bluuebunny/crossref_metadata_2025_split huggingface dataset:
Return to Sports and Clinical Outcomes in Suture-Tape Augmentation for Ankle Instability: A Systematic Review
Authors: Kanakamedala Ajay C. , Mercer Nathaniel P. , Samsonov Alan , Walls Raymond J. , Hurley Eoghan T. , Kennedy John G. 
Published: January 2022

Category: Ankle; Sports Introduction/Purpose: There is minimal literature on the use of suture-tape augmentation in the treatment of chronic lateral ankle instability (CLAI), prompting an investigation on its use and effect during surgery of the lateral ankle. The purpose of this systematic review is to evaluate the evidence for the use of suture-tape augmentation in the treatment of CLAI, and the outcomes following this technique. Methods: A literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they evaluated the use of suture-tape for CLAI. Quantitative and qualitative analysis was performed. Results: There were 11 studies (LOE II: 2, LOE III: 1, LOE IV: 8) with 334 patients and 334 ankles, and 66.7% were females. The mean age of patients was 27.3 years. The mean follow-up was 27.6 months (range: 11.5-38.5). Overall, 9 recurrent instability events (4.1%) were reported for suture-tape augmentation, with no significant difference between Modified Broström repair and suture-tape augmentation (MD;.81, 95% CI,.19, 3.50, I2 = 0%, p = 0.78). There was no significant difference in talar tilt angle (TTA) improvement between Modified Broström repair and suture-tape augmentation (MD; -0.07, 95% CI, -0.68, 60.54, I2 = 0%, p = 0.82). There was no significant difference in anterior talar translation (ATT) improvement between Modified Broström repair and suture-tape augmentation (MD; -0.06, 95% CI, -0.69, 0.56, I2 = 0%, p = 0.84). Conclusion: Suture-tape augmentation did not significantly improve clinical or radiological outcomes in the setting of Modified Broström repair for CLAI. Quicker return to play was the single most important advantage of the suture-tape augmentation procedure identified in the current study. This indicates that there is a role for suture-tape augmentation in ATFL repair for athletes and high-demand patients.
Is Arthroscopic Surgery Favorable for Freiberg’s Disease in Metatarsophalangeal Joint?
Authors: Kim Do Yeon , Lee Kwang-Bok , Park Gun Joo , Kim Jong Kil 
Published: January 2022

Category: Arthroscopy; Midfoot/Forefoot Introduction/Purpose: Freiberg's disease is osteochondrosis involving the metatarsal heads. It is a rare disease, mostly found in the second or third metatarsal. The surgical treatment regimens for this disease have not yet been completely defined. We report the outcomes of cases of Freiberg's disease treated with arthroscopic surgery. To assess the effectiveness of a minimally invasive procedure with arthroscopic surgery for the treatment of Freiberg's disease. Methods: From 2015 to 2019, 13 patients (15 feet) diagnosed with Freiberg's disease were enrolled for arthroscopic surgery. Patients were divided based on the Smillie's classification system; 2 stage I, 8 stage II, 3 stage III, 1 stage IV, and 1 stage V. Arthroscopic procedures included synovectomy, debridement, chondroplasty, microfracture, and loose body removal. For radiological evaluation, we obtained pre- and post-operative follow-up X-rays and MRIs. We evaluated clinical outcomes using the American Orthopaedic Foot & Ankle Society (AOFAS) lesser metatarsophalangeal (MTP)-interphalangeal score, and the Visual Analogue Scale (VAS) score. The MTP joint range of motion (ROM) was measured pre- and post-operatively. Results: Radiological study showed no evidence of osteonecrosis progression in the post-operative follow-up X-ray images in any of the 15 cases. Postoperative 12-month MRIs showed reduction of bone-marrow edema, irregularity of subchondral bone, and cartilage defects in all cases. There were significant improvements in AOFAS scores and VAS scores at post-operative 2 weeks and 3 and 12 months over the pre-operative scores (p < 0.05). The MTP joint ROM improved at the last follow-up (p < 0.05). Conclusion: Arthroscopic surgery applied to Freiberg's disease showed excellent results regardless of grades (Smillie's classification system) in radiological evaluation, clinical outcomes, and MTP joint ROM. We suggest it as a treatment of choice for surgeons when they encounter Freiberg's disease.
Comparison of the Distributions of Mechanoreceptors in the Three Parts of ATFL (Fibula Attach, Mid- Substance, Talar Attach)
Authors: Kim Woo Jong , Lee Young Koo , Hong Young Cheol 
Published: January 2022

Category: Basic Sciences/Biologics; Ankle Introduction/Purpose: To investigate the functional characteristics of the anterior talofibular ligament (ATFL) in the ankle, we divided the ligament into three parts and compare the distribution of mechanoreceptors in each part by type. Methods: The ATFL were obtained from 20 ankles of 10 fresh-frozen cadavers. The ligament was divided into three parts: fibula attach, mid-substance, and talar attach. Historically, mechanoreceptors were identified and classified as Ruffini (type I), Vater-Pacini (type II), Golgi-Mazzoni (type III) corpuscle, Free nerve ending (type IV). Difference in receptor density were compared. Results: The ATFL were obtained from 20 ankles of 10 fresh-frozen cadavers. The ligament was divided into three parts: fibula attach, mid-substance, and talar attach. Historically, mechanoreceptors were identified and classified as Ruffini (type I), Vater-Pacini (type II), Golgi-Mazzoni (type III) corpuscle, Free nerve ending (type IV). Difference in receptor density were compared. Conclusion: There were no significant differences in the densities of the four types of mechanoreceptors among the three parts of the ATFL.
Development of A Risk Stratification Scoring System to Predict General Surgical Complications in Foot and Ankle Surgery Patients
Authors: Kisana Haroon , Hui Clayton , Martin John R. , Stecher Chad , Hustedt Joshua 
Published: January 2022

Category: Ankle; Ankle Arthritis; Arthroscopy; Basic Sciences/Biologics; Bunion; Diabetes; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports; Trauma Introduction/Purpose: Preventing postoperative complications is crucial for patients, surgeons, and healthcare facilities. A risk stratification scoring system was created to help optimize risk factors for general surgical complications in foot and ankle surgery patients. Methods: A total of 85,363 patients that underwent foot and ankle procedures from 2005 to 2017 were identified as part of the American College of Surgeons National Surgical Quality Improvement Program. Independent risk factors associated with postoperative complications within 30 days of surgery were identified and used to develop a point-scoring system to estimate the relative risk for experiencing complications. For validation, the system was tested on a subset of patients from the database who had foot and ankle surgery. Results: The 30-day postoperative complication incidence after foot and ankle surgery was 19.1%. Risk factors associated with postoperative complications were tobacco abuse, age (>64), diabetes mellitus, hypertension, elevated creatinine (>1.3 mg/dL), hypoalbuminemia (<3.5 g/dL), and anemia (male hematocrit <42; female <38). Point scores from each factor were: anemia, +7; hypoalbuminemia, +4; hypertension, +4; elevated creatinine, +3; diabetes mellitus, +3; age over 64, +2; and tobacco abuse, +1. In the validation cohort, patients categorized as low risk (0-5), using the point scoring system had a 2.5% rate of 30-day complications; patients categorized as medium risk (6-10) had a 7.5% complication rate (relative risk = 2.0; 95% CI, 1.7-2.3 compared with low risk) and high risk (>=11), 33.1% (relative risk = 3.7; 95% CI, 3.2-4.3). Conclusion: This point scoring system predicts risk for general postoperative complications after foot and ankle surgery. These data may help foot and ankle surgeons identify areas of clinical concern with patients to reduce the risk of experiencing postoperative complications.
The Circular Arc Curved Nail for Internal Fixation of Tibio-Talo-Calcaneal Arthrodesis
Authors: Klaue Kaj 
Published: January 2022

Category: Ankle; Ankle Arthritis; Diabetes; Hindfoot; Trauma Introduction/Purpose: Normal anatomy demonstrates alignment of the heel, the subtalar facet, the talus, the ankle joint and the distal tibia on a regular curve. This curve lies on a vertical plane which is slightly angulated inwards in relation to the sagittal plane. Today's hindfoot nails are either straight or bent. The hole which accommodates the implant is always straight and thus does not respect the normal alignment of the hindfoot. This technique may cause a plantar neurapraxia, the nail holds poorly the calcaneus and tends to create a hindfoot varus. Purpose of the study is to optimize the technique to Methods: A circular arc bore hole crosses the heel, the posterior subtalar facet, the tibio-talar joint and the distal tibia metaphysis. The hole is bored using a motor driven end cutting flexible reamer which is seated within a rigid curved hull. The nail has the exact same shape than the hull and is impacted up to the distal tibia creating a bone-nail form fit. A distal locking screw crossing the subtalar joint and a proximal locking screw within the tibia concludes the central fixation. 47 patients (23 women and 24 men aging 30 to 84 y (mean 52y)) have been treated so far using this technique. The diagnosis was basically primary and post- traumatic arthritis and includes diabetic arthropathies (4 cases) and failed TAR (3 cases). After 2 weeks our patients did practise partial weight bearing using a cam walker for other 6 weeks. Results: The mean follow-up time of the patient series is 3 years (16-78 months). Two patients with diabetic arthropathy died 2 years and 8 months and the other 8 months post-op after consolidation of the arthrodesis due to their primary disease. 3 cases sustained a deep infection which requested a below knee amputation in 2 cases and a calcanectomy in another case. Within the remaining 42 cases, 37 consolidated their arthrodesis within 2 months; 5 cases had a delayed union and 2 cases had to be revised for a non-union, one in the ankle, the other one in the subtalar joint. Patients with a good bone quality and anatomical hindfoot axes could bear their body weight entirely at 2 months. 1 patient reported remaining pain at 2 years post-op and another case was additionally operated to correct a remaining midfoot deformity (club foot). Conclusion: The tibio-talo-calcaneal arthrodesis can be successfully treated using a central circular arc curved nail respecting a form fit interaction between bone and nail. The anatomical osteo-articular alignment of the hindfoot is corrected or preserved. Due to the safe approaches and the bone-nail form fit, the technique allows for primary stability and prevents shortcomings such as neurological complications and non-union. We expect a shorter period between surgical fixation and full weight bearing.
Minimally Invasive Surgery for Severe Hallux Valgus with Severe Metatarsus Adductus: Case Reports
Authors: Kurashige Toshinori 
Published: January 2022

Category: Bunion; Lesser Toes Introduction/Purpose: Metatarsus adductus (MA) is a congenital transverse plane deformity with an incidence of approximately 30% in patients with hallux valgus. Operative treatment of hallux valgus (HV) with MA can be clinically challenging, and the recurrence rate of HV has been reported as two times higher than in patients without MA. Minimally invasive surgery (MIS) for the correction of HV is growing in popularity; however, only one study has been published on MIS for HV with MA using percutaneous proximal metatarsal osteotomy. We presented our case reports using distal oblique metatarsal minimal invasive osteotomy (DOMMO) for severe MA. Methods: We corrected two feet using DOMMO for severe MA. Minimally invasive chevron Akin osteotomy (MICA) was utilized to correct severe HV. The patient had subluxations in the second and third metatarsophalangeal joints and hammer toe deformities. Therefore, those deformities were concurrently corrected using percutaneous procedures. The patient was allowed immediate full weight bearing postoperatively in a flat rigid shoe for 6 weeks. Radiographic and clinical evaluations were performed preoperatively and one year after surgery. On the anteroposterior radiograph, the hallux valgus angles (HVA), the first intermetatarsal angles (IMA), tibial sesamoid positions (TSP) and metatarsus adductusangles (MAA) were evaluated. On the lateral weight-bearing radiograph, first metatarsal inclination angles were also evaluated. We also evaluate the Japanese Society for Surgery of the Foot (JSSF) hallux and lesser toes scales and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) both before and after MIS for HV with MA. Results: In the first case, the HVA improved from 50° to 16°, the IMA from 15° to 11°, TSP from 7 to 5 using Hardy's classification, and MAA from 27° to 14.5°, pre- to postoperatively. In the second case, the HVA improved from 45° to 11°, the IMA from 10° to 6.5°, TSP from grade 7 to 3, MAA from 30 to 12, pre- to postoperatively. The first metatarsal inclination angles changed from 16.9° and 18.8° to17.7° and 22.0°, respectively. All subluxations and hammer toe deformities were resolved. Although there were delayed unions in the lesser metatarsals, unions were achieved finally. Preoperative JSSF hallux scales and lesser toes scales were 59 points and 64 points, 67 points and 80 points, respectively. Both hallux and lesser toe scales improved to 100 points one year after surgery. All SAFE-Q subscores were also improved one year after surgery. Conclusion: In conclusion, our MIS procedure, consisting of DOMMO of the second, third, and fourth metatarsals and MICA, could correct severe HV with severe MA. The patient was allowed immediate full weight bearing postoperatively in a flat rigid shoe. Although there were delayed unions in lesser metatarsals, unions were finally achieved and good results were demonstrated both radiographically and clinically.
Surgical Outcome of Hindfoot Fusion using a Retrograde Hindfoot Fusion Nail
Authors: Leucht Anna-Kathrin , Veljkovic Andrea N. , Wing Kevin J. , Penner Murray J. , Younger Alastair S. 
Published: January 2022

Category: Hindfoot Introduction/Purpose: TTC fusions are often performed as a salvage procedure in patient with severe hindfoot arthritis or hindfoot deformity. Comorbidities in this patient collective are frequent, leading to increased risk of postoperative complication. The purpose of this study was to evaluate the surgical outcome regarding union rate, reoperation rate and adverse events using a retrograde hindfoot fusion nail. Methods: Patient records of a single center were retrospectively reviewed in which a retrograde hindfoot fusion nail was utilized for hindfoot fusion between July 1st, 2009 and August 31st, 2018. These records included age, gender, BMI, comorbidities, indications for surgery, non-union, re-operation rates and adverse events related to the surgery. The fusions were performed by 4 fellowship trained foot and ankle surgeons at a tertiary care teaching hospital. 58 cases were identified consecutively, in 51 cases a TTC fusion was performed, in 7 cases a tibiotalar fusion with preexisting talocalcaneal fusion. 22 fusions were arthroscopic and 36 open. The average age of patients was 59 years, the average BMI 29. Main indication for the hindfoot fusion were arthritis (55%) and complex hindfoot deformity (43%). Results: An overall union rate of 89.66% was achieved, 5 non-union tibiotalar and 1 non-union tibiotalar + talocalcaneal was documented. In the group of arthroscopic fusion the non-union rate was 9.09%, in the open group 11.11% respectively. The non- union group included patient with elevated BMI (50%), Diabetes mellitus (33%) and smoking (33%). Adverse events were documented in 21%. The reoperation rate was 17%, mostly due to deep infection or wound complication requiring surgical debridement. No patient in the arthroscopic fusion group needed a reoperation due to deep infection or wound complication, whereas in open surgery this rate was 27.78%. Conclusion: A union rate of 89.66% was achieved using a retrograde hindfoot fusion nail in a high risk patient population for non- union. Arthroscopic preparation of the tibiotalar and the subtalar joint seem to prevent postoperative wound complications.
What are the Risk Factors for Infection after Operative Treatment of Subtalar Fracture Dislocations?
Authors: Levitt Eli , Patch David A. , Johnson Michael D. , McLynn Ryan , DeBell Henry , Harris James B. , Spitler Clay A. 
Published: January 2022

Category: Ankle; Trauma Introduction/Purpose: Subtalar fracture dislocations are a rare hindfoot injury with relatively little evidence to inform surgeons about outcomes and risk factors for complications. Some previously documented poor prognostic factors include lateral and complicated dislocations, total talar extrusions, and concomitant fractures. The mechanism of injury often results from high energy trauma and has been reported as severe inversion (medial dislocation) or eversion (lateral dislocation) of the foot. The purpose of this study was to assess the risk factors associated with deep infection after operative treatment of subtalar fracture dislocations. Methods: A retrospective cohort study at a single level 1 trauma center was performed to identify patients who had operative treatment of a subtalar fracture dislocation over an 11 year period (2008-2019). Patients were identified by review of the electronic health record and data collected included patient demographics, injury characteristics, and treatment choices. Deep infection was defined as return to the operating room for debridement. Minimum follow-up for inclusion was 3 months. Descriptive analyses (means, medians, standard deviations, ranges, frequency distributions) were used to assess and describe the group. Chi-square tests of association and independent-sample t tests were used to assess differences between the infected group and those without infection. Results: A total of 154 met criteria for this study. The most common associated fractures were talus (47%) and calcaneus (33%). Approximately every 1 in 8 patients (12.3%) patients developed a deep infection. The infected group was older (47.2 vs 39.5 years, p=0.03). Tobacco users were found to have a significantly higher rate of postoperative deep infection (74 vs 34%, aOR=7.4, 95% CI, 2.3-24.1, p=0.001). There was a significantly higher proportion of infection in patients with Gustilo-Anderson type 3 open fractures (32 vs 12%, aOR=5.7, 95% CI, 1.6-20.3, p=0.007). The infected group had a higher proportion of below the knee amputation (47 vs 1%, p<0.001). Conclusion: Infection after operative management of subtalar fracture dislocations can be devastating, with 47% of infected patients requiring amputation. Risk factors for infection after subtalar fracture dislocation include older age, smoking, type 3 open fracture, and freshwater contamination. Ultimately demographic and injury characteristics seem to drive the risk of infection in subtalar fracture dislocations.
Screws Only Primary Subtalar Arthrodesis for Calcaneus Fractures
Authors: Macknet David M. , Bloomer Ainsley , Mcknight Richard , Johnson Nicholas , Yu Ziqing , Seymour Rachel , Hsu Joseph R. 
Published: January 2022

Category: Hindfoot; Trauma Introduction/Purpose: The initial management of displaced intraarticular calcaneus fractures (DIACFs) is a difficult problem. The results of open reduction internal fixation (ORIF) have been disappointing. Alternatively, ORIF with primary subtalar arthrodesis (PSTA) has gained increasing popularity. The purpose of this study is to review patient-centered and radiographic outcomes of ORIF plus PSTA using screws alone through a sinus tarsi approach. Methods: A retrospective study of all patients from 2013-2019 who underwent ORIF+PSTA for DIACFs was conducted. The same surgical technique was utilized in all cases consisting of only screws, no plates were utilized. Delayed surgeries past 8 weeks were excluded. Demographic and radiographic data was collected. Worker's compensation (WC) claims were noted and analyzed separately. Plain radiographs were assessed preoperatively and post-operatively and Sander's classification was used to characterize injuries. Patient reported outcomes (PROs), complications, and need for revision surgeries was also noted and analyzed at final follow-up. Results: In total, forty-eight DIACFs underwent PSTA with a median follow-up of 194 days. Median time to weight-bearing was 60 days post-operatively. Three fractures were documented as Sanders II, 22 as Sanders III, and 23 as Sanders IV. Seventy-five percent of the WC group returned to work compared to just 58.3% in the non-WC group (p=0.0003). Patients in the WC group were more likely to have had an abnormal pre-operative Bohler's angle (p=0.047) but the two groups did not differ significantly in postoperative Gissane or Bohler angles. Nearly 85% (N=41) achieved >=2 zones of fusion on radiographs by final follow up and 95.8% (N=46) had at least one. Four patients had a complication and 3 required a return to the operative room. Conclusion: Utilizing Screws only primary subtalar arthrodesis for the treatment of DIACFs through a sinus tarsi approach shows promising results with high rates of return to work and fusion, even in the workers' compensation population.