMT II/+II Arthrodesis
Authors: Amann Pascal , Bock Peter 
Published: January 2022

Category: Basic Sciences/Biologics; Midfoot/Forefoot; Trauma Introduction/Purpose: The tarsometatarsal joints, also called Lisfranc-joints, are the joints between the midfoot bones and the tarsal bones. The continuous arthrotic destruction of the tarsometatarsal joints leads to pain and foot deformities. The therapy of choice after failure of conservative therapy is arthrodesis. For this operation there is the possibility of using a transplant screw made of allogenic human bone material (Shark Screw), instead of conventional metal implants. This study investigates the clinical significance and radiological integration of the allogenic bone screw for arthrodesis of the tarsometatarsal joints II/+III. Methods: This is a retrospective study involving 20 feet of 17 patients who received TMT II/+III arthrodesis with an allogenic bone screw (Shark Screw) at Speising Orthopedic Hospital in Vienna, Austria. VAS, FFI, FAOS, and AOFAS were used as measures to compare preoperative and postoperative results. Radiologic integration in the recipient bone was also evaluated. Results: Comparing preoperative with the postoperative score of 20 feet from 17 patients, a significant reduction of the VAS (pain) from 7,6 points to 1,4 points (p=<0,001)), as well as a decrease of the VAS (function) from 7,25 points to 1,8 points has been observed. Further, a significant reduction of the FFI from 62,3% to 16,7% (p=<0,001), and a significant increase from 29,7 points to 79,9 points of the AOFAS (p=<0,001) was detected. Analyzing the FAOS score, there was a significant (p=<0,001) increase of all subscales (Symptoms, Pain, Function and Quality of life). Moreover, in all cases a good radiological integration into the recieverbone was noticed. As a result the screw was, after a follow-up time from 12 months, no longer distinguishable from the original bone. Conclusion: These results demonstrated that the human bone screw used for TMT II/+III arthrodesis has a good outcome and reliable clinical significance. This study may be used for further investigations that should be performed to ensure this result.
The Incidence of Surgical Cancellations: Lessons Learned from the Resumption of Elective Orthopaedic Operating after the First Wave of COVID-19
Authors: Amutharasan Emlyn , Malhotra Karan , Zaveri Amit , Welck Matthew J. 
Published: January 2022

Category: Ankle; Other Introduction/Purpose: In the aftermath of the first wave of COVID-19, there was a significant backlog of elective orthopaedic cases. To address this problem, efficient running of theatres with optimal theatre utilisation was paramount. However, as new processes were introduced to reduce transmission risk, 'last-minute' cancellations of patients were inevitable. We report our experience of resuming elective work, with particular focus on surgical cancellations, and lessons learned. Methods: This was a retrospective, single centre audit at a specialist elective orthopaedic hospital. We identified and examined all cancellations in foot and ankle cases between June and October 2020. Data was analysed and cancellations were categorised into groups by reason of cancellation. Results: There were 36 cancellations out of 193 patients listed (19%). Twenty-one cancellations (57%) were directly related to COVID-19 and its processes. These comprised six patients (17%) with COVID-19 swab related issues including: booking errors, transport problems, non-attendance, and invalid swabs. Three patients (8%) contracted COVID-19 preoperatively. Nine patients (25%) cancelled their procedure at short notice amidst fears of contracting COVID-19 perioperatively. Three (8%) cancellations were due to the patient being unfit on the day of surgery - these issues were not routinely identified at pre-assessment appointments as face-to-face pre-assessment clinics had been suspended. A further 15 cancellations (42%) were due to non- COVID-19 reasons including lack of beds, unwell patients, and patients cancelling for other personal reasons. Conclusion: Mitigation of cancellations is a key factor in maintaining theatre utilisation. Based on our experience we recommend thorough counselling of patients regarding the importance of self-isolation prior to surgery and of the pre-operative swab. Having a designated team to manage COVID-19 swabs is also critical. Reinstatement of face-to-face pre-operative assessments may help identify evolving issues and prevent last-minute cancellations. These lessons are pertinent to trusts, particularly as we emerge from subsequent waves of COVID-19.
Cylindrical Osteochondral Allograft for Osteochondral Lesions of the Talus: A Systematic Review
Authors: Azam Mohammad , Davey Martin S. , Colasanti Christopher , Mercer Nathaniel P. , Hurley Eoghan T. , Shimozono Yoshiharu , Kennedy John G. 
Published: January 2022

Category: Ankle Introduction/Purpose: Ankle injuries commonly result in damage to the articular cartilage of the talus. The use of cylindrical osteochondral allografts (OCA) for osteochondral lesions of the talus (OLT) smaller than 1.5cm is increasingly common, particularly in cases whereby autologous osteochondral transplantation (AOT) is contraindicated. The primary aim of this study is to systematically review the outcomes of cylindrical OCA for OLT. The secondary aim of this study is to compare the outcomes of cylindrical OCA and AOT in the management of similar cases of OLT. Methods: Two independent reviewers searched the literature based on PRISMA guidelines, utilizing the EMBASE, MEDLINE, and The Cochrane Library Databases. Only studies that reported outcomes of cylindrical OCA in the management of OLT were included. Results: Overall, 4 studies with 100 patients including 101 ankles were included in this review. Pre-operative OLT characteristics showed 69.3% of OLT lesions were located medially, with a mean lesion size of 1.47cm2 (0.46 - 4.2 cm2). Overall, 16.8% of ankles required surgical revision following cylindrical OCA; 1.0% (1/101) underwent subsequent arthrodesis, 6.9% (7/101) underwent revision osteochondral grafting and 7.9% (8/101) underwent subsequent arthroscopic debridement. Radiological outcomes between the graft failure were reported as 10.0% (3/30), joint space narrowing as 30.4% (14/46), and cysts as 42.9% (27/63). Significantly higher revision rates were reported following cylindrical OCA when compared to AOT at over two years follow up (28.1% versus 6.7%, p = 0.02). Conclusion: Our systematic review established that although there are high rates of patient satisfaction following cylindrical OCA for OLT, these are less than those reported with AOT for the same condition. Concerns regarding the rates of radiological deterioration as well as the need for surgical revision may represent harbingers for poorer long-term outcomes.