bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors for Loss of Active Shoulder Range of Motion in Massive Rotator Cuff Tears
Authors: Furuhata Ryogo , Matsumura Noboru , Oki Satoshi , Kimura Hiroo , Suzuki Taku , Iwamoto Takuji , Matsumoto Morio , Nakamura Masaya 
Published: January 2022

Background: Patients with massive rotator cuff tears often exhibit loss of active range of shoulder motion, which can interfere with activities of daily living. The risk factors for loss of motion remain largely unknown. Purpose: To clarify the predictive factors that affect the range of motion in chronic massive rotator cuff tears using multivariate analyses. Study Design: Case-control study; Level of evidence, 3. Methods: The authors retrospectively reviewed 204 consecutive patients who were evaluated at their institution with chronic massive rotator cuff tears. In this study, the dependent variable was determined to be active anterior elevation limited to ≤90° or external rotation (ER) with the arm at the side limited to ≤0°. Explanatory variables included age; sex; affected side; duration of symptoms; smoking history; existence of diabetes, hypertension, or rheumatoid arthritis; involved tendons; presence of a 3-tendon tear; rupture of the long head of biceps tendon; superior migration of the humeral head; and cuff tear arthropathy. Baseline variables that were observed to be significant in the univariate analyses were included in multivariate models, which used logistic regression to identify independent predictors of loss of motion. Results: Overall, 73 patients (35.8%) exhibited limited anterior elevation, and 27 (13.2%) exhibited limited ER. Multivariate analyses showed that inferior subscapularis tear (odds ratio [OR], 14.66; 95% CI, 2.95-72.93; P = .001), smoking (OR, 4.13; 95% CI, 1.94-8.79; P < .001), superior migration of humeral head (OR, 3.92; 95% CI, 1.80-8.53; P = .001), and 3-tendon tear (OR, 3.29; 95% CI, 1.32-8.20; P = .011) were significantly associated with the loss of anterior elevation. Teres minor tear (OR, 73.37; 95% CI, 9.54-564.28; P < .001) and superior migration of the humeral head (OR, 3.55; 95% CI, 1.04-12.19; P = .044) were significantly associated with loss of ER. Conclusion: In the current study, a history of smoking, type of torn tendons, and superior migration of the humeral head were associated with loss of active shoulder motion. In particular, the status of inferior subscapularis or teres minor contributed to the onset of pseudoparalysis in massive rotator cuff tears.
Pre-Anesthetic Medical Evaluations: Criteria Considerations for Telemedicine Alternatives to Face to Face Visits
Authors: Khera Kushal D. , Blessman Joseph D. , Deyo-Svendsen Mark E. , Miller Nathaniel E. , Angstman Kurt B. 
Published: January 2022

Background The number of pre-anesthetic medical evaluations (PAMEs) being conducted in primary care is increasing. Due to the COVID-19 pandemic, the use of telemedicine has surged, providing a feasible way to conduct some of these visits. This study aimed to identify patient-related factors where a face to face (FTF) evaluation is indicated, measured by the need for pre-operative testing. Methods A retrospective chart review was conducted on patients age ≥ 18 years who had a PAME between January 2019–June 2020 at a rural primary care clinic in Southeast Minnesota. Data collected included age, gender, Charlson Comorbidity Index Score, medications, revised cardiac risk index (RCRI), smoking status, exercise capacity, body mass index, and pre-operative testing. Logistical regression modeling for odds ratios of outcomes was performed. Results 254 patients were included, with an average age of 64.1 years; 43.7% were female. Most were obese (mean BMI 31.6), non-smoking (93.7%) with excellent functional capacity (87.8% ≥ 5 METs). 76.8% of the planned surgeries were intermediate or high risk. 35.0% ( n = 89) of visits resulted in medication adjustments and 76.7% ( n = 195) in pre-operative testing. Age ≥ 65 years, ≥7 current medications, and diabetes all significantly increased the odds of requiring pre-operative testing ( P < .05). Conclusions This study was able to identify patient-related factors that increased the likelihood of requiring pre-operative testing. Patients who are age ≥ 65 years, ≥7 current medications, and those with diabetes could be scheduled for a FTF evaluation. Others could be scheduled for a telemedicine visit to minimize health-care exposures.
Is Repair of the Superficial Deltoid Ligament Alone Enough to Restore Medial Ankle Stability in Deltoid Ligament Injuries? A Cadaveric Study
Authors: Abd-Ella Mohamed M. 
Published: January 2022

Category: Trauma Introduction/Purpose: Deltoid ligament injuries are controversial in many aspects: the best method to assess the stability of a Weber B fibular fracture, the indications of deltoid repair after lateral side surgical fixation, the best technique of deltoid repair and the efficacy of superficial deltoid repair alone, compared to repair of both deep and superficial deltoid ligaments, to restore medial ankle stability. The last point is specifically important because of the technical difficulty of repairing the deep deltoid ligament, specially if performed after fixation of the fibular fracture and the syndesmosis, which is the common scenario. The aim of the study was to evaluate the ability of superficial deltoid repair without deep deltoid repair to restore medial ankle stability in cases of deltoid ligament injuries. Methods: Ten fresh frozen ankle cadaveric specimens were used. Anteromedial dissection was performed to expose the ankle joint and to visualize the deltoid ligament. After good exposure, stress valgus and stress external rotation tests were performed with observation of the medial gutter and the medial part of the ankle joint for any widening. In all specimens, the ankle was stable at this point. Then, the superficial deltoid ligament was detached by sharp dissection from the medial malleolus followed by transection of the deep deltoid ligament completely at its midportion. Stress valgus and stress external rotation tests were repeated to demonstrate the gross instability of the ankle joint. Then, the superficial deltoid ligament was repaired using a suture anchor to the medial malleolus without any repair of the deep deltoid ligament. Then, stress valgus and stress external rotation tests were performed again to assess the medial ankle stability. Results: All ankles were stable initially as confirmed by stress valgus and stress external rotation tests. After cutting both components of the deltoid ligament, the ankles were found to be grossly unstable using the same tests. After repair of the superficial deltoid, all ankles were stable again with a medial space equal to the initial status and with negative stress valgus and stress external rotation tests. Conclusion: Surgical repair of the superficial deltoid ligament without repair of the deep deltoid ligament in cases of deltoid ligament injury may be sufficient to restore medial ankle stability. Limitations of the study include that all potential secondary restraints are intact in the cadaveric study compared to the actual situation where other structures like the capsular attachments may be injured especially if a fracture dislocation is encountered. Clinical trials are needed to confirm this finding.
Risk Factors for Postoperative Falls in Foot and Ankle Surgery
Authors: Andrews Nicholas A. , Halstrom Jared R. , Fellows Kenneth J. , Hughes Austin , Patch David A. , Harrelson Whitt , Sinha Tanvee , Shah Ashish 
Published: January 2022

Category: Other Introduction/Purpose: Falls following orthopaedic surgery are a known entity in the healthcare field possessing significant patient morbidity and driving increased healthcare cost. The vast majority of studies have focused on the incidence and risk factors for postoperative falls in the inpatient setting, however, this is in direct contrast to shifts seen toward same-day outpatient orthopaedic surgery over the past decade. It is crucial to better understand the incidence and risk factors for falls in a mixed inpatient and outpatient model. Additionally, no study to date has examined the risk factors for falls after foot and ankle surgery. Methods: A total of 168 patients were administered a questionnaire and interviewed to investigate the incidence of postoperative falls. Patients completed surveys pertaining to fall history pre- and post-operatively, fall risks, current medical status, and use of an ambulatory assist device. Medical records were reviewed. Questionnaires and interviews were completed at 2 week and 6-week post-operative follow up visits. Factors found to be associated with postoperative falls in univariate analysis (p<.05) were included in a binary logistic regression model. Results: Full six-week follow-up was present in 138 patients. A total of 87 (63.0%) females and 51 (37.0%) males with a median age of 52 (21 IQR) and BMI of 32.4 (11 IQR) were included. The total fall incidence in the first six postoperative weeks was 29.7% (41 patients). In multivariate analysis, antidepressant use and VAS score at two weeks postoperatively were independently associated with falls OR 3.6 (95% CI 1.3 - 10.1) and OR 1.3 (95% CI 1.1 -1.5), respectively. The results of other variables included in the model were as follows: The Johns Hopkins Fall Risk Score OR 1.0 (95% CI.87-1.2), total number of medications excluding as needed OR.85 (95% CI.65-1.1), anticonvulsant use OR 1.8 (95% CI.67 - 5.0), and history of falls in the past six months preoperatively 1.6 (.95% CI.44 - 5.7). Conclusion: The high outpatient fall rate in foot and ankle surgery warrants awareness of risk factors. Antidepressant use has been associated with falls, but has not been established as a risk factor for postoperative falls. Surgeons should be aware of the risk of postoperative falls in this patient population. The postoperative VAS score at two weeks was also shown to be independently associated with falls. Adequate postoperative pain control is vital to minimize such falls. This study has identified antidepressant use and postoperative VAS score at two weeks as two independent risk factors for postoperative falls in foot and ankle surgery.
Predictors of Outcomes of Microfracture for Osteochondral Lesions of the Talus
Authors: Dankert John , Kennedy John G. , Shimozono Yoshiharu , Deyer Timothy , Mercer Nathaniel P. 
Published: January 2022

Category: Ankle Introduction/Purpose: Microfracture has been widely published as a treatment modality for osteochondral lesions of the talus (OLT). However, little is known about the outcome predictors following microfracture for smaller-sized OLT (<100mm2). This study sought to define the predictors of both clinical and magnetic resonance imaging (MRI) outcomes for small OLT treated with microfracture. Methods: A retrospective cohort study investigating patients who received arthroscopic microfracture for OLT (<10mm or 100mm2) between 2008 and 2017 were evaluated. Multivariate regression models were used to evaluate factors affecting post- operative Foot and Ankle Outcome Scores (FAOS) and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scores. Kaplan-Meier survival curves with log-rank test were constructed and endpoint was defined as the requirement of revision surgery. Results: Eighty-seven patients were included in the study. The mean follow-up time was 41.4+-28.7 months. The mean FAOS pain score significantly improved from 60.4+-14.8 preoperatively to 79.3+-12.8 at final follow-up (p<0.001). Patients with uncontained- type OLT had an approximately 9-point worse FAOS pain score compared to contained-type OLT (p=0.036). Patients with cystic OLT also had an approximately 9-point worse pain FAOS compared to non-cystic OLT (p=0.026). Patients with larger lesion sizes had worse postoperative MOCART scores (p=0.012). Both Uncontained-Cyst and Uncontained-Noncyst groups had significantly worse FAOS pain than the Contained-Noncyst group (p<0.001, p=0.026). Survival rates in uncontained and contained lesions were 51.5% and 84.4%, respectively (p=0.616). Conclusion: Lesion uncontainment and the existence of cysts are independent predictors of poor clinical outcome following arthroscopic microfracture for smaller-sized OLT (<100mm2).
Return to Physical Activity after Isolated Subtalar Arthrodesis
Authors: Grimm Patrick D. , Irwin Todd A. , Jones Carroll P. 
Published: January 2022

Category: Hindfoot Introduction/Purpose: Subtalar arthrodesis has been shown to provide reliable pain relief and deformity correction for a variety diagnoses including include primary arthritis, posttraumatic arthritis, inflammatory arthritis, talocalcaneal coalitions, and hindfoot deformity. However, the level of functional activity achievable following this procedure is unknown. The aim of this study was to assess physical activity and functional outcomes in patients following isolated, primary subtalar arthrodesis. Methods: A retrospective review of isolated primary subtalar fusions was performed. Inclusion criteria were: age between 18 and 65, isolated primary subtalar fusion that achieved bony union, minimum 4 month radiographic follow up (XR or CT), and 1 year minimum questionnaire follow up. Patients who had neuromuscular diagnoses, adjacent joint arthritis, inflammatory arthritis, contralateral ankle or hindfoot pathology, significant medical comorbidities, or were treated under worker's compensation were excluded. The primary outcome measure was the Foot and Ankle Ability Measure. Additional patient reported outcomes included a novel functional assessment questionnaire, Coughlin Satisfaction Score, and a contralateral hindfoot comparison score. Results: Patient reported outcome measures were collected from 15 (10 F, 5 M) patients at a median of 78 (49, 106) months following surgery. The median FAAM ADL subscore was 83.3 (71.4, 98.8) and the sports subscore was 59.4 (40.6, 87.5). The majority (58%) of patients maintained the same level of physical activity before and after surgery. Fewer patients were able to golf, rollerskate/ice skate, run, weightlift, or take aerobics/yoga after surgery. More patients were able to dance, hike, play tennis/pickleball, or walk for exercise. More patients were able to wear shoes without limitations and fewer patients required a brace or orthotics. Good and excellent outcomes were reported by 73% of the cohort. The median contralateral comparison score for the cohort was 90 (50, 100). Conclusion: Isolated subtalar arthrodesis can provide reliable pain relief and allow reasonable functional outcomes as demonstrated in this patient cohort. In general, most patients maintain their level of function and have fewer limitations with shoe wear. Select, higher impact activities may be more challenging for patients with a fused subtalar joint. These findings may be used to help surgeons appropriately counsel patients about expected postoperative physical activity following an isolated subtalar arthrodesis.
Subtalar Arthrodesis and Dynamic Medial Column Stabilization in the Surgical Treatment of Rigid Progressive Collapsing Foot Deformity: A Comparative Analysis with Triple Arthrodesis
Authors: Kim Jaeyoung , Ji-Beom Kim , Lee Woo-Chun 
Published: January 2022

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: In the surgical treatment of rigid progressive collapsing foot deformity (PCFD), triple arthrodesis has been commonly used for its ability to correct multiplanar deformities. However, complications associated with postoperative stiffness resulting from the added number of arthrodesis have led to an interest in more joint sparing options. A recent study has shown that dynamic medial column stabilization (DMCS), which transfers flexor hallucis longus tendon to the first metatarsal base, successfully restores medial longitudinal arch without the need for arthrodesis. This study aimed to evaluate the results of subtalar arthrodesis with dynamic medial column stabilization (DMCS) in treating rigid PCFD compared to the triple arthrodesis. Methods: Sixteen patients (18 feet) who underwent triple arthrodesis (TA group) and 24 patients (24 feet) who underwent subtalar arthrodesis and DMCS (SA+DMCS group) for surgical correction of rigid PCFD were reviewed. Five radiographic parameters were measured preoperatively, 3 months, 6 months postoperatively, and at the last follow-up (minimum 2 years) to compare the amount of correction and its maintenance. Clinical outcomes were assessed using a visual analogue scale (VAS) and foot function index (FFI). Complications such as non-union, development of adjacent joint arthritis were recorded. Results: TA group demonstrated a greater amount of correction in the Meary angle than the SA+DMCS group at 3 months postoperatively. However, the TA group showed a significant decrease in the medial cuneiform height, navicular-1st metatarsal angle, and Meary angle at 6 months compared to the initial reduction at 3 months. In contrast, the SA+DMCS group maintained initial correction throughout the follow-up (Figure 1). Clinical scores improved in all patients. Degenerative arthritis in the NC and TMT joints newly developed in nine and one foot, respectively, in the TA group. In contrast, there were no patients with newly developed arthritis in the SA+DMCS group. Postoperative valgus talar tilt occurred with nine ankles in the TA group, whereas only one ankle in the SA+DMCS group. One non-union of the subtalar arthrodesis occurred in the SA+DMCS group. Conclusion: SA+DMCS group demonstrated a comparable amount of correction as the TA group and maintained initial correction throughout the follow-up period. Additionally, the SA+DMCS group developed fewer complications than the TA group. The current findings suggest that SA+DMCS may be a viable option in treating rigid PCFD deformity with less concern for the complications related to the stiffness.
2021 Roger A. Mann Award Winner: Long-Term Revision Rates and Functional Outcomes of Total Ankle Arthroplasty and Ankle Arthrodesis
Authors: Loewy Evan M. , Goodson Kevin M. , Huang Kevin , Perkins Alexandrea , Walling Arthur K. 
Published: January 2022

Category: Ankle Arthritis; Ankle Introduction/Purpose: Recent studies have shown acceptable long-term survival rates with TAA however there remains a general paucity of information directly comparing ankle arthroplasty to arthrodesis over long-term follow-up. This study compares revision rates and functional outcomes for a large cohort of patients undergoing ankle arthrodesis or arthroplasty. All surgeries were performed by a single surgeon from 1999 to 2013. Ankle arthrodesis was performed using a standardized 3-screw technique with anterior plate supplementation. Arthroplasty was performed utilizing the Scandinavian Total Ankle Replacement (STAR) prosthesis. Methods: A retrospective chart review was performed for 335 consecutive cases in 326 patients (198 ankles in the arthrodesis group and 137 in the arthroplasty group). Patient demographics including age, sex, body mass index (BMI), and preoperative diagnoses were collected. Foot Function Index (FFI) scores were obtained and recorded at final outpatient follow-up. Primary outcomes included the rate of revision surgery and functional outcome scores. Secondary outcomes included perioperative complications such as polyethylene fracture and patients who went on to undergo postoperative subtalar fusion for symptomatic adjacent joint arthritis. Results: Ten (6%) ankles in the arthrodesis group and twenty-one (15%) in the arthroplasty group required revision surgery at a mean of 8.9 +- 6.5 and 61.1 +- 52.9 months, respectively [P=.039]. One hundred four of the 335 cases were available to complete functional outcome surveys at final follow-up at a mean of 11.2 +- 4.1 years from time of surgery (minimum 6-year follow-up). Mean FFI scores were significantly better in the arthroplasty group (40.3 +- 36.9) than in the arthrodesis group (61.5 +- 45.1) [P=.011]. Thirteen polyethylene components in 12 TAAs (8.7%) required replacement for fracture at an average of 9.6 +- 4.2 years postoperatively. Seven (3.5%) cases in the arthrodesis group and three (2.2%) in the arthroplasty group went on to undergo subtalar fusion at an average of 4.9 +- 3.9 years post-operation [P=.536]. Conclusion: Long-term functional outcome scores were better in TAA patients; however, the revision rate for major complications was found to be greater over time. While the ankle arthroplasty group did show a slightly lower frequency of adjacent joint arthritis progression leading to subsequent subtalar fusion, this difference was not statistically significant. To our knowledge, this is the largest and longest-term follow-up comparing the STAR prosthesis to ankle arthrodesis published in the United States to date.
Inter-Rater Reliability of Classifications for Fifth Metatarsal Base Fractures
Authors: Michalski Max , Kwon John Y. , Ingall Eitan M. , Chiodo Christopher P. 
Published: January 2022

Category: Trauma; Midfoot/Forefoot; Sports Introduction/Purpose: Fractures of the fifth metatarsal base have been a source of confusion since their original description by Jones in 1902. The term Jones' fracture has been used indiscriminately leading to further confusion. Zone classifications have been described but never evaluated for their reliability. The most recent classification, metaphyseal versus metaphyseal-diaphyseal is unknown to most surgeons. The purpose of this study was to evaluate the inter-rater reliability of American Orthopaedic Foot & Ankle Society (AOFAS) members classifying fractures of the base of the fifth metatarsal. Methods: A survey was emailed to members of the AOFAS including radiographs of 18 fifth metatarsal base fractures. Demographic information was collected in addition to evaluation of the 18 sets of radiographs using three classification systems. Surgeons were asked if the fracture is a Jones' fracture, zone of the fracture and if the fracture was metaphyseal or metaphyseal- diaphyseal. A total of 223 surgeons with an average experience of 14 years in practice (range: fellow - 50 years) completed the initial survey for inter-rater reliability. Additionally, each surgeon was asked which zones or zone junctions they consider a Jones' fracture. Reliability was tested using Fleiss' Kappa scores. Results: Inter-rater agreement for use of the term Jones' fracture was moderate (kappa 0.533, 95% confidence interval (CI) [0.530, 0.535]). The zone classification had an inter-rater agreement was moderate (kappa 0.537, 95% CI [0.535, 0.539]). Inter- rater agreement for metaphyseal versus metaphyseal-diaphyseal was substantial (kappa 0.705, 95% CI [0.702, 0.708]). Results of surgeon definition of a Jones' fracture is seen in Figure 1. Conclusion: This is the largest study of its kind looking at inter-rater reliability of an orthopaedic classification with 223 raters. The terminology regarding the classification of fifth metatarsal base fractures remains confusing and inconsistent. The term Jones' fracture has little meaning in terms of communicating these injuries as there is only moderate agreement when surveying surgeons and it is defined differently by most. The zone classification has similar reliability as the Jones' fracture. The terms metaphyseal and metaphyseal-diaphyseal was the most reliable means to describe these fractures.