bluuebunny/crossref_metadata_2025_split huggingface dataset:
Total Ankle Arthroplasty Outcome in Patients with Inflammatory vs Non-Inflammatory Arthritis: Systematic Review and Meta-Analysis
Authors: Kachooei Amir R. , Mousavian Alireza , Schon Lew C. , Daniel Joseph N. , Pedowitz David I. 
Published: January 2022

Category: Ankle; Ankle Arthritis Introduction/Purpose: The decision regarding total ankle replacement is challenging in inflammatory arthritis patients regarding more inferior bone quality, large bone cysts, and increased risk for infections. This systematic review aimed to compare the short and long-term results of total ankle replacement, including the revision rate and the patient-reported outcomes between inflammatory rheumatoid arthritis (RA) versus non-inflammatory ankle osteoarthritis (OA). Methods: All published clinical studies on total ankle arthroplasty were searched in the databases. We extracted the data, specifically the American Orthopaedic Foot & Ankle Society (AOFAS) improvement, complication rate, and the reoperation rate. The results were also analyzed based on the prosthesis type. Results: In total, 34 trials were included in our study. Out of 5,078 patients, the underlying condition was rheumatoid arthritis in 1,327 patients and was non-inflammatory osteoarthritis in 2,849 patients. There was statistically significant higher AOFAS improvement in the patients with RA vs. OA with a mean follow-up of 63 months (P=0.009). The rates of TAA removal or revision were estimated at 16% (95% CI, 10%-23%) in the OA and 13% (95% CI, 9%-18%) in the RA group. Overlapping confidence intervals showed no significant difference in the rate of failure between RA and OA. The survival rate was 66% in the OA group and 88% in the RA group during a 63-month follow-up. Conclusion: Total ankle replacement is a safe procedure in RA patients with fewer minor and major complications relative to other reasons for ankle osteoarthritis.
Comparing Rates of Fusion and Time to Fusion in A Viable Cellular Allograft vs Autograft in Forefoot, Midfoot, and Hindfoot Fusions
Authors: Murphy G. Andrew , Sarfani Shumaila , Richardson David R. , Bettin Clayton C. , Grear Benjamin J. 
Published: January 2022

Category: Other; Ankle Arthritis; Hindfoot; Midfoot/Forefoot Introduction/Purpose: Allograft is routinely used to enhance bone healing in foot and ankle surgery. One allograft in particular employs viable cells and bone scaffolding in a gel base. There is little evidence that compares how this material effects rate of fusion (ROF) and time to fusion (TTF) when compared to autograft in routine forefoot, midfoot, and hindfoot fusions. Our study investigates the use of a viable cellular allograft and its effect on these two variables in a population of patients undergoing fusions in the foot and ankle. Methods: A retrospective review was conducted over a five-year span of patients undergoing fusions in the foot and ankle where the cellular allograft was used. We compared the ROF and TTF between the following three graft groups: cellular allograft alone, autograft alone, and combined allograft + autograft. Data was retrieved from the patients' electronic medical record and TTF was recorded as the time, in days, it took for a solid radiographic fusion to form. Secondary variables collected included etiology of disease (post-traumatic, inflammatory, or diabetic arthropathy) and also analyzed for effect on ROF and TTF. Results: Two hundred and twenty-five patients underwent a fusion in the foot or ankle over a five-year period. Autograft alone was used in 101 patients, the cellular allograft alone was used in 88 patients, and a combination of autograft and the cellular allograft was used in 36 patients. Each group were similar in their comorbid conditions and demographics. The ROF of the autograft only group was 88% (89/101), compared to the cellular allograft group's ROF of 89% (78/88), and the combination graft group's ROF of 75% (27/36). The average TTF between each group varied slightly, with the cellular allograft group fusing the fastest at 86, followed by the autograft alone group at 97 days, and the combined group at 112 days. Conclusion: Our study investigated the use of a viable cellular allograft and its effect on ROF and TTF compared to autograft alone and autograft combined with said cellular allograft. We found no significant difference in ROF between autograft alone and the cellular allograft alone but did find a significant difference in ROF for the combined group resulting in lower rate of fusion. Additionally, use of the cellular allograft resulted in fastest time to fusion compared to autograft alone or a combination of the graft types.
Hallux Valgus Multiplanar Correction Surgery Through a Minimally Invasive Technique. Our Initial Experience.
Authors: Pacheco Florencia , Mac-iver Pablo E. Mocoçain , Elgueta Stephane , Díaz Andres Keller , Radkievich Ruben D. , Villagran Diego A. , Salinas David A , Marti Marisol 
Published: January 2022

Category: Bunion; Other Introduction/Purpose: Recently, minimally invasive surgery for hallux valgus correction has regained popularity. The minimally invasive Chevron and Akin (MICA), has been proved to be as satisfactory for patients as conventional open techniques. However, due to its design, it is difficult to correct the coronal plane malalignment, which could lead to the recurrence of the deformity. Instead, a Bösch-type osteotomy allows multiplanar correction, and with an upgrade in its fixation we can create a stable third- generation percutaneous osteotomy. We report our early results using the minimally invasive Bösch and Akin osteotomy (MIBA). Methods: This was a prospective case series of our first 40 patients (41 feet) undergoing MIBA procedure. Outcome measures included the Manchester-Oxford Foot Questionnaire (MOXFQ), the AOFAS Forefoot Score, and the visual analog scale (VAS) for pain assessment. Radiographic measures included the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and the pronation of the metatarsal. All complications and emitted radiation dosage were reported as well. Results: At 12 months MOXFQ and AOFAS improved from 54.8 to 0.66 (p=0) and 39.1 to 99.2 (p=0), respectively. The mean preoperative VAS was 5.8, and improved during the first week to 1.3 (p<0.05). There was also a significant improvement in all radiographic parameters. We had two significant and five minor complications. Conclusion: The MIBA procedure is a safe and effective option to achieve a multiplanar hallux valgus correction.
The Weil Osteotomy for Angular Correction of Axial Plane Deformities of the Lesser MTP Joints: A Radiographic Analysis
Authors: Strickland Carson D. , Cline Joseph T. , Villarreal Eric D. , Murphy G. Andrew 
Published: January 2022

Category: Lesser Toes; Midfoot/Forefoot Introduction/Purpose: The oblique shortening (Weil) osteotomy of the distal metatarsal neck has been described as an effective means of correcting lesser toe metatarsophalangeal joint deformity. Previous studies have focused on clinical outcomes, complications, and the magnitude of plantar displacement and shortening. The aim of this study was to quantify the magnitude of axial plane correction obtainable when a medial or lateral displacing Weil osteotomy was used in conjunction with other procedures in forefoot reconstruction surgery. Methods: Consecutive patients with a minimum 12-month follow-up who were treated by the senior surgeon from January 1, 2008, to September 1, 2018, were included. Review of the medical records identified 234 toes in 190 patients that had medial or lateral displacement Weil osteotomies as a part of their treatment for metatarsalgia and lesser toe deformity. Concomitant procedures were recorded. Pre- and post-operative weightbearing radiographs were analyzed to determine the amount of transverse plane change and residual varus/valgus alignment. Radiographs were then classified as good (<10 degrees of angulation), intermediate (10-15 degrees), or bad (>15 degrees). Any worsening of the post-operative alignment compared to the pre- operative alignment was noted. Follow-up notes were reviewed for clinical observations of floating toe, resting alignment, persistent pain and swelling at 3 months, complications, and need for revision surgery. Results: The average transverse plane correction was 12.5 degrees (range 0-45 degrees). Most toes remained in some degree of radiographic varus or valgus alignment as a true neutral toe was rare. Over a third, (35%, n=81) had increased postoperative angulation; 42% of radiographs were graded as good alignment (n=99), 20% as intermediate (n=46), and 38% as bad (n=90). The most common concomitant procedures were PIP joint resection arthroplasty and distal chevron bunionectomy. Review of clinic notes revealed low incidences of floating toe (7%, n=16), clinical malalignment (8%, n=18), and need for revision surgery (3%, n=8). Persistent swelling was the most common complication, present in 44% of patients at the 3-month follow-up. Conclusion: The medial and lateral displacing Weil osteotomy can be a powerful tool to correct lesser toe MTP joint transverse plane deviation. It was typically used with PIP joint resection and hallux valgus procedures to improve the lesser toes and overall forefoot alignment. Interestingly, most toes had a neutral or good clinical alignment regardless of the radiographic alignment. Further studies to correlate radiographic and clinical outcome measures may help define its role in correcting lesser toe deformity.
Autologous Matrix-Induced Chondrogenesis (AMIC) with Lateral Ligament Stabilization for Osteochondral Lesions of the Talus in Patients with Ankle Instability
Authors: Viehöfer Arnd F. , Ackermann Jakob , Wirth Stephan H. , Casari Fabio A. , Weigelt Lizzy , Germann Christoph 
Published: January 2022

Category: Ankle; Hindfoot; Sports Introduction/Purpose: Autologous matrix-induced chondrogenesis (AMIC) has shown to result in favorable clinical outcome in patients with osteochondral lesions of the talus (OLT). Yet, the influence of ankle instability on cartilage repair of the ankle has still to be determined. This study sought to compare the clinical and radiographic outcome in patients with and without concomitant lateral ligament stabilization (LLS) undergoing AMIC for the treatment of OLT. Methods: This study evaluated AMIC that were implanted in patients for the treatment of symptomatic OLT with and without concomitant ankle instability. Postoperative MRI, Tegner, AOFAS and Cumberland Ankle Instability Tool (CAIT) were obtained at a minimum follow-up of 2 years. A musculoskeletal radiologist scored all grafts according to the MOCART 1 and 2.0 scores. Patients were stratified into two groups based on whether they underwent concomitant LLS for ankle instability. Patients without LLS served as controls. Patients were matched 1:1 for BMI, lesion size, follow-up and age. Results: Twenty-six patients that underwent AMIC with a mean follow-up of 4.2 +- 1.5 years were enrolled in this study (13 with and 13 without concomitant ankle instability). Patients' mean age was 33.4 +- 12.7 years with a BMI averaging 26.2 +- 3.7. Patients with concomitant LLS showed worse clinical outcome measured by AOFAS (85.1 +- 14.4 vs. 96.3 +- 5.8, p=0.034) and Tegner (3.8 +- 1.1 vs. 4.4 +- 2.3, p=0.012). No difference was seen between both groups regarding MOCART 1 and 2.0 scores (p=0.714 and p=0.371, respectively). Additionally, postoperative CAIT and AOFAS significantly correlated in patients that underwent concomitant LLS (r=0.766, p=0.002) with a CAIT score of > 24 (stable ankle joint) resulting in AOFAS scores comparable to scores in patients with isolated AMIC (90.1 +- 11.6 vs. 95.3 +- 6.6; p=0.442). Conclusion: The results of this study suggest a negative influence of ankle instability on the clinical outcome of cartilage repair with AMIC for the treatment of OLT. If postoperative ankle stability is achieved in patients with LLS, however, comparable outcome as seen after isolated AMIC can be expected.
Evaluation of Lisfranc Injuries: How Involved is the First Tarsometatarsal Joint?
Authors: Wong Liam H. , Chrea Bopha , Atwater Lara C. , Meeker James E. 
Published: January 2022

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Lisfranc injuries are among the most debilitating injuries to the midfoot. Various classification systems have characterized the injury patterns with specific focus on the interval between the base of the second metatarsal and the medial cuneiform as well as the importance of the ligamentous structures of the midfoot. The medial ligamentous restraints of the first tarsometatarsal (TMT) joint and the bony involvement of these injuries remains unclear. Improved knowledge on how the first TMT joint is affected in Lisfranc injuries will provide information on how best to manage these injuries. Methods: We conducted a single institution review of all Lisfranc fractures from 2010 through 2020. Patients were identified by CPT codes. Hardcastle and Myerson Lisfranc injury classifications and computed tomography and radiograph characterizations of the first TMT joint were identified by three foot and ankle trained orthopaedic surgeons. Light's kappa statistics (mean weighted Cohen's kappa) evaluated inter-rater reliability of Lisfranc classifications. The effects injury mechanism and Lisfranc classification on the first TMT joint were further assessed using t-test, Mann-Whitney U, Fisher's exact test, and analysis of variance. Results: Of 71 patients with a Lisfranc injury, 62 (87%) had a sign of injury to the first TMT joint, which significantly varied by Lisfranc classification (P<0.001; Table). Light's kappa coefficient for inter-rater reliability was 0.46. A fragment of the first TMT articular surface was present in 39 patients (55%; median size=10mm) and a medial capsular avulsion fragment was seen in 28 patients (39%). A fracture was present in the medial cuneiform in 25 patients (35%) and in the first metatarsal in 18 patients (25%). Forty-nine patients (69%) had medial/lateral TMT joint incongruence (median overhang=4mm); 21 (30%) had dorsal/plantar incongruence (median overhang=6mm), which significantly differed by Lisfranc classification (P<0.02) and gender (Female=3.5mm; Male=7mm; P<0.03). Angulation of articular surfaces in the first TMT joint over 5 degrees on the transverse/antero-posterior plane occurred in 32 patients (45%) and in 12 patients (17%) on the sagittal/lateral plane, which significantly differed between Lisfranc classifications (P<0.03). Conclusion: Lisfranc injuries have great potential for long-term disability requiring careful screening and diagnosis. The overwhelming majority of Lisfranc injuries include damage to the first tarsometatarsal joint. This is the first study to our knowledge that characterizes this in detail. This study found that the most common patterns involving the first TMT joint included joint incongruity, capsular avulsion and articular surface fracture. A better understanding of injuries to the first TMT can help orthopaedic surgeons with diagnosis and management.
The Use of Deep Machine Learning in Detecting Subtle Lisfranc Joint Instability on Weightbearing Radiographs and Non-Weightbearing CT Scans
Authors: Ashkani-Esfahani Soheil , Mojahed-Yazdi Reza , Bhimani Rohan , Kerkhoffs Gino , Waryasz Gregory R. , DiGiovanni Christopher W. , Lubberts Bart , Guss Daniel 
Published: January 2022

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Diagnosis of subtle Lisfranc joint instability, as a commonly missed foot injury, has remained a concern since it can result in future disabilities if inadequately treated. Weightbearing radiographs (WBR) and conventional CT scans are the most frequent methods in healthcare centers all around the world that are used to assess tarsometatarsal injuries, specifically the Lisfranc joint. However, their accuracy in detecting subtle cases varies depending on the experience and expertise of the interpreter as well as the quality of the images. We aimed to evaluate the use of deep learning and deep convolutional neural network (DCNN) in the detection of subtle Lisfranc instability using WBR and CT scans. Our hypothesis was that this method can increase the accuracy and hasten the interpretation using these modalities. Methods: We gathered 200 WBR and 200 CT scans of cases with subtle Lisfranc instability who were diagnosed intraoperatively; 200 WBR and 200 CT scans of patients with otherwise healthy feet were added as the control group. To increase the confidence in the results we implemented saliency maps to visualize the location of the injury as a heat map and exhibit the process of decision-making by the algorithm. The data of the study was expressed as sensitivity, specificity, accuracy, and the area under the curve (AUC). We used Inception DCNN model as the pre-trained DCNN model in this study. Results: The performance of the DCNN using WBR resulted in sensitivity=93.6%, specificity=91.1%, Accuracy= 94.7, AUC=98.2%. DCNN applied on CT scan resulted in sensitivity=95.8%, specificity=96.9%, accuracy= 93.2, and AUC=98.4%. In cases that the injury was detected correctly by the DCNN, the saliency map had shown the location of the injury correctly as well (100%, Figure 1 ). Conclusion: Here we showed that using DCNN on the currently used interpretation method can significantly improve the accuracy of interpretation using WBR and CT scans in the detection of subtle Lisfranc instability. WBR has lower costs and a lower rate of radiation, thus, improving its performance using deep learning methods can lead to a significant improvement in healthcare quality for the patient and reduced costs for the system.
Analysis of Complications Following Distal Ankle Nerve Blocks for Foot and Ankle Procedures
Authors: Bartholomew Ania , Slone Tyler , Ciesa Michael , Cheney Nicholas A. , Clark Brian C. 
Published: January 2022

Category: Ankle; Arthroscopy; Bunion; Hindfoot; Midfoot/Forefoot; Other Introduction/Purpose: Popliteal nerve blocks are a common procedure employed by anesthesiologists to augment intraoperative anesthesia and provide postoperative pain control. Unfortunately, these can be associated with unintended complications including pain, numbness, and foot drop, sometimes without clear resolution. Studies from Kahn (2017), Anderson (2015), Park (2018), Lauf (2020) suggest complications higher than previously reported with Lauf (2020) finding short-term complication rates of 10.1% and 4.1% long-term as confirmed by EMG. Our study looked to address the complication rates from an alternative anesthetic procedure, a distal ankle nerve block involving anesthesia to the five nerve(s) more intimately involved in the surgical procedure. This alternative technique may provide equivalent anesthetic properties and pain relief as popliteal blocks, with fewer complications for many patients across various demographics. Methods: We retrospectively reviewed patient charts and messaging from 2019 to 2021 that received a distal ankle field block for various surgical procedures including ankle arthroscopy, ankle fractures, and lateral ankle stabilizations. The five nerves anesthetized in the distal ankle nerve block included the tibial, superficial and deep peroneal, sural, and saphenous. Thus far, 61 surgeries have been reviewed and analyzed for neuropathic complications and confirmed via EMG. Results: Of the 61 patients analyzed, 3 patients were found to have a superficial peroneal neuropathy that included dorsal numbness as a result of the distal ankle block, resulting in a 4.92% complication rate. 1 patient required a rescue block to be performed postoperatively for pain. The remaining 57 patients recovered appropriately and without complications. No motor complications have been found from patients receiving distal ankle nerve blocks, as performed by the senior author. Conclusion: With the absence of motor complications and markedly reduced incidence of sensory complications, distal ankle nerve blocks may be a beneficial alternative to popliteal nerve blocks for various foot and ankle orthopedic surgeries. As motor complications can result in life-altering disability, an anesthetic procedure with reduced negative motor outcomes can improve surgery and recovery prognosis. Future directions for this study include adding more patients to increase the sample size, as well as continuing to follow current patients, monitoring symptoms or complications.
Percutaneous Modified Lapidus Procedure with Early Weightbearing: Technique and Early Outcomes of the First 30 Cases
Authors: Bean Bryan , Mangold Devin R. , Abousayed Mostafa , Coleman Michelle M. , Thompson John , Guyton Gregory P. 
Published: January 2022

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Minimally invasive techniques (MIS) have focused on first metatarsal osteotomies in hallux valgus correction. Concurrently, new fixation methods allow early weightbearing protocols with the open Lapidus procedure, with nonunion rates comparable to those of more traditional protocols requiring nonweightbearing. We aimed to assess clinical and radiographic results of an MIS-modified Lapidus technique with axial nail fixation (Phantom Lapidus Intramedullary Nail: Paragon28, Englewood, CO USA) and early weightbearing. Methods: After institutional review board approval, the first 30 consecutive percutaneous MIS-modified Lapidus procedures by a single surgeon were retrospectively reviewed. Indications for surgery included moderate to severe hallux valgus deformity with or without first tarsometatarsal joint (TMT) instability, first TMT arthritis, adolescent bunion, and failed prior surgery. All patients initiated weightbearing within 12 days and returned to regular footwear by 6 weeks postoperatively. Patients had a minimum follow-up period of 3 months (average 8.3 months). The pre- and postoperative visual analog scale (VAS) pain scores, intra- and postoperative complications, and need for revision surgery were recorded. Pre- and postoperative radiographs were used to evaluate the hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), and sesamoid station. Postoperative radiographs were evaluated for signs of hardware loosening and union of the first TMT arthrodesis site. A postoperative CT scan was obtained if nonunion was suspected. Results: Thirty consecutive percutaneous modified Lapidus procedures were performed in 28 patients. VAS scores improved from 4.1 preoperatively to 1.8 at final follow-up. The IMA decreased 8.3 degrees to an average of 5.9 degrees. The HVA decreased 19.2 degrees to 11.7 degrees. The medial column was shortened by 0.6%. There were no intraoperative complications. There were two reoperations, including one nonunion requiring revision first TMT fusion with autograft and one hallux valgus recurrence requiring a distal chevron osteotomy. There were no wound complications, surgical site infections, hardware complications, postoperative transfer metatarsalgia, or nerve-related problems. Conclusion: The current study provides clinical evidence that the intramedullary nail is a biomechanically stable construct evidenced by the high union rate, lack of hardware failure, and tolerance for early weightbearing. This percutaneous modified Lapidus technique may allow for a low rate of wound complications, accelerated rehabilitaion, and improved cosmesis.