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Journal Cover Foot & Ankle International
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   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1071-1007
   Published by Sage Publications Homepage  [852 journals]
  • Comparison of All-Inside Arthroscopic and Open Techniques for the Modified
           Brostròˆm Procedure for Ankle Instability
    • Authors: Yeo, E. D; Lee, K.-T, Sung, I.-h, Lee, S. G, Lee, Y. K.
      Pages: 1037 - 1045
      Abstract: Background:No reported study has compared clinical and radiologic outcomes between an all-inside arthroscopic modified Broström operation (MBO) and an open MBO. The purpose of this study was to compare clinical and radiologic outcomes of all-inside arthroscopic and open MBOs.Methods:From August 2012 to July 2014, 48 patients were included. They were divided into 2 groups: all-inside arthroscopic MBO (25 patients) and open MBO (23 patients). The American Orthopaedic Foot & Ankle Society (AOFAS) ankle–hindfoot score, visual analog scale (VAS) score, and Karlsson score were used to evaluate clinical outcomes. Anterior talar translation and talar tilt were used to evaluate radiologic outcomes. All patients had lateral ankle instability. MBO was performed in 87 patients. Of these, 50 patients met the inclusion criteria. All patients had giving way, persistent pain, and an inability to resume their preinjury activity level for more than 6 months. Patients were randomized into 2 groups, all-inside arthroscopic MBO and open MBO, using a permuted block randomization method. Clinical outcome evaluations were performed preoperatively, at 6 weeks and 6 months postoperatively, and at a final follow-up at a minimum of 12 months postoperatively using the Karlsson score, the AOFAS ankle-hindfoot score, and pain VAS scores. Radiologic outcome evaluations were performed preoperatively and at 1 year postoperatively at final follow-up using anterior talar translation, and talar tilt angle.Results:After randomization, 25 ankles were allocated to the all-inside arthroscopic MBO group and 25 to the open MBO group. Two ankles in the open MBO group were excluded from the analysis because they were lost to follow-up. Thus, evaluations were performed for 25 ankles in the all-inside arthroscopic MBO group and 23 in the open MBO group. There was no difference in age, gender, symptom duration, preoperative AOFAS, VAS, Karlsson scores, anterior talar translation, or talar tilt between the 2 groups (all P > .05). At the final follow-up, the AOFAS, VAS, and the Karlsson scores had improved significantly in both groups (P < .001). There was no difference in the Karlsson, AOFAS, or VAS scores, anterior talar translation, or talar tilt between the 2 groups at final follow-up (all P > .05).Conclusions:There was no difference in the clinical or radiologic outcome between the all-inside arthroscopic MBO and open MBO for the treatment of lateral ankle instability at up to 1 year after surgery. An all-inside arthroscopic MBO should be considered carefully in patients who have lateral ankle instability.Level of Evidence:Level I, randomized controlled trial.
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716666508
      Issue No: Vol. 37, No. 10 (2016)
  • Influence of Surgeon Volume on Inpatient Complications, Cost, and Length
           of Stay Following Total Ankle Arthroplasty
    • Authors: Basques, B. A; Bitterman, A, Campbell, K. J, Haughom, B. D, Lin, J, Lee, S.
      Pages: 1046 - 1051
      Abstract: Background:Increased surgeon volume may be associated with improved outcomes following operative procedures. However, there is a lack of information on the effect of surgeon volume on inpatient adverse events and resource utilization following total ankle arthroplasty (TAA).Methods:A retrospective cohort study of TAA patients was performed using the Nationwide Inpatient Sample (NIS) from 2003 to 2009. High-volume surgeons were considered as those with volume ≥90th percentile of surgeons performing TAA. Multivariate regression was used to compare the rates of adverse events, hospital length of stay, and total hospital charges between surgeon volume categories.Results:A total of 4800 TAA patients were identified. The 90th percentile for surgeon volume was 21 cases per year. Mean length of stay was 2.8 ± 2.3 days and mean hospital charges were $45 963 ± $43 983. On multivariate analysis, high-volume surgeons had decreased overall complications (OR 0.5, P = .034) and rate of medial malleolus fracture (OR 0.1, P = .043), decreased length of stay (–0.9 days, P < .001), and decreased hospital charges (–$20 904, P < .001).Conclusions:Surgeons with volume ≥90th percentile had a decreased rate of complications, decreased length of stay, and reduced hospital charges compared to other surgeons.Level of Evidence:Level III, comparative study.
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716664871
      Issue No: Vol. 37, No. 10 (2016)
  • Association of Cigarette Use and Complication Rates and Outcomes Following
           Total Ankle Arthroplasty
    • Authors: Lampley, A; Gross, C. E, Green, C. L, DeOrio, J. K, Easley, M, Adams, S, Nunley, J. A.
      Pages: 1052 - 1059
      Abstract: Background:Tobacco use is a known risk factor for increased perioperative complications and having worse functional outcomes in many orthopedic procedures. To date, no study has elucidated the effect of cigarette smoking on complications or functional outcome scores after total ankle replacement (TAR).Methods:We retrospectively reviewed the records of 642 patients who had TAR between June 2007 and February 2014 with a known smoking status. These patients were separated into 3 groups based on their smoking status: 34 current smokers, 249 former smokers, and 359 nonsmokers. Outcome scores and perioperative complications, which included infection, wound complications, revision surgeries, and nonrevision surgeries were compared between the groups.Results:When comparing perioperative complications in the active smokers to the nonsmokers, we found a statistically significant increased risk of wound breakdown (hazard ratio [HR] 3.08, P = .047). Although the active smokers had an increased rate of infection (HR 2.61, P = .392), revision surgery (HR 1.75, P = .470), and nonrevision surgery (HR 1.69, P = .172), these findings were not statistically significant. With regard to outcome scores, all groups demonstrated improvement at 1- and 2-year follow-up compared with their preoperative outcome scores. However, the active smokers had less improvement in their outcome scores than the nonsmokers at 1- and 2-year follow-up. Furthermore, there was no significant difference in the outcome scores when comparing the nonsmokers to the former smokers.Conclusion:Active cigarette smokers undergoing TAR had a significantly higher risk of wound complications and worse outcome scores compared with nonsmokers and former smokers. Furthermore, tobacco cessation appeared to reverse the effects of smoking, which allowed TAR to be an effective and safe procedure for providing pain relief and improving function in former smokers as they had perioperative complication rates and outcomes similar to nonsmokers.Level of Evidence:Level III, retrospective comparative series.
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716655435
      Issue No: Vol. 37, No. 10 (2016)
  • Association of Short-term Complications With Procedures Through Separate
           Incisions During Total Ankle Replacement
    • Authors: Criswell, B; Hunt, K, Kim, T, Chou, L, Haskell, A.
      Pages: 1060 - 1064
      Abstract: Background:Surgeons disagree about the safety of adding adjuvant procedures requiring separate incisions during total ankle replacement (TAR). This study tested the hypothesis that complication rates for patients in the first year after TAR would be greater when combined with procedures through separate incisions.Methods:A retrospective review was performed on a consecutive series of 124 patients who underwent total ankle replacement between 2007 and 2013. Demographics, case-specific data, and postoperative complications over the first year were collected. A chi-square analysis was performed to compare differences in complication rates among patients with and without additional procedures requiring a separate incision. The average patient age was 67±10 years. Fourteen patients (11%) were diabetic and 2 patients (2%) were current smokers. Eighty-seven (70%) had prior trauma leading to arthritis. Ninety-seven (78%) cases used the Scandinavian Total Ankle Replacement (STAR), 16 (13%) Salto Talaris, and 11 (9%) In Bone implants. Ten (8%) cases were revisions. Excluding percutaneous Achilles lengthening, 35 of 124 patients (28%) had a total of 54 adjuvant procedures requiring a separate incision during TAR. These included 9 (7%) calcaneal osteotomies, 8 (6%) medial malleolar fixation, 6 (5%) subtalar fusions, 5 (4%) lateral ligament repair, 4 (3%) open Achilles lengthening, 4 (3%) removal of hardware, 2 (2%) first metatarsal osteotomy, and 8 other procedures.Results:Overall, 32 (26%) of the 124 patients had a complication, including 15 (12%) delayed wound healing, 6 (5%) malleolar fracture, and 11 other complications. At 1 year, 24 (27%) of 89 patients without additional incisions and 8 (23%) of 35 patients with additional incisions, excluding percutaneous Achilles lengthening, had any complication (P = .64).Discussion:This study did not demonstrate an association between additional procedures requiring a separate incision during TAR and early complications. Overall complication rates were similar to previously reported series of TAR. This study suggests that surgeons can add adjuvant procedures during TAR to improve alignment, stability, or treat adjacent segment arthritis without affecting short-term complication rates. The necessity or utility of these adjuvant procedures requires further study.Level of Evidence:Level III, comparative series.
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716651964
      Issue No: Vol. 37, No. 10 (2016)
  • Psychosocial Risk Factors for Postoperative Pain in Ankle and Hindfoot
    • Authors: Mulligan, R. P; McCarthy, K. J, Grear, B. J, Richardson, D. R, Ishikawa, S. N, Murphy, G. A.
      Pages: 1065 - 1070
      Abstract: Background:The purpose of this study was to examine factors associated with pain after elective ankle and hindfoot reconstruction.Methods:Patients who underwent major ankle or hindfoot reconstruction over a 3-year period were identified. Retrospective chart review determined patient demographics, comorbidities, surgeries, tobacco, alcohol, and narcotic use, chronic pain, and mood disorders. Primary outcomes were cumulative amount of narcotic prescribed (morphine milligram equivalent dose) in the initial 90-day postoperative period, beyond 90 days, and visual analog pain score (VAS) at a minimum of 1-year follow-up. One hundred thirty-two patients (139 operations) met the inclusion criteria.Results:The average narcotic amount prescribed in the initial 90 days after surgery was 1711 mg (morphine equivalent), and narcotic prescriptions were required after 52 surgeries (35%) past 90 days. Preoperative narcotic use (P < .01), chronic pain disorder (P = .02), and mood disorder (P < .01) were significant risk factors for continued narcotic use past 90 days. Tobacco use (P = .01) and chronic pain disorder (P < .01) also were significant risk factors for increased initial postoperative narcotic use. The average VAS score in 91 patients at an average of 2.7-year follow-up was 2.1. Mood disorder was a risk factor for increased VAS (P < .01). No other associations were noted.Conclusion:Patients being treated for chronic pain, diagnosed with a mood disorder, taking any amount of narcotics preoperatively, or using tobacco products had a statistically significant increased risk for pain postoperatively. The presence of risk factors should prompt physicians to discuss pain management strategies before surgery.Level of Evidence:Level III, comparative series.
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716655142
      Issue No: Vol. 37, No. 10 (2016)
  • Pain Resolution After Hallux Valgus Surgery
    • Authors: Chen, J. Y; Ang, B. F. H, Jiang, L, Yeo, N. E. M, Koo, K, Singh Rikhraj, I.
      Pages: 1071 - 1075
      Abstract: Background:Although more than 1500 publications on hallux valgus can be found in the current literature, none of them have reported on the course of pain resolution after hallux valgus surgery. Thus, this study aimed to investigate pain resolution after hallux valgus surgery and to identify predictive factors associated with residual pain at 6 months after surgery.Methods:We prospectively followed up 308 patients who underwent hallux valgus surgery at a tertiary hospital at 6 months and 2 years after surgery. Multivariate logistic regression analysis was performed to evaluate the risk factors associated with residual pain after surgery.Results:Ninety-four patients (31%) had some degree of residual pain at 6 months after surgery. After excluding 4 patients who developed osteoarthritis of the first metatarsophalangeal joint over the next 18 months, 73 of the remaining 90 (81%) experienced improvement in visual analog scale (VAS) by the 2-years follow-up. Their median VAS improved from 4 (interquartile range [IQR] 3, 5) at 6 months to 0 (IQR 0, 3) at 2 years (P < .001). A higher preoperative VAS increased the risk of having persistent pain at 6 months after sugery (odds ratio [OR] 1.388, 95% confidence interval [CI] 1.092, 1.764, P = .007), whereas a higher preoperative Mental Component Score of SF-36 (MCS) reduced this risk (OR 0.952, 95% CI 0.919, 0.987, P = .007).Conclusions:As much as 31% of patients will have residual pain at 6 months after surgery. Preoperative VAS and MCS are predictors for residual pain. However, these patients will continue to improve over the next 18 months, with 71% of them being pain free at 2 years after surgery.Level of Evidence:Level II, prospective comparative study.
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716653084
      Issue No: Vol. 37, No. 10 (2016)
  • Superior Tuber Displacement in Intra-articular Calcaneus Fractures
    • Authors: Ghorbanhoseini, M; Ghaheri, A, Walley, K. C, Kwon, J. Y.
      Pages: 1076 - 1083
      Abstract: Background:Intra-articular calcaneus fractures result in heel shortening, widening, varus malalignment, and loss of height. Little has been written regarding superior displacement of the calcaneal tuber, which warrants consideration as previous literature has demonstrated issues arising from a shortened triceps surae. We sought to determine the amount of tuber elevation seen in calcaneus fractures as compared to normal calcanei and propose 2 new measurements that aid in quantifying displacement and may aid in the surgical management of calcaneus fractures.Methods:Lateral radiographs of 220 normal calcanei were examined. Two novel measurements, the talo-tuber angle and talo-tuber distance, were used to establish normative data for calcaneal tuber positioning. Lateral radiographs of 50 calcaneus fractures treated operatively were examined and the same measurements were obtained before and after surgery to determine the amount of superior tuber elevation.Results:Normative data demonstrated a mean of 38.6 degrees (±SD = 4.3, range: 26.2-58.4) when using the talo-tuber angle and 54.5 mm (±SD = 7.3, range: 36.2-72.6) when using the talo-tuber distance in normal calcanei. Patients sustaining calcaneus fractures demonstrated a mean of 29.5 degrees (±SD = 5.9, range: 20-46.4) for the talo-tuber angle and 39.0 mm (±SD = 9.4, range: 24.0-62.9) for the talo-tuber distance. These values changed to a mean of 37 degrees (±SD = 5.2, range: 26.4-50) for the talo-tuber angle and 51.8 mm (±SD = 8.6, range: 33.2-75.7) for the talo-tuber distance after surgery. There was a statistically significant difference (P value < .01) for both talo-tuber angle and distance between normal and fractured calcanei. Inter- and intra-observer agreement was excellent.Conclusion:Superior displacement of the calcaneal tuber is a deformity seen in intra-articular calcaneus fractures that has been poorly described that warrants increased awareness and correction at the time of surgery. We propose 2 novel measurements with associated normative data that may aid surgeons in quantifying this deformity and assessing anatomic reduction.Level of Evidence:Level III, comparative study.
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716651965
      Issue No: Vol. 37, No. 10 (2016)
  • Delayed Open Reduction Internal Fixation of Missed, Low-Energy Lisfranc
    • Authors: Cassinelli, S. J; Moss, L. K, Lee, D. C, Phillips, J, Harris, T. G.
      Pages: 1084 - 1090
      Abstract: Background:The aim of this study was to determine the outcome of delayed presentation (at least 6 weeks from the time of injury) of low-energy Lisfranc injuries limited to the first and second tarsometatarsal joints treated with open reduction internal fixation.Methods:8 patients with an average age at surgery of 39.8 years were retrospectively reviewed with a mean time to surgery from injury of 15.1 (range of 6.3 to 31.1) weeks. We used radiographic measurements, physical examination, SF-12 scores, Foot and Ankle Ability Measure (FAAM) scores, VAS scores and return to work or sports as outcome measures. Patients were treated with an open reduction and internal fixation as opposed to a formal arthrodesis with a variety of internal fixation. All 8 patients were available for follow-up and outcome reporting at an average of 3.1 years (minimum 2.0) postoperatively.Results:The mean VAS improved from 8.5 to 2.8 postoperatively. The mean postoperative physical and mental SF-12 scores were 46.8 and 57.1, respectively. The mean postoperative overall and sports FAAM scores were 75.4 and 65.9, respectively. There were no radiographic signs of a late diastasis at the Lisfranc joint. All patients including 2 workers compensation cases returned to work and all were able to return to their prior sporting activity.Conclusion:A delayed open reduction internal fixation of patients with missed, low-energy Lisfranc injury was performed and resulted in decreased pain. In this series, a fair to good functional outcome was observed, and the ability to return to work or previous sport was possible for all patients studied.Level of Evidence:Level IV, retrospective case series.
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716655355
      Issue No: Vol. 37, No. 10 (2016)
  • Clinical and Functional Outcomes of Gastrocnemius Recession for Chronic
           Achilles Tendinopathy
    • Authors: Molund, M; Lapinskas, S. R, Nilsen, F. A, Hvaal, K. H.
      Pages: 1091 - 1097
      Abstract: Background:Although gastrocnemius recession has been proposed and used in the treatment of chronic noninsertional Achilles tendinopathy, only weak evidence exists to support this operative indication. The purpose of our study was to assess the clinical and functional outcomes of patients treated with gastrocnemius recession at 2 institutions for this problem.Methods:Thirty-four patients were identified through our medical records and asked to participate in this study. Thirty patients (35 legs) responded to the invitation. Sixteen patients were eligible for clinical follow-up, and 14 patients responded by letter or telephone interview. Two patients did not want to participate, and 2 patients could not be reached. Data were collected by a satisfaction questionnaire, the Victorian Institute of Sports Assessment–Achilles (VISA-A) questionnaire, a visual analog scale (VAS) for pain, a functional test battery, and a clinical examination.Results:A subgroup with preoperative data (n = 8) showed an increase in the mean VISA-A score from 39.5 to 91.9. The mean overall VISA-A score (n = 30) was 91.4 at follow-up. The mean VAS for pain score when walking decreased from 7.5 before surgery to 0.8 after surgery. Twenty-eight of 30 patients reported that they were satisfied with their results after surgery. Functional testing showed no difference in gastrocnemius-soleus function between the operated and nonoperated leg (n = 10).Conclusion:The findings support the promising results from other studies regarding gastrocnemius recession as an effective and safe way of treating chronic Achilles tendinopathy. The patients recovered both in terms of pain and function.Level of Evidence:Level IV, retrospective case series.
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716667445
      Issue No: Vol. 37, No. 10 (2016)
  • Treatment of Foot and Ankle Neuroma Pain With Processed Nerve Allografts
    • Authors: Souza, J. M; Purnell, C. A, Cheesborough, J. E, Kelikian, A. S, Dumanian, G. A.
      Pages: 1098 - 1105
      Abstract: Background:Localized nerve pain in the foot and ankle can be a chronic source of disability after trauma and has been identified as the most common complication following operative interventions in the foot and ankle. The superficial location of the injured nerves and lack of suitable tissue for nerve implantation make this pain refractory to conventional methods of neuroma management. We describe a novel strategy for management using processed nerve allografts to bridge nerve gaps created by resection of both end neuromas and neuromas-in-continuity.Methods:A retrospective review of a prospectively maintained database was performed of all patients who received a processed nerve allograft for treatment of painful neuromas in the foot and ankle between May 2010 and June 2015. Patient demographic and operative information was obtained, as well as preoperative and postoperative pain assessments using a conventional ordinal scale and PROMIS (Patient Reported Outcomes Measurement Information System) Pain Behavior and Pain Interference assessments. Twenty-two patients were identified, with postoperative pain assessments occurring at a mean of 15.5 months after surgery.Results:Neuromas of the sural and superficial peroneal nerves were the most common diagnoses, with 3-cm nerve allografts being used as the interposition graft in the majority of cases. Eight patients had end neuromas and 18 patients had neuromas in continuity. Analysis of paired data demonstrated a mean ordinal pain score decrease of 2.6, with 24 and 31 percentage-point decreases in PROMIS Pain Behavior and Pain Interference measures, respectively. All changes were significant (P < .002).Conclusion:The painful sequelae of superficial nerve injuries in the foot and ankle was significantly improved with complete excision of the involved nerve segment followed by bridging of the resulting nerve gap with a processed nerve allograft. This approach limits surgery to the site of injury and reconstitutes the peripheral nerve anatomy.Level of Evidence:Level IV, retrospective case series.
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716655348
      Issue No: Vol. 37, No. 10 (2016)
  • Neurologic Deficit Associated With Lateralizing Calcaneal Osteotomy for
           Cavovarus Foot Correction
    • Authors: VanValkenburg, S; Hsu, R. Y, Palmer, D. S, Blankenhorn, B, Den Hartog, B. D, DiGiovanni, C. W.
      Pages: 1106 - 1112
      Abstract: Background:Lateralizing calcaneal osteotomy (LCO) is a frequently used technique to correct hindfoot varus deformity. Tibial nerve palsy following this osteotomy has been described in case reports but the incidence has not been quantified.Methods:Eighty feet in 72 patients with cavovarus foot deformity were treated over a 6-year span by 2 surgeons at their respective institutions. Variations of the LCO were employed for correction per surgeon choice. A retrospective chart review analyzed osteotomy type, osteotomy location, amount of translation, and addition of a tarsal tunnel release in relation to the presence of any postoperative tibial nerve palsy. Tibial nerve branches affected and the time to resolution of any deficits was also noted.Results:The incidence of neurologic deficit following LCO was 34%. With an average follow-up of 19 months, a majority (59%) resolved fully at an average of 3 months. There was a correlation between the development of neurologic deficit and the location of the osteotomy in the middle third as compared to the posterior third of the calcaneal tuber. We found no relationship between the osteotomy type, amount of correction, or addition of a tarsal tunnel release and the incidence of neurologic injury.Conclusions:Tibial nerve palsy was not uncommon following LCO. Despite the fact that deficits were found to be transient, physicians should be more aware of this potential problem and counsel patients accordingly. To decrease the risk of this complication, we advocate extra caution when performing the osteotomy in the middle one-third of the calcaneal tuberosity. Although intuitively the addition of a tarsal tunnel release may protect against injury, no protective effect was demonstrated in this retrospective study.Level of Evidence:Level III, retrospective cohort study.
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716655206
      Issue No: Vol. 37, No. 10 (2016)
  • Osteochondral Autograft Transfer Combined With Cancellous Allografts for
           Large Cystic Osteochondral Defect of the Talus
    • Authors: Zhu, Y; Xu, X.
      Pages: 1113 - 1118
      Abstract: Background:Large cystic osteochondral defects of the talus can be challenging to treat. This retrospective control study looked at the use of osteochondral autograft transfer combined with cancellous allograft in patients with advanced cartilage and subchondral bone damage of the talus.Methods:Thirteen patients were treated with large cystic osteochondral defect of the talus between February 2010 and July 2013. All of these cystic osteochondral defects were larger than 15 mm in diameter. The subchondral defects were filled with cancellous allograft and the center of the lesions were sealed with an osteochondral cylinder autograft that was harvested from the ipsilateral medial femoral condyle. The visual analog scale (VAS) score for pain during daily activities, American Orthopaedic Foot & Ankle Society Ankle and Hindfoot (AOFAS-AH) scores and subjective satisfaction survey rating were obtained. Plain radiographs and magnetic resonance imaging of the ankle were obtained before and after surgery. In 5 cases, arthroscopy was performed 12 months postoperatively, and the cartilage repair was assessed with the criteria of the International Cartilage Repair Society. Twelve patients were available for follow-up at a mean of 25.4 months (range, 18 to 48 months).Results:Average postoperative AOFAS-AH score 12 months after surgery was 88±7 compared with 64±10 preoperatively. The mean VAS score decreased from 6±1 preoperatively to 1±1 at the latest follow-up. Seven patients rated their result as excellent, 5 as good and none as fair. The radiolucent area of the cysts disappeared on the plain radiographs in all cases. The mean International Cartilage Repair Society arthroscopic score from follow-up arthroscopy was 9±1 points.Conclusions:The use of osteochondral autograft transfer combined with cancellous allograft was an effective option for the treatment of large cystic talar osteochondral lesions.Level of Evidence:Level IV, retrospective case series.
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716655345
      Issue No: Vol. 37, No. 10 (2016)
  • Multisegment Foot Kinematic and Kinetic Compensations in Level and Uphill
           Walking Following Tibiotalar Arthrodesis
    • Authors: Bruening, D. A; Cooney, T. E, Ray, M. S, Daut, G. A, Cooney, K. M, Galey, S. M.
      Pages: 1119 - 1129
      Abstract: Background:Foot and ankle movement alterations following ankle arthrodesis are still not well understood, particularly those that might contribute to the documented increase in adjacent joint arthritis. Generalized tarsal hypermobility has long been postulated, but not confirmed in gait or functional movements. The purpose of this study was to more thoroughly evaluate compensation mechanisms used by arthrodesis patients during level and uphill gait through a variety of measurement modalities and a detailed breakdown of gait phases.Methods:Level ground and uphill gait of 14 unilateral tibiotalar arthrodesis patients and 14 matched controls was analyzed using motion capture, force, and pressure measurements in conjunction with a kinetic multisegment foot model.Results:The affected limb exhibited several marked differences compared to the controls and to the unaffected limb. In loading response, ankle eversion was reduced but without a reduction in tibial rotation. During the second rocker, ankle dorsiflexion was reduced, yet was still considerable, suggesting compensatory talar articulation (subtalar and talonavicular) motion since no differences were seen at the midtarsal joint. Also during the second rocker, subjects abnormally internally rotated the tibia while moving their center of pressure laterally. Third rocker plantarflexion motion, moments, and powers were substantially reduced on the affected side and to a lesser extent on the unaffected side.Conclusion:Sagittal plane hypermobility is probable during the second rocker in the talar articulations following tibiotalar fusion, but is unlikely in other midfoot joints. The normal coupling between frontal plane hindfoot motion and tibial rotation in early and mid stance was also clearly disrupted. These alterations reflect a complex compensatory movement pattern that undoubtedly affects the function of arthrodesis patients, likely alters the arthrokinematics of the talar joints (which may be a mechanism for arthritis development), and should be considered in future arthrodesis as well as arthroplasty research.Level of Evidence:Level III, comparative study.
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716655205
      Issue No: Vol. 37, No. 10 (2016)
  • Posterior to Anteriorly Directed Screws for Management of Talar Neck
    • Authors: Beltran, M. J; Mitchell, P. M, Collinge, C. A.
      Pages: 1130 - 1136
      Abstract: Background:Screws placed from posterior to anterior have been shown to be biomechanically and anatomically superior in the fixation of talar neck and neck-body fractures, yet most surgeons continue to place screws from an anterior start point. The safety and efficacy of percutaneously applied posterior screws has not been clinically defined, and functional outcomes after their use is lacking.Methods:After institutional review board approval, we performed a retrospective review of 24 consecutive talar neck fractures treated by a single surgeon that utilized posterior-to-anterior screw fixation. Clinical, radiographic, and functional outcomes were assessed at a minimum follow-up of 12 months. Functional outcomes including the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, Olerud-Molander Scores, and the Short Form 36 (SF-36) measurement were collected and reviewed. Average patient follow-up was 44 months.Results:According to the classification system of Canale and Kelly, there were 4 type I fractures, 15 type II fractures, 4 type III fractures, and 1 type IV fracture. Four patients had open fractures. One superficial wound infection occurred, 1 patient reported FHL stiffness, and 6 complained of numbness or paresthesias in the distribution of the sural nerve (5 transient, 1 permanent). One reoperation was required to exchange a screw impinging on the talonavicular joint. Radiographically, 44% developed a positive Hawkins sign, and the specificity of this finding was 100% for talar dome viability. Avascular necrosis developed in 43% of patients, with 33% revascularizing and none going on to collapse. Subtalar arthrosis developed in 62% of patients.Conclusion:Screws placed from posterior to anterior are a useful technique in the treatment of talar neck fractures. Functional outcomes following their use appear favorable compared with recent reports with minimal risk to local structures.Level of Evidence:Level IV, retrospective case series.
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716655434
      Issue No: Vol. 37, No. 10 (2016)
  • Distal Metatarsal Osteotomy for Moderate to Severe Hallux Valgus
    • Authors: Cassinelli, S. J; Herman, R, Harris, T. G.
      Pages: 1137 - 1145
      Abstract: Hallux valgus is the most common disorder of the hallux and often results in pain, functional disability, and impaired gait patterns. The goals of surgical management are to correct the deformity while improving patients’ pain and function. Traditional treatment of moderate to severe hallux valgus deformities consist of proximal osteotomy and/or arthrodesis given their powerful corrective ability. Despite their corrective power, proximal osteotomies are more technically demanding, have a higher rate of complications, and require a more restricted post-operative recovery. We present an alternative technique for the treatment of moderate to severe hallux valgus. With this operation, a single distal medial incision is utilized to create a chevron osteotomy and lateral release. This procedure can achieve and maintain the desired correction and outcome without the need for a protracted recovery period.Level of Evidence: Level V, expert opinion.
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716667280
      Issue No: Vol. 37, No. 10 (2016)
  • Quo Vadis' Perspectives on the Future of Foot & Ankle Fellowship
    • Authors: Hamid, K. S; Nunley, J. A.
      Pages: 1146 - 1148
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716642245
      Issue No: Vol. 37, No. 10 (2016)
  • Letter Regarding: Early Complications and Secondary Procedures in
           Transfibular Total Ankle Replacement
    • Authors: Martinelli, N; Bianchi, A, Romeo, G, Malerba, F.
      Pages: 1149 - 1149
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716669540
      Issue No: Vol. 37, No. 10 (2016)
  • Response to "Letter Regarding: Early Complications and Secondary
           Procedures in Transfibular Total Ankle Replacement"
    • Authors: Schon; L. C.
      Pages: 1150 - 1150
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716670157
      Issue No: Vol. 37, No. 10 (2016)
  • Letter Regarding: Rotational Dynamics of the Normal Distal Tibiofibular
           Joint With Weight-Bearing Computed Tomography
    • Authors: Chen, D.-w; Hu, W.-k, Yu, B.-q.
      Pages: 1151 - 1151
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716667504
      Issue No: Vol. 37, No. 10 (2016)
  • Response to "Letter Regarding: Rotational Dynamics of the Normal Distal
           Tibiofibular Joint With Weight-Bearing Computed Tomography"
    • Authors: Lepojärvi, S; Niinimäki, J, Pakarinen, H, Leskelä, H.-V.
      Pages: 1152 - 1153
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716670156
      Issue No: Vol. 37, No. 10 (2016)
  • Education Calendar
    • Pages: 1154 - 1154
      PubDate: 2016-09-30T14:47:04-07:00
      DOI: 10.1177/1071100716672863
      Issue No: Vol. 37, No. 10 (2016)
School of Mathematical and Computer Sciences
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