bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accuracy of Weightbearing CT vs Non-Weightbearing CT Scans for Patient-Specific Instrumentation in Total Ankle Arthroplasty
Authors: Berlet Gregory C. , McCoy Antonio M. Malloy , Consul Devon , Umbel Benjamin D. , Thompson Mitchell 
Published: January 2022

Category: Ankle Introduction/Purpose: Total ankle arthroplasty (TAA) is a popular and viable option for end stage ankle arthritis. Accuracy and reproducibility in placing the implant on the mechanical axis has been shown to be paramount in total ankle replacement. Patient specific pre-operative navigation up until this past year has been based off of non-weightbearing computerized tomography (CT). Our institution has created a protocol to use weightbearing CT in the pre-operative patient specific navigation for TAA using the ProphecyTM system. The purpose of our study was to compare the accuracy and reproducibility of implant alignment and size using WBCT versus prior studies using NWBCT for the Prophecy reports. Methods: Patients who underwent TAA using our WBCT protocol for their Prophecy scans had their charts reviewed to see if they met the proper inclusion criteria. Inclusion criteria was a primary TAA with proper follow-up to have first post-operative weightbearing radiographs. The first post-operative weightbearing radiographs were used to measure alignment of the axis of the implant in frontal and sagittal planes comparative to the tibial axis. These results were then compared to the pre-operative prophecy scans to determine reproducibility. The size of the implants components were also recorded for each patient and compared to the pre-operative predicted implant sizes from the patient specific reports. Our results were also compared to previous studies on reproducibility of patient specific navigation when using non-weightbearing CT. Results: Ten patients met our inclusion criteria of WBCT ProphecyTM preoperative planning. 100% of the TAA were within the intended target of less than 50 varus or valgus. The average post-operative coronal alignment was an average of 0.844 degrees. Average sagittal plane deformity was 1.88 degrees post-operative. Tibial component size was properly predicted 100% of the time and talar component in all but one patient. Conclusion: This data supports superior accuracy and reproducibility in pre-operative patient specific navigation when utilizing WBCT for TAA vs published controls with non-weightbearing CT.
Maintenance of First Ray Length after First Metatarsophalangeal Joint Distraction Arthrodesis Using Allograft Discs: A Statistical Analysis
Authors: Berlet Gregory C. , Malloy McCoy Antonio M. , Thompson Mitchell , Consul Devon , Prissel Mark A. 
Published: January 2022

Category: Midfoot/Forefoot Introduction/Purpose: The first metatarsophalangeal joint (MTPJ) is one of the most common locations for arthritis in the foot. When conservative methods fail, two main surgical treatment options exist, fusion or joint implant. For various reasons these surgeries can fail leaving relatively few salvage options. A common salvage option is the first MTPJ distraction arthrodesis. Use of allograft discs to decrease surgical time and donor site morbidity has become an increasingly popular option for MTP distraction arthrodesis. The purpose of this study was to look at the maintenance of the first ray length in first MTPJ distraction arthrodesis using allograft discs. Methods: We reviewed 14 patients who underwent first MTPJ distraction arthrodesis, measuring first ray length at the first post- operative weightbearing radiograph and most recent weightbearing radiograph. Average follow up was 12.75 months between radiographs. Results: Average shortening was 3 mm on the lateral measurements and 2.3 mm on the AP measurements. CT verified overall nonunion rate was 43% whereas, symptomatic nonunion rate was 21%. Conclusion: Amount of shortening and graft size did appear to have a positive correlation. Union rate did not affect shortening of first ray, but revision for a failed implant arthroplasty did correlate with increased shortening compared to revision for a failed first MTPJ fusion. Our data suggests a 2-3 mm shortening of the first ray can be predicted over the first 12 months after a first MTPJ distraction arthrodesis using allograft discs. Longer term studies with larger patient populations, and a comparative study to cortical autograft would provide more accurate insight to outcomes of first MTPJ distraction arthrodesis.
3-D Generated Anatomic Custom Talar Cement Spacers: A Technical Tip and Literature Review
Authors: Broughton Kimberly K. , Chien Bonnie Y. , Stenquist Derek S. , Williams Caroline , Miller Christopher P. , Kwon John Y. 
Published: January 2022

Category: Basic Sciences/Biologics; Hindfoot; Trauma Introduction/Purpose: Three dimensional printing is an actively emerging field within the realm of medical devices. This technology expands therapeutic options and customization of implants to individual patients. The ability to create products that replicate normal bony anatomy has been a significant advancement in the setting of difficult clinical scenarios. 3-D generated, custom implants increase the potential for joint and limb salvage with the goal of improving functional outcomes. We present a technical tip for utilizing 3-D printing technology to create custom, anatomically-matched antibiotic cement spacers for limb- salvage applications. We present two illustrative cases and share our experiences, lessons learned, and a succinct review of the pertinent literature merging 3-D printing and the use of antibiotic cement as temporary and permanent reconstructive solutions. Methods: While the majority of 3-D printing is done for the purpose of generating devices for implantation, we present a technical tip for designing a 3-D printed mold from which to create an antibiotic cement spacer for implantation. Two case illustrations demonstrate comorbid patients presenting with infected implants, osteomyelitis, bone loss, deformity and wound dehiscense. We describe the process of patient selection, implant design, fabrication, and implantation of a custom molded antibiotic cement talus for the purpose of limb salvage. Results: Case illustrations present two successful limb salvage patients while giving a thorough explanation of our technique, learned tips and tricks. This applied technology builds on prior use of antibiotic cement in limb salvage of the lower extremity, most of which is joint sacrificing. 3-D printing the mold for an anatomic talus cement spacer results in a joint sparing limb salvage solution. Conclusion: Utilization of currently available 3-D printing technology as applied to production of anatomic cement spacers should be considered to enhance limb salvage. This innovative application of printing technology is merged with current, pertinent literature regarding antibiotic cement to offer surgeons expanded options for temporary or definitive reconstructive techniques in some of the most challenging patients.
Infrequent Adventitious Bursitis Associated with A Palpable Metatarsal Mass: Series of Cases
Authors: Cafruni Virginia M. , Parise Ana C. , Verbner Jonathan M. , Villena Daniel S. , Conti Leonardo A. , Sotelano Pablo , Carrasco Nelly M. , Araujo Maria Gala Santini 
Published: January 2022

Category: Midfoot/Forefoot Introduction/Purpose: Adventitious bursae are structures that appear in adulthood, as a mechanism for protection. It may develop at sites where subcutaneous tissue (ST) is exposed to friction and high pressure. In the forefoot, adventitious bursitis is usually adjacent to bony prominences of the metatarsal heads and is one of the causes of forefoot pain. There are different stages of the pathology, at the beginning there is a small bursa without cavity, subsequently this cavity will gradually acquire a larger size, until becoming independent. The degeneration of the connective tissue which is the characteristic of the adventitious bursa. Figure 1.We present four cases of adventitious bursitis in patients who complained of a fluctuating mass on the forefoot associated with localized pain on palpation and pressure. Methods: We reviewed the cases of 4 patients treated by one of us (MGSA) for forefoot pain associated with a palpable mass. We obtained the information from the medical records: clinical presentation, radiographs, ultrasound, magnetic resonance imaging (MRI), treatment, histological diagnosis (if it was available) and outcomes. Pain was assessed with visual analog scale (VAS). Results: The four patients complained of a mass on the forefoot associated with pain. The skin was normal with no signs of infection. Ultrasound and MRI showed heterogeneous images in the ST in high pressure areas. Patients were diagnosed according to the previous studies and treated conservatively. The treatment consisted of cryotherapy and walker boot until they had shoe insoles with metatarsal olive in order to unload the metatarsus. Forefoot pain improved markedly from an initial VAS of 8.5 to 3.5 in the first month and the palpable mass decreased. Except in one patient whose studies were not conclusive and mass does not decrease in size and she required an excisional biopsy. The anatomopathological diagnosis was consistent with adventitial bursitis. Conclusion: Adventitious bursitis of the plantar forefoot is not a frequent pathology and it can be confused with a foreign body granuloma, localized infection or a tumoral mass among other possible diagnoses due to the clinical and imaging presentations. It is important to take this diagnosis into account when dealing with metatarsalgia and have fluent communication with the radiologist in order to avoid an unnecessary surgery and to establish the appropriate treatment to improve the symptoms.
Tarsal Tunnel Syndrome Following Medializing Calcaneal Osteotomy
Authors: Cafruni Virginia M. , Bilbao Facundo , Galich Facundo , Cardone Guillermo , Carrasco Nelly M. 
Published: January 2022

Category: Hindfoot Introduction/Purpose: The tarsal tunnel syndrome is a compressive neuropathy that affects either the posterior tibial nerve, within the tarsal tunnel, or one of its terminal branches. It can be caused by extrinsic or intrinsic factors. Even though the tarsal tunnel syndrome has been reported as a complication of lateralizing calcaneal osteotomy, we have not identified in the literature reports of this syndrome associated to medializing calcaneal osteotomy. We report the case of a 60-year-old female who developed a tarsal tunnel syndrome, on the third postoperative week, following a medializing calcaneal osteotomy for flatfoot correction with stage IIB posterior tibial tendon dysfunction. Methods: We reviewed and obtained the information from the medical records of this patient: clinical examination, radiographs, computed tomography, magnetic resonance imaging, and outcome. Pain was assessed with visual analog scale (VAS). Results: The patient is a 60-year-old female with left stage II posterior tibial tendon dysfunction who failed to respond to conservative treatment. Medializing and lengthening (Evans) osteotomies of the calcaneus were performed, together with posterior tibial tendon repair and spring ligament reconstruction. In the postoperative, after a cast replacement into a more plantigrade position, the patient developed symptoms that suggested a compressive neuropathy of posterior tibial nerve within the tarsal tunnel associated to calcaneal medializing osteotomy. Initial conservative treatment failed and the posterior tibial nerve was explored under loupe magnification and the tarsal tunnel was released. Figure 1. An immediate improvement in pain was observed postoperatively and almost full recovery occurred within 6 months. Conclusion: In our case report, the tarsal tunnel syndrome was a consequence of the osteotomy fragment displacement that generated a reduction of the tarsal tunnel volume. It has been described that the tarsal tunnel syndrome symptoms become more evident with ankle dorsiflexion and eversion, in our patient this can be associated with the symptom exacerbation presented when the cast was placed into plantigrade position. We conclude that even though in the literature the tarsal tunnel syndrome has been mainly associated to lateralizing osteotomies, it is important to take this complication into account when performing a medializing osteotomy.
Factors Associated with Surgical Success of End Stage Ankle Arthritis with Minimum 4-Year Follow-Up
Authors: Chawla Sagar , Shofer Jane , Norvell Daniel , Ledoux William R. , Sangeorzan Bruce J. 
Published: January 2022

Category: Ankle Arthritis; Ankle Introduction/Purpose: Both total ankle arthroplasty (TAA) and ankle arthrodesis (AA) are effective treatments for ankle arthritis. This study sought to use a statistical modeling approach to determine factors associated with success following either surgery. While a number of studies have explored risk factors associated with complications, our aim was to guide management based on factors which may be predictive of success. Methods: We retrospectively analyzed data from a prospective multicenter cohort study conducted between May 2012 and May 2015. We compared outcomes in 448 patients who had follow-up of at least 4 years and were treated for ankle arthritis with either TAA or AA. We collected baseline factors including demographics, pre- and post-operative outcome scores including the Foot and Ankle Ability Measure (FAAM), Short Form-36 (SF-36) Physical and Mental Component Summary scores, pain, ankle related adverse events, and radiographs (coronal tilt and sagittal subluxation). We defined fully Successful as an increase in the FAAM ADL score by the minimum clinically important difference (MCID) and the absence of post-operative complications. We performed a multivariate logistic regression model adjusted for age, sex, BMI, and surgery type to identify associations with success. Results: Of the 517 patients who consented, had surgery and completed post-operative surveys, 414 (80.0%) underwent TAA and 103 (19.9%) underwent AA. Of the 517 patients, 448 patients (86.7%) had a minimum of 4-year follow-up. Of the 448 patients, 331 (73.9%) were successful) outcome and 117 (26.1%) were not fully successful. Out multivariable logistic model found female sex (0.83 +- 0.03, p=0.002), treatment with TAA (0.80 +- 0.020, p=0.001), and no previous surgery (0.82 +- 0.03, p=0.030) as variable significantly associated with success. Notably, mental health factors and pre-operative radiographic measurements, including coronal tilt and sagittal subluxation, were not significantly associated with success. Conclusion: Surgeons treating patients with ankle arthritis have two viable surgical alternatives. Recognizing the factors associated with mid-term success may be as valuable as knowing risk factors associated with failure. In addition, we also find variables thought to affect outcomes, mental health and pre-operative radiographic measurements such as coronal plane misalignment, were not found to significantly affect outcomes.
Anterior Capsule Reconstruction in the Setting of PVNS
Authors: Chopra Aman , Lukosius Eric Z. , Parekh Selene G. 
Published: January 2022

Category: Ankle; Other Introduction/Purpose: Pigmented villonodular synovitis (PVNS) is a rare benign proliferative disease affecting tendon sheaths and synovial tissue. Most cases of PVNS arise in the hip and knee joints, while < 5% of total cases occur in the foot and ankle. PVNS of the ankle has a high rate of recurrence and can be destructive to the affected joints if incompletely removed. This case series analyzes functional outcomes after PVNS surgical resection and anterior ankle capsular reconstruction, using a novel technique. Methods: This case series included three patients who underwent surgery between 2010 and 2020 for their ankle pain and swelling caused by PVNS. The surgical technique involved a posterior, midline approach for PVNS resection of the affected ankle joint, followed by a standard anterior approach for capsular excision. Subsequent anterior capsular reconstruction was performed with a regenerative tissue matrix and a bioresorbable anchoring system. Preoperative and postoperative range of motion testing for the ankle and subtalar joints were assessed along with appropriate radiographs and MRI imaging. Results: All three surgical procedures for PVNS of the ankle resulted in successful recovery and promising clinical outcomes. The mean cohort age was 43.7 (R:36-58) years and follow-up period was 52.3 (R:4-123) months. Preoperative ankle dorsiflexion and plantarflexion along with subtalar inversion and eversion range of motion were all normal. Postoperative ankle motion and subtalar motion were recorded at final follow up and found to be unchanged. No complications or recurrence of PVNS occurred. Conclusion: This case series demonstrates that PVNS surgical resection and anterior ankle capsular reconstruction is a safe and effective treatment modality that allows for maintenance of pre-operative motion. Further investigation is warranted to better understand the clinical outcomes of this surgical technique on PVNS recurrence.
Comparing Open vs Minimally Invasive Techniques for the Correction of Hallux Valgus: Clinical and Patient Reported Outcomes
Authors: Chrea Bopha , Day Jonathan , Dean Daniel M. , Cortina Rose E. , Reilly Megan , Caolo Kristin C. , Cerrato Rebecca A. , Johnson A. 
Published: January 2022

Category: Bunion Introduction/Purpose: Multiple operative techniques have been developed for hallux valgus with varying success. While correction has been traditionally achieved through open surgical approaches, there has been a growing interest in minimally invasive surgical (MIS) techniques. The purpose of this study was to compare clinical and patient-reported outcomes for patients undergoing hallux valgus correction with Lapidus, Scarf and MIS. Our hypothesis was that while a superior clinical correction would be achieved with open techniques there would be similar patient-reported outcomes among open and MIS techniques. Methods: A total of 257 patients who underwent Lapidus (n=82), Scarf (n=82) or MIS (n=93) hallux valgus correction between January 2017- January 2020 at one of two academic institutions by 1 of 9 foot and ankle-fellowship trained orthopedic surgeons were included in this study. Only 3 of 9 performed MIS correction. The average age at the time of surgery 55.4 (range 14-79). Patients were required to have a minimum baseline and 1-year postoperative Patient-Reported Outcomes Measurement Information Scores (PROMIS) and minimum 3-month clinical follow-up. Retrospective chart review was performed to assess the incidence of postoperative complications and reoperations, with an average clinical follow-up of 8 months. Results: All groups had statistically significant differences between pre- and post-operative measurements of HVA, IMA, DMAA, and tibial sesamoid position (<0.05). In addition, the Lapidus group demonstrated change in all parameters measured including Meary's angle, sagittal IMA and Seiberg index. All groups had statistically significant improvement in the PROMIS physical function, pain interference, and global health physical at 1 year (p<0.05). The Lapidus group had significant improvement in all 6 PROMIS domains measured. There were no significant differences in PROMIS score changes from pre to post-op for any PROMIS domain when comparing MIS vs Scarf vs Lapidus. Complications: Minor Complications were classified as infection, symptomatic hardware, delayed union, nerve irritation, transfer metatarsalgia (Lapidus n=14 (17.1%), Scarf n=2 (2.4%), MIS n=15 (16.1%)). Major complications were classified as nonunion, recurrence, hallux varus, recurrence (HVA >20) (Lapidus n=7 (8.5%), Scarf n=9 (11.0%), MIS n=9 (9.7%)). Conclusion: In the last decade, there has been a growing interest in the use of minimally invasive surgical MIS techniques for the treatment of hallux valgus. When compared with traditional open techniques using Lapidus and Scarf osteotomies MIS presents a safe and effective approach to treating hallux valgus.
Low Tibial Valgization Osteotomy for Varus Ankle Arthritis: Does Age Effect the Outcome?
Authors: Chun Kyung Ah , Choi Jun Young , Suh Jin Soo 
Published: January 2022

Category: Ankle; Ankle Arthritis Introduction/Purpose: Evidence-based literature identifying the age limit for low tibial valgization osteotomy (LTO) is lacking to date. We addressed the following research questions: (1) is LTO effective for ankle arthritis in patients over 65 years?; (2) does patients' age alter the effectiveness of LTO?; and (3) does preoperative Takakura stage affect the degree of correction in patients over 65 years? Methods: We retrospectively reviewed the radiographic and clinical findings of 49 cases which underwent LTO. Patients were divided into two groups according to age at operation (19 cases in group 1 aged >=65 years and 30 cases in group 2 aged <65). Patients in a single group were regrouped into two subgroups according to preoperative Takakura stage (stage II+IIIA versus IIIB) to determine if the degree of correction varied in Takakura stage IIIB. Results: Significant changes in radiographic parameters were observed with no significant differences in the amounts of correction between groups 1 and 2. Comparison of Takakura stage II+IIIA in group 1 to that in group 2 and stage IIIB in group 1 to that in group 2 revealed no significant differences in the amounts of correction. Conclusion: LTO could be indicated for patients over 65 years if patient selection was appropriate. LTO in patients over 65 years showed similar radiographic improvements to those in younger patients, and the correction was successfully maintained during the follow-up period. The correctional power of all radiographic parameters did not vary by preoperative Takakura stage.
Limited Evidence for Biological Adjuvants in Hindfoot Arthrodesis: A Systematic Review and Meta- Analysis of Clinical Comparative Studies
Authors: Dankert John , Seow Dexter , Yasui Youichi , Miyamoto Wataru , Calder James D. , Kennedy John G. 
Published: January 2022

Category: Hindfoot; Ankle; Ankle Arthritis; Basic Sciences/Biologics; Trauma Introduction/Purpose: The purpose of this study was to evaluate the efficacy of biological adjuvants in hindfoot arthrodesis. Methods: A systematic review of the PubMed and Embase databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using specific search terms and eligibility criteria. Assessment of evidence was three-fold: level of evidence by criteria published by The Journal of Bone & Joint Surgery, quality of evidence by the Newcastle-Ottawa scale and conflicts of interest. Meta-analysis was performed by fixed-effects models for studies of low heterogeneity (I2 <25%) and random-effects models for studies of moderate to high heterogeneity (I2 >=25%). Results: Hindfeet totaled 1579 patients as protocol and 1503 patients per protocol. Final reported mean follow-up ranged from 2.8 months to 43 months. Twelve of the 17 included studies were comprised of patients with comorbidities associated with reduced healing capacity. Based on the random-effects model for non-union rates for autograft versus allograft, the risk ratio was 0.82 (95% CI, 0.13 to 5.21; I2 = 56%; p = 0.83) in favour of lower non-union rates for autograft and for autograft versus rhPDGF/ß-TCP, the risk ratio was 0.90 (95% CI, 0.74 to 1.10; I2 = 59%; p = 0.30) in favour of lower non-union rates for rhPDGF/ß-TCP. Conclusion: There is a lack of data to support the meaningful use of biological adjuvants compared to autograft/allograft for hindfoot arthrodesis. The meta-analysis favoured the use of autograft when compared to allograft, but favoured rhPDGF/ß-TCP instead when compared to autograft in the short-term follow-up.