bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Extracellular Matrix Cartilage Allograft May Improve Infill of the Defects in Bone Marrow Stimulation for Osteochondral Lesions of the Talus
Authors: Azam Mohammad , Shimozono Yoshiharu , Williamson Emilie , Mercer Nathaniel P. , Hurley Eoghan T. , Huang Hao , Deyer Timothy , Kennedy John G. 
Published: January 2022

Category: Ankle Introduction/Purpose: The purpose of this study is to evaluate the effectiveness of Extracellular Matrix Cartilage Allograft (EMCA) as an adjuvant to bone marrow stimulation (BMS) compared to BMS alone in the treatment of osteochondral lesions of the talus (OLT). Methods: A retrospective cohort study comparing patients treated with BMS with EMCA (BMS-EMCA group) and BMS alone (BMS group) between 2013 and 2019 was undertaken. Clinical outcome was evaluated with the Foot and Ankle Outcome Score (FAOS) pre-and postoperatively. Postoperative MRIs were evaluated using a modified Magnetic Resonance Observation of Cartilage Tissue (MOCART) score. Comparisons between groups were made with the Man-Whitney U test for continuous variables and the χ2 or Fisher exact test for categorical variables. Results: Twenty-four patients underwent BMS with EMCA (BMS-EMCA group) and 24 patients underwent BMS alone (BMS group). The mean age was 40.8 years (range, 19 to 60 years) in BMS-EMCA group and 47.8 years (range, 24 to 60 years) in BMS group (p=0.060). The mean follow-up time was 20.0 months (range, 12-36 months) in BMS-EMCA group and 26.9 months (range, 12 to 55 months) in BMS group (p=0.031). Both groups showed significant improvements in all FAOS subscales. No significant differences between groups were found in all postoperative FAOS. The mean MOCART score in BMS-EMCA group was higher (76.3 vs 66.3), but not statistically significant (p=0.176). The MRI analysis showed that 87.5% of BMS-EMCA group had complete infill of the defect with repair tissue, however less than half (46.5%) of BMS group had complete infill (p=0.015). Conclusion: BMS with EMCA is an effective treatment strategy for the treatment of OLT and provides better cartilage infill in the defect on MRI. However, this did not translate to improved functional outcomes compared with BMS alone in the short-term.
Bosch Osteotomy for Hallux Valgus Correction: Results at a Mean 10-Year Follow-Up
Authors: Bernasconi Alessio , Rizzo Maria , Russo Anna Paola , Vallefuoco Salvatore , Guarino Amedeo , Mariconda Massimo 
Published: January 2022

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Boesh osteotomy (BO) is a surgical option for the correction of hallux valgus (HV). The aim of this study was to assess the long-term clinical and radiographic results in a cohort of patients treated at our institution. Methods: In this retrospective cohort study, we included 58 HVs (28 right, 30 left) in 46 patients (42 females, 4 males; mean age and BMI at surgery 44 +- 15 (range, 15-64) years and 26 +- 4 (range, 22-38) points, respectively) who underwent HV correction by BO and were followed at a minimum of 7 years. The range of motion (ROM), the American Orthopaedic Foot & Ankle Society's Forefoot scale (AOFAS-FS) and the Visual Analogic Scale (VAS) for pain were recorded. On weightbearing radiographs, the Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), the Distal Metatarsal Articular Angle (DMAA) and the Sesamoid position were measured and compared with pre-operative values. The complication rate and first metatarsophalangeal joint stiffness were also assessed. Results: At a mean follow-up of 10+-2 (range, 7-17) years, mean+-standard deviation AOFAS-FS and VAS were 89+-11 (range, 67-93) and 2.1+-2.8 (range, 0-7) points, respectively. In 62% of patients there was no pain while in 38% an occasional pain was referred. In 42 (72%) cases there was no limitation in the choice of footwears. Radiographically, we found a significant improvement in the HVA (from 33.9°+-6.7 to 18.8°+-5.6, p<0.001), in the IMA (14.2°+-3.1 to 9.4°+-2.7, p<0.001), in the DMAA (from 30.3°+-6.8 to 11.5°+-5.1, p<0.001) and in the sesamoid position (median value from 3 to 1, p<0.001). In 36 (62%) cases the ROM was greater than 75° while in 22 (38%) it ranged between 30° and 75°. Complications occurred in 6 (10%) cases (3 superficial infections, 1 accidental removal of the K-wire, 1 metatarsal head necrosis and 1 development of osteoarthritis), which did not require any surgery at the longest follow-up. Conclusion: Boesh technique provided satisfactory clinical and radiographic outcomes in the correction of Hallux Valgus which persisted at a mean 10-year follow-up. The complication rate was not different from more recent techniques described in literature.
Weightbearing CT Assessment of Foot and Ankle Joints in Pes Planovalgus Using Distance Mapping
Authors: Bernasconi Alessio , Netto Cesar de Cesar , Siegler Sorin , Jepsen Maui , Lintz Francois 
Published: January 2022

Category: Hindfoot; Ankle; Other Introduction/Purpose: The goal of this study was to describe the abnormal joint surface interaction at the ankle, hindfoot and midfoot joints in patients presenting with Pes Planovalgus (PP) using three-dimensional (3D) distance mapping on weightbearing computed tomography (WBCT) images by comparing a series of PPs to a series of normally-aligned feet. We hypothesized that in PPs joint interactions would reveal significantly increased spaces in the medial side of the ankle, hindfoot and midfoot joints. Methods: In this case-control study, ten feet (10 patients) with asymptomatic PP (cases; N=10) were compared to 10 matched- paired (by age, gender and body mass index) normally-aligned feet (10 patients) (controls; N=10). Three-dimensional models were produced from the images and distance maps representing joint surface configuration were generated for the ankle, hindfoot and midfoot joints. The distance maps for each joint were then compared between the two groups and between regions in the same group. Results: In PP patients there was a significantly increased surface-to-surface distance anteromedially at the ankle joint (+46.3%, p<0.001) along with an increased distance on the anterior halves of both the medial (+21.3%, p=0.098) and lateral malleoli (+22.7%, p=0.038). At the posterolateral corner of the posterior facet of the subtalar joint we found an increased surface-to- surface distance (by 57.1%, p< 0.001), while at the talonavicular joint there was a reduction of the distance at the superomedial corner (-20%, p=0.097) along with a significant increase in the upper central (+20%, p=0.039) and lateral (+30.7%, p=0.015) zones. A reduction of the surface-to-surface distance was also observed in three of the four zones of the calcaneocuboid joint. Finally, a statistically significant increase in the mean distance was observed at the naviculocuneiform and tarsometatarsal joints in a range between 38% and 93.4% (p<0.001 in all cases). Conclusion: We found significant differences in surface-to-surface interaction at the foot and ankle joints between Pes Planovalgus and normally-aligned controls. Distance mapping on WBCT images could be used in clinical practice as a diagnostic support to gauge the morphological changes of articular spaces occurring in Pes Planovalgus.
Cost-Effectiveness of Weight-Bearing Computed Tomography in Diagnosing Syndesmotic Instability
Authors: Bhimani Rohan , Searle Owen F. , Ashkani-Esfahani Soheil , Waryasz Gregory R. , Kerkhoffs Gino , DiGiovanni Christopher W. , Guss Daniel , Lubberts Bart 
Published: January 2022

Category: Ankle; Sports; Other Introduction/Purpose: To optimize clinical outcomes, accurate diagnosis and treatment of syndesmotic instability is critical, but subtle instability can be challenging to identify. Weightbearing computed tomography (WBCT) has proved to be a reliable tool for diagnosing syndesmotic instability under physiologic load. We aimed to examine the cost-effectiveness of WBCT with radiographs and/or conventional CT for the diagnosis of syndesmotic instability from a patient perspective. Methods: A decision tree model was constructed to examine the cost-effectiveness of WBCT versus conventional CT (NWB CT) versus weightbearing (WB) radiographs versus non-weightbearing (NWB) radiographs (base case) as initial imaging with additional possible imaging for1268 patients with suspected syndesmotic instability. Patient's clinical and radiological notes were evaluated until the diagnosis of syndesmotic instability was established. The decision tree's probabilities, durations, and image counts were based on patient data. The main outcomes were 1) total imaging costs needed before syndesmotic instability was diagnosed, 2) quality-adjusted life-years (QALYs), 3) incremental cost-effectiveness ratios (ICERs), and 4) overall radiation dose prior to diagnosis. Imaging costs and radiation dose were derived from National Medicare reimbursement rates and the American College of Radiology, respectively. An incremental cost-effectiveness ratio threshold of $50,000 per quality-adjusted life years was used to evaluate cost-effectiveness. In addition, one-way and two-way sensitivity analyses were performed to determine the robustness of our findings. Results: WBCT resulted in 0.057 additional QALY gained per week compared with NWB radiographs, indicating WBCT to be more effective than NWB radiographs. Costs for WBCT imaging were $38.71 higher than NWB radiographs for an ICER of $38,563.96/QALY. Applying a commonly used threshold of $50,000 per QALY, the patient's willingness-to-pay for the amount of quality-adjusted life-year gained from using WBCT as an initial imaging modality was $54.41, suggesting WBCT first imaging strategy was a cost-effective intervention. In our study, the cost of WBCT imaging was $157.35. Sensitivity analyses demonstrated that WBCT was more cost effective than NWB radiographs up to a cost of $173.05. Additionally, initial WBCT resulted in lower overall radiation dosage (6.4 uSv) compared to the use of the other three imaging modalities as initial imaging strategy (initial NWB radiographs - 12.41 uSv; initial WB radiographs - 8.30 uSv, NWB CT first - 25 uSv). Conclusion: WBCT leads to higher QALYs compared to other diagnostic imaging modalities, resulting in improved outcomes for patients by eliminating redundant imaging.
Anatomy of the Naviculocuneiform Joint
Authors: Borrelli George J. , Qatu Mossub , Traynor Christopher J. , Weistroffer Joseph , Jastifer James R. 
Published: January 2022

Category: Midfoot/Forefoot; Basic Sciences/Biologics Introduction/Purpose: The naviculocuneiform (NC) joint has a role in numerous pathologies of the foot and ankle. There is little in the published literature quantifying the cartilage of the articulating surface and its unique anatomical features. The purpose of this study was to quantify and describe the articular surface of the NC joint. Our hypothesis was that the cartilage surface would have anatomic features that would guide surgeons when performing procedures such as joint preparation and screw placement. Methods: Twenty cadaver NC joints were dissected, and the articular cartilage quantified by calibrated digital imaging software. Results: The mean dorsal to plantar height of the navicular facets was 18mm, with a maximum height not exceeding 21mm. The mean height of the medial, middle, and lateral cuneiform facets was 15mm, 17mm, and 15mm, respectively. The mean length from the medial to middle navicular facet was 14mm, approximately 41.3% the mean length across all three navicular facets (34mm). For the distal navicular articulation, 75.4% of the mean surface area was articular cartilage. For the proximal medial, middle, and lateral cuneiform articulations, 69.6%, 75.7%, and 75.8% of the mean surface areas were articular cartilage, respectively. Conclusion: This study provides an anatomic description of the NC joint to guide surgeons when operating on the NC joint. Two clinical observations can be made from this data. First, when preparing the NC joint for arthrodesis from a dorsal approach, the surgeon should be aware that the cartilage of the NC joint can extend up to 21mm from dorsal to plantar. This is also a useful estimate of screw length in the subchondral bone. Second, the central third of the navicular, where the majority of navicular stress fractures occur, lies in the inter-facet ridge between the medial and middle facets.
Medium to Long-Term Results of Combined Deltoid and Foot Reconstruction for PCFD (Stage IV) Valgus Ankle
Authors: Caolo Kristin C. , Netto Cesar de Cesar , Garfinkel Jonathan , Roney Andrew R. , Zhu Jiaqi , Deland Jonathan T. 
Published: January 2022

Category: Ankle; Hindfoot; Other Introduction/Purpose: There is limited documentation of the results of the treatment of advanced progressive collapsing deformity with talar tilt. No article to our knowledge with pre-and post-operative ankle x-rays has more than eight patients and average follow up more than three years. Methods: This article presents the results of twenty consecutive patients with medium to long term follow up. All patients had deltoid reconstruction with tendon graft from the talus to the tibia and foot reconstruction to achieve a heel centered under the lower leg, a stable midfoot and a mild to moderately plantarflexed first metatarsal. Patients were followed an average 10.8 years (SD = 4.6, Range 4.6-17) and had standing pre-and post-operative radiographs along with FAOS and PROMIS scores. Radiographs were assessed for talar tilt preoperatively, early postoperatively and at final follow up. Data was analyzed with paired t-tests, Mann Whitney U test, fisher's exact test and univariable linear regression. All p-values are two-sided and statistical significance was evaluated at the 0.05 alpha level. Results: Two patients failed the procedure; one had an ankle fusion and the second infection eventually required a BKA. The remaining 18 patients were satisfied with their procedure, maintained significant improvement in outcome scores and talar tilt and required no other procedure on their ankle. The mean talar tilt preoperatively was 10.9 degrees (SD = 3.9) and at final follow up 4.2 degrees (SD = 2.8) (P<0.0001). Initial correction of the talar tilt as documented by early post-operative (mean early follow-up years = 2.2, SD = 1.9) with standing radiograph was maintained within 3 degrees in comparison to final radiographic follow up (Mean=0.56, 95%CI (-0.40, 1.51) P<0.0001). Conclusion: Combined deltoid and foot reconstruction, as described, has acceptable results in majority of patients at medium to long term follow up.
Effectiveness of Endoscopic Assisted Repair in Achilles Tendon Ruptures Compared to Percutaneous and Open Repair
Authors: Ceccarini Paolo , Marzano Fabrizio , di Giacomo Lorenzo , Rinonapoli Giuseppe , Caraffa Auro 
Published: January 2022

Category: Arthroscopy; Sports; Trauma Introduction/Purpose: The Achilles tendon rupture is the third most common tendon's injury, with an incidence of 16- 18/100000. Various repair's techniques are described, however the best surgical treatment remains controversial. Our purpose was to evaluate the effectiveness of endoscopic assisted repair compared to traditional open repair and percutaneous technique. Methods: We carried out a prospective observational study in patient operated in our Orthopedic Department between 2017 and 2019. We enrolled 47 patients (40 M; 7F), with a mean age 42,5 y.o with a mean follow up 32 months (12-60). The patients were divided in 3 groups according to the surgical procedures. Group A included 15 patients underwent to endoscopic assisted repair, Group B: 11 patients with percutaneous repair and group C 21 patients open repair. Demographic data, injury mechanisms, operation's time and technique were recorded. At final f-u complications, functional score (VAS, AOFAS AH, ATRS) were requested. The statistical analysis was performed with the t-student test. IRB approved. Results: The 78% of injuries occurred during recreational sport activities, with a majority during football amatorial matches. Operation's time was 42,5 minutes for group A, 33,3 for group B, 33,5 for group C. Among group A, 1 patient developed a DVT. In group B no major complications were reported. In group C a patient suffered from infection with suture insufficiency. Ankle stiffness was reported in 25% of patients in group C. No axonotmesis or neurotmesis of suralis was observed; 16 of patients complained transitory paresthesia in the postoperative. The mean time to return to work's activity was 44,2 days for group A, 35,6 days for group B, and group C 91,1 days, while the mean time to return to drive was in average 72,1 days for group A, 66 days for group B, 92,3 days for group C. ATRS was 79,3 for group A, 87,6 group B and 72,75 group C. Conclusion: This technique is safe and achievable with low postoperative pain and complications, early return to activities, and satisfactory functional outcomes. Compared to standard percutane-ous repair, endoscopy-assisted repair of Achilles tendon ruptures may be useful because it ensures precise placement of sutures through the ten-don and real-time visualization of the gap. Further large-scale, randomized and prospective clinical trials must be the subject of future prospective study.
Hallux Valgus Pronation Correction by Scarf Osteotomy: Prospective Case Series with WB-CT Scan
Authors: Chaparro Felipe R. , Ortiz Cristian A. , Espinoza Aravena Raul M. , Pellegrini Manuel J. , Carcuro Giovanni M. 
Published: January 2022

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Hallux valgus is one of the most prevalent foot deformities. Coronal metatarsal rotation (pronation) has been recognized as a key element in hallux valgus deformity and an important prognostic factor for recurrence. New surgical techniques have been developed in order to specifically address pronation deformity but tend to be technically demanding. With the advent of weight bearing CT (WBCT), accurate pronation measurement has improved. Deformity correction by means of metatarsal osteotomies has been an effective way to correct transverse plane deformity but its capacity for pronation correction is not well established. Purpose: Assess transverse and coronal plane rotation deformity correction by WBCT in hallux valgus patients after scarf osteotomy. Methods: We prospectively analyzed hallux valgus deformity in patients who underwent Scarf osteotomy for symptomatic hallux valgus with preoperative and at least 3 month postoperative WBCT for comparison. Intermetatarsal angle (IMA), hallux valgus angle (HVA) and alpha angle (AA) for first metatarsal rotation (pronation) was measured by 3 different observers. The intraclass correlation was determined. Pre and postoperative measurement change was established by T-test and Wilcoxon for related samples. Results: 40 feet in 25 patients were included. The interclass correlation between observers was 0.9 for AA (pronation), 0.92 for IMA and 0.95 for HVA in preoperative evaluation and 0.94 for AA, 0.65 for IMA and 0.82 for HVA in postoperative evaluation. The mean preoperative and postoperative AA of the first metatarsal was 8.9 degrees (range -8.83-24,40, SD 6.8) and 6.3 degrees (range -10.7-28.4, SD 8.3) respectively, resulting in a significant first ray pronation change of -2.5 degrees (P =.006). The media preoperative and postoperative IMA was 13.1 degrees (SD 2.9) and 4.9 degrees (SD 2.0) respectively, demonstrating a significant change (P <.001). The media preoperative and postoperative HVA was 25 degrees (SD 6.7) and 5.9 degrees (SD 4.2) respectively, demonstrating a significant change (P <.001) Conclusion: The Scarf osteotomy for hallux valgus deformity has a significant power to correct both transverse and coronal plane (pronation) deformity.
Low Tibial Valgization Osteotomy for More Severe Varus Ankle Arthritis
Authors: Choi Jun Young , Suh Jin Soo 
Published: January 2022

Category: Ankle Arthritis Introduction/Purpose: Low tibial valgization osteotomy with medial opening wedge (LTO) is generally indicated for ankle arthritis with a small talar tilt (TT). We addressed the following research questions: the efficacy of LTO for more significant varus ankle arthritis, the effect of additional inframalleolar correction followed by LTO, and the preoperative or operation related factors influencing postoperative TT decrease. Methods: We retrospectively reviewed the radiographic and clinical findings of 31 patients with more significant varus ankle arthritis (>=8 degrees) who underwent LTO or LTO plus inframalleolar correction. We grouped the included patients according to combination with inframalleolar correction and postoperative decreased TT. Furthermore, a binary logistic regression analysis was performed to determine the factors influencing postoperative TT decrease. Results: Even though the mean TT was unchanged postoperatively (from 12.1 to 9.9 degrees, P =.052), clinical parameters were significantly increased. In the group with concomitant inframalleolar correction, we found that TT was more corrected (3.9 vs 1.8 degrees, P =.023) with a greater lateralization of the talar center and a greater correction of the hindfoot alignment to valgus. The results of the binary logistic regression analysis showed a significant relationship between postoperative decreased TT and preoperative talar center migration (P =.016), hindfoot alignment angle (P =.033), hindfoot moment arm (P =.041), and hindfoot alignment ratio (P =.016). Conclusion: LTO in more significant varus ankle arthritis could result in clinical improvement, although TT was not significantly changed. We recommend adding inframalleolar correction after LTO for the patients with more significant varus ankle arthritis.