bluuebunny/crossref_metadata_2025_split huggingface dataset:
Talar Osteoperiostic Grafting from the Iliac Crest (TOPIC): 2-Year Results of a Novel Press-Fit Surgical Treatment for Large Talar Osteochondral Lesions
Authors: Dahmen Jari , Stufkens Sjoerd A. , Kerkhoffs Gino 
Published: January 2022

Category: Ankle Introduction/Purpose: The purpose of this study was to present the surgical technique and to evaluate the clinical and radiological outcomes of a new press-fit OATS technique for large primary and secondary talar osteochondral defects of the talus, Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC). Methods: Forty patients underwent a press-fit TOPIC procedure. Mean age was 38 years (SD 4.6). Pre- and postoperative clinical assessment at 12- and 24-months follow-up included the American Orthopaedic Foot & Ankle Society (AOFAS) score, the Short- Form 36 (SF-36) Mental Component Scale (MCS) and Physical Component Scale (PCS), the Numeric Rating Scales (NRS) of pain at rest, during walking and stairclimbing, and the Foot and Ankle Outcome Score (FAOS). Return to work was assessed in time and rate. Remodeling of the contour of the talus, bone ingrowth and consolidation of the implanted graft were assessed on computed tomography (CT) one year post-operatively. Results: All patients were available for the two-year follow-up. The AOFAS improved from 48 to 90 (p<0.05). All NRS scores improved: the NRS during rest from 3 to 0 (p<0.05), the NRS during walking from 5 to 1 p<0.05), and the NRS during stairclimbing from 5 to 1 (p<0.05). Both components of the SF-36 improved. The PCS improved from 34 to 47 (p<0.05) and the MCS from 37 to 66 (p<0.05). All FAOS subscales significantly improved. 70% returned to sport at pre-injury sports level and mean time to return to sports was 9 months (SD 2.4). All patients showed remodeling of the talus and all grafts showed consolidation as well as bone ingrowth on the CT scans. All patients returned to work, at a mean time of 4 months post-operatively (SD 4.4). One patient had a temporary loss of n. saphenous sensibility. Conclusion: The TOPIC procedure is a highly promising surgical treatment option for large primary and secondary talar OCDs. Despite these good mid-terms clinical, sports and radiological outcomes, longer follow-up is necessary to assess the clinical outcome and the progression of osteoarthritis at the long term.
An Anatomical Study of the Sural Nerve: A Review of Cadaveric Data and Comparison with 3 Tesla MRI
Authors: Ghetti Claudio B. , Mitchell Brendon , Shah Vrajesh J. , Huang Brady K. , Kent William , Foran Ian M. 
Published: January 2022

Category: Ankle Introduction/Purpose: The sural nerve (SN) is a distal cutaneous nerve that provides sensation to the lateral foot and ankle, and is at risk of iatrogenic injury during surgery at the foot and ankle.1 Previous anatomic studies of the SN are limited to cadaveric studies with small sample sizes.2,3,4,5,6,7,8,9 We analyzed a large cohort of high-field 3 Tesla (3T) magnetic resonance images (MRI) of the ankle to obtain a more generalizable, in-vivo sample of the distal course of the SN. A comparison of this in- vivo method of measurement vs. cadaveric studies may provide surgeons with a more accurate representation of SN anatomy and its relation to anatomic landmarks. Methods: We performed a retrospective review of 3T MRI studies of the ankle performed at our institution between January 2015 and December 2020. Three blinded reviewers measured the vertical distance of the SN to the distal tip of the lateral malleolus (DTLM), the horizontal distance of the SN to the DTLM, and the lateral border of the Achilles tendon (LBA) at the level of the DTLM. Also measured was the horizontal distance of the SN to the LBA at the level of superior Achilles insertion (SAI) onto the calcaneus as well, as 5 cm above the SAI. Intraclass correlation coefficient was calculated to assess reliability between reviewers. A total of 204 3T MRIs of the ankle were included. Results: The mean vertical distance from the SN to the DTLM was 2.2 +- 0.5 cm (ICC, 0.85; range 0.9-3.6 cm). The mean horizontal distance of the SN to the DTLM at the level of DTLM was 1.7 +- 0.3 cm (ICC, 0.98; range 0.8-3.0 cm). The mean horizontal distance of the SN to the LBA at the level of DTLM was 1.9 cm +- 0.3 cm (ICC, 0.91; range 1.0-2.9 cm). The mean horizontal distance from the SN to the LBA at the level of the SAI and 5 cm above the SAI was 2.6 +- 0.4 cm (ICC, 0.85; range 1.4-3.7 cm) and 0.9 +- 0.2 cm (ICC, 0.87; range 0.4-1.8 cm), respectively. Neither height nor BMI were strongly associated with the distance of the SN to any of our anatomic landmarks (R2 < 0.08 for all measurements). Conclusion: Several of our measurements summarized in differed from those reported in previous cadaveric studies. Although our mean horizontal distance of SN to LBA at SAI differed notably from cadaveric studies (2.6 cm vs 1.8-2.1 cm), a 2018 ultrasound study of the SN by Popieluszko et al observed a mean distance of 2.4 cm for this measurement. This concordance may indicate reliability between in-vivo methods of measurement vs. cadaveric studies. In-vivo measurements may also provide a more accurate representation of the anatomy, as these methods are not subject to the effects of embalming and dissection required of cadaveric studies.
Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus: Does Gender Impact Outcomes?
Authors: Gianakos Arianna L. , Okedele Olasumnbo , Flynn Sean , Mulcahey Mary K. , Kennedy John G. 
Published: January 2022

Category: Ankle Introduction/Purpose: Autologous osteochondral transplantation (AOT) is commonly used in the treatment of osteochondral lesions (OCL) of the talus. There is limited data comparing gender differences in the incidence and presentation of talar OCLs and resultant outcomes following AOT. The purpose of this study is to compare these differences between male and female patients. Methods: Eighty-seven consecutive patients who underwent AOT were retrospectively reviewed. Patients were divided into two groups based on gender. Demographic data and OCL defect characteristic data were recorded. Functional outcomes were assessed pre- and post-operatively using the Foot and Ankle Outcome Score (FAOS). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used to assess cartilage incorporation. Results: Fifty-six (64%) males and 31 (36%) females with a mean clinical follow-up was 47.2 months were included in this study. OCL defect size was significantly larger in male patients (112.8mm2) when compared with female patients (88.7mm2) (p<0.0001). Male patients presented with a significantly longer duration of symptoms (p<0.001) and OCLs were more likely to be associated with a recognized trauma (p=0.0006) when compared with female patients who typically presented with associated chronic ankle instability. Mean FAOS improved pre- to postoperatively from 50 to 81(p< 0.001) with a statistically significant increase found in male patients (p<0.0001). The mean MOCART score was 82.1 in male and 86.7 female patients. (p<0.0001).No differences were found in knee donor site morbidity, complication rate, or revision surgery between male and female patients. Conclusion: Our study demonstrates that male patients typically present with talar OCLs that are larger in size, associated with a recognized trauma, and with longer symptom duration when compared with female patients. Talar OCLs in female patients typically were smaller in size and associated with chronic ankle instability. In addition, male patients had greater improvement in FAOS scores following AOT. Therefore, understanding these differences may influence the management and treatment of talar OCLs in male and female patients.
Lower Extremity Injury Rates on Artificial Turf and Natural Grass Playing Surfaces: A Systematic Review
Authors: Gould Heath P. , Lostetter Stephen J. , Samuelson Eric R. , Guyton Gregory P. 
Published: January 2022

Category: Sports Introduction/Purpose: Artificial turf (AT) playing surfaces have emerged as a common alternative to natural grass (NG) at all levels of athletic competition from youth to professional. While several prior articles have compared the lower extremity injury rates on AT and NG, the heterogeneity of these studies in terms of design and methodology has led to widely variable results. The purpose of this systematic review was to determine whether any definitive conclusions can be drawn with regard to the risk of lower extremity injury on AT and NG playing surfaces. Methods: A systematic review of the English-language literature was performed according to the PRISMA guidelines. All included studies presented a direct comparison of injury rates on AT versus NG playing surfaces. No restrictions were made with regard to sport, level of competition, level of evidence, or year of publication. Studies that examined only head injury rates (e.g. concussions) without any comparison of overall injury rates or lower extremity injury rates were excluded. Systematic reviews and meta-analyses were also excluded. The following data elements were extracted from each article: publication year, study design, level of evidence, industry funding, cohort selection process (ad-hoc vs. systematic), sport, level of competition, number of athletic seasons, injury setting, AT type, overall injury rate, knee rate, and foot & ankle injury rate. AT types were classified into Old Generation (1st or 2nd generation) or New Generation (3rd generation or higher). Results: 53 articles met inclusion criteria. 31 articles compared overall injury rates on AT versus NG. Roughly one-half of these studies (51.6%) found no significant difference between NG and AT, while roughly one-third (35.5%) found a higher overall injury rate on AT and just 4 studies (12.9%) found a higher overall injury rate on NG. Similarly, of the 26 articles comparing knee injury rates, 14 studies (53.8%) reported no difference between AT and NG, 8 studies (30.8%) reported a higher injury rate on AT, and 4 studies (15.4%) reported a higher injury rate on NG. With regard to foot & ankle injuries, however, a majority of articles (14/24, 58.3%) reported a higher injury rate on AT. Comparatively few articles (3/24, 12.5%) reported a higher foot & ankle injury rate on NG, while the remaining articles (7/24, 29.2%) reported no difference in foot & ankle injury rate between AT and NG. Conclusion: The present study is a systematic review of 53 articles in the English-language literature that compared injury rates on AT and NG. Our findings suggest that the rates of overall injury and knee injury are similar between these two playing surfaces, though AT may be associated with a higher rate of foot & ankle injuries compared to NG.
Trends in Medicare Physician and Facility Fee Reimbursement in Orthopaedic Foot and Ankle
Authors: Hui Clayton , Kisana Haroon , Martin John R. , Stecher Chad , Hustedt Joshua 
Published: January 2022

Category: Ankle; Ankle Arthritis; Arthroscopy; Bunion; Diabetes; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports; Trauma Introduction/Purpose: The purpose of the study was to examine the trends in physician and facility reimbursement for the orthopaedic foot and ankle subspecialty utilizing the 23 most common foot and ankle surgeries based on national payment amounts. Methods: The Current Procedural Terminology (CPT) codes and corresponding Medicare Severity - Diagnosis Related Group (MS-DRG) codes for the 23 most common orthopaedic foot and ankle surgeries were identified. With the CPT codes, physician reimbursement was obtained through querying the Medicare Physician Fee Schedule (MPFS) for the work, malpractice, and practice expense relative value units (RVU) and then multiplying the total RVUs by the yearly conversion factor. CPT codes were also utilized to gather hospital outpatient reimbursement data from the Hospital Outpatient Prospective Payment System (OPPS) database. Hospital inpatient reimbursement rates were obtained from the Hospital Inpatient Prospective Payment System (IPPS) database utilizing the MS-DRG codes. All amounts were then adjusted for inflation using the Consumer Price Index (CPI). Results: From 2008 to 2021, physician reimbursement for the 23 most common orthopaedic foot and ankle surgeries decreased by 20%, with a mean Compound Annual Growth Rate (CAGR) of -1.7%. Hospital inpatient reimbursement increased by 34.7% with a mean CAGR of 2.3%; while outpatient hospital reimbursement increased by 97.2% with a mean CAGR of 5.1%. Conclusion: Over the past 13 years, physician reimbursement for common orthopaedic foot and ankle surgeries has declined while hospital reimbursement has increased. The larger increase in outpatient reimbursement compared to inpatient reimbursement highlights how CMS aims to transition surgeries from the inpatient setting to the more efficient and less expensive outpatient setting. This downward pressure on physician reimbursement while incentivizing outpatient services could have many unintended consequences on the landscape of foot and ankle practice in the US.
Elevated Body Mass Index Does Not Adversely Influence the Outcomes of Arthroscopic Treatment for Osteochondral Lesions of the Talus
Authors: Koh Don T. , Xia Zhan , Li Zongxian , Tay Kae Sian , Tan Shi Ming , Yeo Nicholas , Rikhraj Inderjeet S. 
Published: January 2022

Category: Ankle; Arthroscopy; Hindfoot; Trauma Introduction/Purpose: Osteochondral lesion of the talus (OLTs) is a common condition found in patients with chronic ankle pain after previous ankle sprains. Conservative measures such as analgesics, activity modification and immobilisation of the affected ankle are usually applied as first line treatments. Surgical management are indicated after conservative management have failed. This study evaluates the influence of body mass index (BMI) on the early clinical outcomes of arthroscopic debridement and microfracture of OLTs. Methods: An IRB approved study was conducted between 2007 and 2017. A total of 252 patients with symptomatic OLTs who failed conservative management underwent arthroscopic debridement and microfracture of OLTs over the affected ankle. Postoperatively, all patients underwent a standardised postoperative rehabilitation protocol. Patients who underwent previous fractures, previous infections or associated ligamentous injury of the affected ankle were excluded from this study. Patients from this cohort were divided into two groups based on BMI. The normal BMI group (NB-Group) (BMI 18.5-25.0kg/m2) and raised BMI group (RB-Group) (BMI >=25kg/m2). Visual Analogue Score (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score as well as the Physical and Mental Components of the Short-Form 36 Questionnaire (PCS and MCS respectively) were prospectively collected from these cohort during their standard postoperative outpatient follow up. Results: A total of 252 patients were reviewed. Patients from either group were otherwise well matched demographically (Table 1). The operative duration was significantly shorter for NB-Group compared to RB-Group. Patients from both groups had significant improvement VAS, AOFAS and PCS scores postoperatively at 6 months and 24 months after surgery (Table 2).Between both groups, patients had comparable VAS, AOFAS as well as PCS scores at preoperative, 6 months postoperative and 24 months postoperatively (p > 0.05). However, MCS in the RB-Group showed a gradual deterioration over 24 months postoperatively and was significantly poorer compared to the NB-Group at 24 months (p = 0.036) (Figure 1). Conclusion: Arthroscopic debridement and microfracture is a reliable procedure, providing significant improvement in pain relief and functional improvement in patients. A raised BMI did not adversely affect pain and functional outcomes. However, patients with raised BMI required a longer duration of procedure and had significantly poorer MCS scores at 24 months after surgery.
Are SER-II Ankle Fractures Actually Anatomic? Bilateral CT Demonstrates Subtle Non-Anatomic Mortise & Syndesmotic Alignment in the Setting of Apparent Normal Radiographs
Authors: Kwon John Y. , Chien Bonnie Y. , Ingall Eitan M. , Staffa Steven , Williams Caroline , Miller Christopher P. 
Published: January 2022

Category: Ankle; Trauma Introduction/Purpose: Current treatment of ankle fractures is predicated on 1-2 mm of talar shift leading to abnormal contact pressures. Determination of anatomic alignment has conventionally been based on plain radiographs. The ability of x-ray to detect subtle mortise displacement however is unknown. The purpose of this investigation is to determine if CT scan can detect malalignment undetectable utilizing plain radiography when assessing injuries assumed to have anatomic mortise alignment. The findings have implications for utilizing higher resolution diagnostic imaging to assess malalignment and challenging the validity of previous literature in which conclusions of anatomic mortise alignment were determined based on plain radiography. Methods: 24 patients with stress-negative, stable SER-II type ankle fractures were included. Contralateral ankle mortise radiographs were obtained in addition to static and gravity stress radiographs of the injured side. Bilateral CT scans were performed once patients were deemed to have achieved clinical/radiographic healing. Measurements of the medial clear space (MCS) and syndesmosis were performed by two blinded orthopedic surgeons at two different time points. Intraclass correlation coefficients (ICC) were calculated to evaluate the intra- and inter-rater reliability and consistency of measurements. Statistical analyses were performed to determine any differences between x-ray and CT scan measurements to detect discrepancies between the injured and normal ankle measurements. Statistical significance was defined as a two-sided alpha error of less than 0.05 (p < 0.05). Results: Despite plain radiographs demonstrating no statistical side-to-side differences and achieving apparent final anatomic alignment in the majority of the cohort, CT MCS on coronal, axial planes and syndesmosis measurements were significantly different when comparing the injured to the normal contralateral ankle by on average of about 0.5mm. There was also excellent intra and interobserver agreement achieved for the measurements. Conclusion: CT is superior to plain radiography in detecting subtle mortise/syndesmotic displacement and side-to-side differences undetectable by x-ray. These findings challenge conventional assumption of anatomic alignment for SER II injuries and reliance on x-rays to assess anatomic alignment. While injured ankles uniformly demonstrated non-anatomic alignment as compared to the uninjured side, the clinical implications of subtle malalignment are unknown. However, broad reaching implications of this preliminary study include challenging the validity of x-ray to detect possibly clinically-relevant mortise malalignment in patients presenting with isolated lateral malleolus fractures.
Functional Outcomes Following Operative Management of Ankle Fractures: Intermediate Length Follow-Up
Authors: LaTulip Scott M. , Rascoe Alexander S. , Audet Megan , Vallier Heather 
Published: January 2022

Category: Ankle; Ankle Arthritis; Trauma Introduction/Purpose: Ankle fractures are among the most commonly surgically treated orthopaedic injuries, with debate regarding their long-term outcomes and the clinical benefit of contemporary fixation strategies. The purpose of this study was to retrospectively evaluate the functional outcomes of patients following surgical management of ankle fractures, and to determine what, if any, limitations and effects their injury has on their daily lives. The authors of this study hypothesized that despite patients having some degree of measurable impairments, these did not cause meaningful disruption in their everyday lives. Methods: We retrospectively reviewed a total of 259 patients who underwent surgical management of their ankle fractures between 2004 and 2012. Two separate patient reported outcome measures, the Foot Function Index (FFI) and Short Musculoskeletal Function Assessment (SMFA) were obtained at a minimum of 5 years following time of surgery. Multivariate linear regression analysis was performed to compare FFI and SMFA against several patient and injury specific variables. Results: A total of 259 patients with ankle fractures were included in the study population. 7 of the demographic and injury- related variables were found to have a statistically significant relationship to both the FFI and SMFA scores. The multivariate linear regression analysis using these 7 variables in addition to both sub-group components of the SMFA to predict the total FFI score yielded an output adjusted-r2 = 0.78. The SMFA dysfunction sub-category was found to correlate with FFI (standardized beta 0.85, p<0.001), but the SMFA bothersome sub-category did not (p=0.866). Ankle pain limiting function and Medicaid insurance status were also predictive of higher FFI scores. Conclusion: Despite patients, at times, experiencing persistent issues with pain and mild activity limitations following surgical management of ankle fractures, these did not lead to measured burdens in daily activities. At a moderate-length follow-up, patients overall do well from a functional standpoint after sustaining ankle fractures treated surgically.
Cost of Operative Fixation of Ankle Fractures: Comparing Orthopaedics and Podiatry
Authors: Luginbuhl Joshua C. , Deemer Alexa R. , Gokcen Eric C. 
Published: January 2022

Category: Trauma; Other Introduction/Purpose: Ankle fractures pose a unique situation as both podiatrists and orthopaedic surgeons are licensed to treat them. Despite increasing emphasis on value-based medical care, there are few cost analyses focused on the treatment of ankle fractures. The goal of this study is to determine if there are cost differences between an orthopaedic surgeon and podiatrist to operatively manage an ankle fracture. Methods: Retrospective cohort study of patients who underwent ankle fracture fixation over a 22 month period at an academic level 1 trauma center. Patient data was subcategorized by surgeon type and treatment groups. Four treatment groups were included: lateral malleolus open reduction and internal fixation (ORIF), bimalleolar/trimalleolar ORIF (no posterior malleolus fixation), lateral malleolus ORIF with syndesmotic fixation, bimalleolar/trimalleolar ORIF (no posterior malleolus fixation) with syndesmotic fixation. Primary outcome was total (OR time cost + Implant cost) cost per case. Results: A total of 134 cases met criteria. Eighty-five cases were treated by a total of 4 orthopaedic surgeons while 49 were treated by 8 podiatrists. There was significantly longer OR time (minutes) for lateral malleolus ORIF (111 vs 134.92), lateral malleolus ORIF with syndesmotic fixation (130.53 vs 156.7), and bimalleolar/trimalleolar ORIF (no posterior malleolus fixation) with syndesmotic fixation (162.13 vs 208) when podiatry was the treating team. Average total cost per case was significantly more for lateral malleolus ORIF (+$1188.45), lateral malleolus ORIF with syndesmotic fixation (+$2259.16), and bimalleolar/trimalleolar ORIF with syndesmotic fixation (+$2837.29) when podiatry was the treating team. Conclusion: Lateral malleolus ORIF, lateral malleolus ORIF with syndesmotic fixation, and bimalleolar/trimalleolar ORIF with syndesmotic fixation costs less per case when performed by an orthopaedic surgeon based on OR time costs and implant costs.