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Journal Cover   Foot & Ankle International
  [SJR: 1.202]   [H-I: 68]   [12 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1071-1007
   Published by Sage Publications Homepage  [759 journals]
  • Correlation of Postoperative Midfoot Position With Outcome Following
           Reconstruction of the Stage II Adult Acquired Flatfoot Deformity
    • Authors: Conti, M. S; Chan, J. Y, Do, H. T, Ellis, S. J, Deland, J. T.
      Pages: 239 - 247
      Abstract: Background: No studies investigating the effect of the midfoot (talonavicular joint) position on clinical outcomes following flatfoot reconstruction have been performed. The purpose of our study was to determine whether a postoperative abducted or adducted forefoot alignment, as determined from anteroposterior (AP) radiographs, was associated with a difference in outcomes using the Foot and Ankle Outcome Score (FAOS). Methods: Midfoot abduction was defined on postoperative AP radiographs, evaluated at a mean of 1.9 years in 55 patients from the authors’ institution who underwent flatfoot reconstruction for a stage II adult acquired flatfoot deformity (AAFD), as a lateral incongruency angle greater than 5 degrees, a talonavicular uncoverage angle greater than 8 degrees, and a talo–first metatarsal angle greater than 8 degrees based on previously reported measurements. Patients with 2 or more measurements in the abduction category were classified as the abduction group (n = 30); those with 1 or fewer measurements in the abduction category were placed in the adduction group (n = 25). The preoperative and postoperative FAOS values with a mean follow-up of 3.1 years were compared using Wilcoxon rank-sum tests. Results: Patients corrected to a position of adduction showed significantly lower improvement in the FAOS daily activities (P = .012) and quality of life subscales (P = .046). The mean improvement in subscale scores for the adducted group was lower for pain (P = .052) and sports activities (P = .085) but did not reach statistical significance. No significant difference in the FAOS symptoms subscale (P = .372) between groups was found. Conclusion: Correction of the talonavicular joint to a position of adduction following a stage II AAFD was associated with decreased patient outcomes in daily activities and quality of life compared with an abducted position. These results suggest that overcorrection to a position of midfoot adduction leads to a lesser amount of individual patient improvement in reconstruction of a stage II AAFD. Level of Evidence: Level III, comparative series.
      PubDate: 2015-03-02T14:20:51-08:00
      DOI: 10.1177/1071100714564217
      Issue No: Vol. 36, No. 3 (2015)
  • Medial Displacement Calcaneal Osteotomy Using Minimally Invasive Technique
    • Authors: Kheir, E; Borse, V, Sharpe, J, Lavalette, D, Farndon, M.
      Pages: 248 - 252
      Abstract: Background: Medial displacement calcaneal osteotomy is a common procedure often used as part of pes planovalgus deformity correction. Traditionally the osteotomy is performed using a direct lateral or extended lateral approach, which may carry the risk of wound problems, infection and neurovascular injury. The authors describe a minimally invasive technique to perform the osteotomy and achieve the desired correction. The article illustrates our experience and learning curve with the use of this technique as an option for calcaneal osteotomy. Methods: We retrospectively reviewed the records of a sequential series of patients since 2011 whose calcaneal osteotomies were performed by 2 surgeons, after cadaveric training using a minimally invasive operative approach. Prior to 2011, similar surgeries, performed by the senior authors, were undertaken using a direct lateral approach. Thirty cases were identified; 29 had tibialis posterior reconstruction coupled with calcaneal osteotomy for acquired flexible planovalgus deformity and 1 patient had surgery for a malunited calcaneal fracture. Results: Radiological and clinical union occurred in all 30 cases (100%). The radiographs of all cases were reviewed by a specialist musculoskeletal radiologist. There were no neurovascular or wound complications. All patients had restoration of neutral hindfoot alignment. One patient required screw removal after union, resolving all symptoms. Conclusion: This series suggests that minimally invasive calcaneal osteotomy surgery can achieve excellent union rates aiding correction of deformity with no observed neurovascular or soft tissue complications. For surgeons experienced in open surgery, there is a short learning curve after appropriate training. Level of Evidence: Level IV, case series.
      PubDate: 2015-03-02T14:20:51-08:00
      DOI: 10.1177/1071100714557154
      Issue No: Vol. 36, No. 3 (2015)
  • Initial Hospital-Related Cost Comparison of Total Ankle Replacement and
           Ankle Fusion With Hip and Knee Joint Replacement
    • Authors: Younger, A. S. E; MacLean, S, Daniels, T. R, Penner, M. J, Wing, K. J, Dunbar, M, Glazebrook, M.
      Pages: 253 - 257
      Abstract: Background: Total hip and knee arthroplasty (THA and TKA) are accessible to patients with end-stage hip and knee arthritis in most health care systems. The availability of total ankle arthroplasty (TAA) to patients with end-stage ankle arthritis is often restricted because of prosthesis cost. Ankle fusion (AF) is often offered as the only alternative. Patients should have equal access to procedures that are equivalent in total cost. We compared total costs of TAA, AF, THA, and TKA for similar cohorts in a government-funded teaching hospital. Methods: A subset of 13 TAA and 13 AF patients were selected from the Canadian Orthopaedic Foot and Ankle Society Prospective Ankle Reconstruction Database, and 13 THA and 13 TKA patients were randomly selected from the Canadian Joint Replacement Registry. Total cost was estimated from operating room time, hospital stay, surgeon billing, and equipment used. Results: Mean total cost associated with TAA was $13,500 ± 1000 and was the same as THA ($14,500 ± 1500) and TKA ($12,500 ± 1000). Mean total cost associated with AF was significantly less at $5500 ± 500. Mean operating room time was longer, but mean hospital stay was shorter for the ankle procedures compared with THA and TKA. Conclusion: All arthroplasties had similar total costs. Total ankle arthroplasty should not be denied based on prosthetic cost alone, as total procedure cost is equivalent to THA and TKA. We believe ankle fusion is a less expensive and preferable alternative for some patient groups. Level of Evidence: Level II, comparative series.
      PubDate: 2015-03-02T14:20:51-08:00
      DOI: 10.1177/1071100714558844
      Issue No: Vol. 36, No. 3 (2015)
  • Effect of Diabetes Mellitus on Perioperative Complications and Hospital
           Outcomes After Ankle Arthrodesis and Total Ankle Arthroplasty
    • Authors: Schipper, O. N; Jiang, J. J, Chen, L, Koh, J, Toolan, B. C.
      Pages: 258 - 267
      Abstract: Background: The aim of this investigation was to analyze a nationally representative admissions database to evaluate the effect of diabetes mellitus on the rate of perioperative complications and hospitalization outcomes after ankle arthrodesis (AAD) and total ankle arthroplasty (TAA). Methods: Using the Nationwide Inpatient Sample database, 12 122 patients who underwent AAD and 2973 patients who underwent TAA were identified from 2002 to 2011 based on ICD-9 procedure codes. The perioperative complications and hospitalization outcomes were compared between diabetic and nondiabetic patients for each surgery during the index hospital stay. Results: The overall complication rate in the AAD group was 16.4% in diabetic patients and 7.0% in nondiabetic patients (P < .001). Multivariate analysis demonstrated that diabetes mellitus was independently associated with an increased risk of myocardial infarction (relative risk [RR] = 3.2, P = .008), urinary tract infection (RR = 4.6, P < .001), blood transfusion (RR = 3.0, P < .001), irrigation and debridement (RR = 1.9, P = .001), and overall complication rate (RR = 2.7, P < .001). Diabetes was also independently associated with a statistically significant increase in length of hospital stay (difference = 0.35 days, P < .001), more frequent nonhome discharge (RR = 1.69, P < .001), and higher hospitalization charges (difference = $1908, P = .04). The overall complication rate in the TAA group was 7.8% in diabetic patients and 4.7% in nondiabetic patients. Multivariate analysis demonstrated that diabetes was independently associated with increased risk of blood transfusion (RR = 9.8, P = .03) and overall complication rate (RR = 4.1, P = .02). Diabetes was also independently associated with a statistically significant increase in length of stay (difference = 0.41 days, P < .001) and more frequent nonhome discharge (RR = 1.88, P < .001), but there was no significant difference in hospitalization charges (P = .64). Conclusion: After both AAD and TAA, diabetes mellitus was independently associated with a significantly increased risk of perioperative complications, nonhome discharge, and length of hospital stay during the index hospitalization. Level of Evidence: Level III, comparative series.
      PubDate: 2015-03-02T14:20:51-08:00
      DOI: 10.1177/1071100714555569
      Issue No: Vol. 36, No. 3 (2015)
  • Predictors of Peroneal Pathology in Brostrom-Gould Ankle Ligament
           Reconstruction for Lateral Ankle Instability
    • Authors: Burrus, M. T; Werner, B. C, Hadeed, M. M, Walker, J. B, Perumal, V, Park, J. S.
      Pages: 268 - 276
      Abstract: Background: Chronic ankle instability has a well-known association with intra- and extraarticular ankle pathologies, including peroneal tendonitis and subluxation. Patients with peroneal pathology are at risk for failure of conservative treatment for their ankle instability, thus identifying these patients is important and helps to guide management. There has been no literature looking at, in patients with chronic ankle instability, which associated ankle pathologies and patient characteristics are predictive of peroneal pathology. Methods: A retrospective chart review was performed on all patients (N = 136) who underwent a Broström–Gould ankle ligament reconstruction at a single institution from 2010 to 2014. Preoperative clinical examinations and MRIs as well as operative procedures were documented. Patients with and without peroneal pathology were divided into 2 cohorts, and their preoperative characteristics underwent a univariate analysis with P < .05 defined as showing a significant difference. Results: Of patients undergoing lateral ankle ligament reconstruction, 53.3% required operative intervention for symptomatic peroneal tendon pathology. Female gender was the only significant predictor of peroneal pathology (P = .008). The presence of an osteochondral lesion of the talus (OLT) was a significant negative predictor of peroneal pathology (P < .001). The remainder of the variables (age, BMI, duration of symptoms, tobacco, traumatic etiology, worker’s compensation, global hyperlaxity, contralateral ankle instability, sport participation, ankle tilt, and deltoid tear) did not show a significant difference between cohorts. Conclusion: In patients who underwent Broström–Gould ankle ligament reconstruction for chronic lateral ankle instability, female gender was significantly associated with concomitant peroneal tendon pathology. Conversely, preoperative MRI findings of an OLT showed a significant negative association with peroneal pathology. All of the other variables did not show a positive or negative association. Level of Evidence: Level III, retrospective comparative case series.
      PubDate: 2015-03-02T14:20:51-08:00
      DOI: 10.1177/1071100714556759
      Issue No: Vol. 36, No. 3 (2015)
  • Postoperative Pain and Preemptive Local Anesthetic Infiltration in Hallux
           Valgus Surgery
    • Authors: Gądek, A; Liszka, H, Wordliczek, J.
      Pages: 277 - 281
      Abstract: Background: Several techniques of anesthesia are used in foot surgery. Preemptive analgesia helps to prevent the development of hypersensitivity in the perioperative period. The aim of our study was to assess the role of preemptive local anesthetic infiltration and postoperative pain after hallux valgus surgery. Methods: We evaluated 118 patients who underwent modified chevron and miniinvasive Mitchell–Kramer bunionectomy of the first distal metatarsal. After spinal anesthesia each patient randomly received an infiltration of local anesthetic or the same amount of normal saline 10 minutes before the skin incision. We measured the intensity of pain 4, 8, 12, 16, 24, and 72 hours after the release of the tourniquet using a visual analogue scale (VAS). Rescue analgesia and all other side effects were noted. Results: Preemptive analgesia resulted in less pain during the first 24 hours after surgery. The decrease of VAS score was significantly lower in the study group during all the short postoperative periods measured. The rescue analgesia was administered in 11.9% of patients in the injected group and 42.4% in the placebo group (P < .05). In the injected group we did not observe significant difference in VAS score between patients post–chevron and miniinvasive Mitchell–Kramer osteotomy of the first distal metatarsal. No systemic adverse effects were noted. One persistent injury of dorsomedial cutaneous nerve was observed. Conclusion: Preemptive local anesthetic infiltration was an efficient and safe method to reduce postoperative pain after hallux valgus surgery. The analgesic effect was satisfactory in both traditional and minimally invasive techniques. Level of Evidence: Level I, prospective randomized study.
      PubDate: 2015-03-02T14:20:51-08:00
      DOI: 10.1177/1071100714553790
      Issue No: Vol. 36, No. 3 (2015)
  • Salvage of Avascular Necrosis of the Talus by Combined Ankle and Hindfoot
           Arthrodesis Without Structural Bone Graft
    • Authors: Tenenbaum, S; Stockton, K. G, Bariteau, J. T, Brodsky, J. W.
      Pages: 282 - 287
      Abstract: Background: Osteonecrosis of the talus is a well-recognized pathology, which can result in significant hindfoot collapse resulting in poor function and pain. Treatment with intramedullary tibiotalocalcaneal arthrodesis (IMTCA) using a retrograde intramedullary nail is widely utilized for severe concomitant tibiotalar and subtalar pathologies. This study reports the results of ankle and hindfoot arthrodesis in patients with arthritis and deformity caused specifically by talar osteonecrosis. Methods: Fourteen ankle and hindfoot arthrodeses with retrograde intramedullary nail were studied, with a mean follow-up of 26 months. Medical records were reviewed for operative technique, concomitant procedures, bone graft used, and postoperative complications including nonunion, infection, nerve injury, wound healing issues, and the need for additional surgeries. Clinical outcomes included Visual Analogue Scale for pain, the AOFAS Ankle/Hindfoot Score, and the SF-36 questionnaire. Results: Over 80% of cases had osteonecrosis involving the entire body of the talus. In 4 cases tibiocalcaneal arthrodesis was performed, with the remaining talar head-neck portion fused to anterior aspect of tibia. Union was achieved in all cases. The mean preoperative VAS score was 6.9 (range 5 to 9, SD ± 1.5) decreasing to 1.7 (range 0 to 6, SD ± 2.2) postoperatively (P = .00008). The mean preoperative AOFAS score was 32.7 (range 20 to 46, SD ± 8.7), increasing to 72.1 (range 46 to 86, SD ± 10.1, P = .00003). The mean preoperative SF-36 physical component score was 30.5 (range 21 to 42, SD ± 6.9) increasing to 42.8 (range 20 to 60, SD ± 11.4) postoperatively (P = .02). Complications included 1 stress fracture, 4 hardware removals, and 1 superficial infection. Conclusion: Ankle and hindfoot arthrosis due to extensive talar AVN can be successfully treated with IMTCA. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2015-03-02T14:20:51-08:00
      DOI: 10.1177/1071100714558506
      Issue No: Vol. 36, No. 3 (2015)
  • Diagnostic Accuracy of 3.0 Tesla Magnetic Resonance Imaging for the
           Detection of Articular Cartilage Lesions of the Talus
    • Authors: Gatlin, C. C; Matheny, L. M, Ho, C. P, Johnson, N. S, Clanton, T. O.
      Pages: 288 - 292
      Abstract: Background: Talar chondral defects can be a source of persistent ankle pain and disability. If untreated, there is an increased risk of osteoarthritis. The purpose of our study was to determine diagnostic accuracy of 3T MRI in detecting Outerbridge grades 3 and 4 articular cartilage lesions of the talus in a clinical setting, utilizing a standardized clinical MRI protocol. Methods: Patients who had a 3T ankle MRI and subsequent ankle surgery, by a single surgeon, were included in this study. MRI exams were performed 180 days or less before surgery. Seventy-nine ankles in 78 patients (mean age of 42.3 years) were included in this study. Mean body mass index was 26.3. A standard clinical MRI exam was performed on a 3T MRI scanner. Mean days from MRI to surgery was 39 days. All MRI exams were read and findings recorded by a musculoskeletal radiologist. Arthroscopic examination was performed by a single orthopaedic surgeon. Detailed arthroscopic findings and demographic data were collected prospectively and stored in a data registry. Of the 78 patients, 31 (39.2%) reported previous ankle surgery. Pain was the primary reason for seeking medical attention as reported by 95% of patients, followed by instability in 44% and loss of function with 42%. Results: Prevalence of Outerbridge grade 3 and 4 talar articular cartilage defects identified at arthroscopy was 17.7%. The 3T MRI demonstrated a sensitivity of 0.714, specificity of 0.738, positive predictive value of 0.370, and negative predictive value of 0.923. Conclusion: Sensitivity and specificity levels were acceptable for detection of grades 3 and 4 articular cartilage defects of the talar dome using 3T MRI. The high negative predictive value may be beneficial in preoperative planning. While these values are acceptable, a high index of suspicion should be maintained in the appropriate clinical setting. Level of Evidence: Level II, diagnostic study.
      PubDate: 2015-03-02T14:20:51-08:00
      DOI: 10.1177/1071100714553469
      Issue No: Vol. 36, No. 3 (2015)
  • Radiographic Study of the Fifth Metatarsal for Optimal Intramedullary
           Screw Fixation of Jones Fracture
    • Authors: Ochenjele, G; Ho, B, Switaj, P. J, Fuchs, D, Goyal, N, Kadakia, A. R.
      Pages: 293 - 301
      Abstract: Background: Jones fractures occur in the relatively avascular metadiaphyseal junction of the fifth metatarsal (MT), which predisposes these fractures to delayed union and nonunion. Operative treatment with intramedullary (IM) screw fixation is recommended in certain cases. Incorrect screw selection can lead to refractures, nonunion, and cortical blowout fractures. A better understanding of the anatomy of the fifth MT could aid in preoperative planning, guide screw size selection, and minimize complications. Methods: We retrospectively identified foot computed tomographic (CT) scans of 119 patients that met inclusion criteria. Using interactive 3-dimensional (3-D) models, the following measurements were calculated: MT length, "straight segment length" (distance from the base of the MT to the shaft curvature), and canal diameter. Results: The diaphysis had a lateroplantar curvature where the medullary canal began to taper. The average straight segment length was 52 mm, and corresponded to 68% of the overall length of the MT from its proximal end. The medullary canal cross-section was elliptical rather than circular, with widest width in the sagittal plane and narrowest in coronal plane. The average coronal canal diameter at the isthmus was 5.0 mm. A coronal diameter greater than 4.5 mm at the isthmus was present in 81% of males and 74% of females. Conclusion: To our knowledge, this is the first anatomic description of the fifth metatarsal based on 3-D imaging. Excessive screw length could be avoided by keeping screw length less than 68% of the length of the fifth metatarsal. A greater than 4.5 mm diameter screw might be needed to provide adequate fixation for most study patients since the isthmus of the medullary canal for most were greater than 4.5 mm. Clinical Relevance: Our results provide an improved understanding of the fifth metatarsal anatomy to guide screw diameter and length selection to maximize screw fixation and minimize complications.
      PubDate: 2015-03-02T14:20:51-08:00
      DOI: 10.1177/1071100714553467
      Issue No: Vol. 36, No. 3 (2015)
  • Assessment of Coronal Plane Subtalar Joint Alignment in Peritalar
           Subluxation via Weight-Bearing Multiplanar Imaging
    • Authors: Probasco, W; Haleem, A. M, Yu, J, Sangeorzan, B. J, Deland, J. T, Ellis, S. J.
      Pages: 302 - 309
      Abstract: Background: Patients with adult-acquired flatfoot deformity (AAFD) develop peritalar subluxation, which may stem from valgus inclination of the inferior surface of the talus. We hypothesized that patients with AAFD would have an increased valgus tilt of the subtalar joint in the coronal plane compared to controls when assessed with a novel multiplanar weight-bearing imaging (MP-WB). Methods: Eighteen normal and 36 stage II AAFD patients scheduled to undergo operative reconstruction were evaluated by MP-WB through measuring 3 novel angles of the subtalar joint in the coronal view: (1) angle between inferior facet of the talus and the horizontal/floor (inftal-hor), (2) angle between inferior and superior facets of the talus (inftal-suptal), and (3) angle between inferior facet of the talus and superior facet of the calcaneus (inftal-supcal). Intra- and interobserver reliability were evaluated via intraclass correlation coefficients (ICCs). Differences in angles between AAFD patients and controls were evaluated using Wilcoxon rank-sum test. Results: Intra- and interobserver reliability were excellent for inftal-hor (ICC .942 and .991, respectively) and inftal-suptal (ICC .948 and .989, respectively), and moderate-good for inftal-supcal (ICC .604 and .742, respectively). Inftal-hor and inftal-suptal angles were found to be significantly greater in AAFD patients (P < 0.001) at all 3 locations along the posterior subtalar joint, while inftal-supcal did not demonstrate a significant difference (P = .741). While controls exhibited varus orientation at the anterior aspect of the joint, AAFD patients maintained a valgus orientation throughout. Conclusion: Inftal-hor and inftal-suptal angles provided a reliable means of evaluating the orientation of the subtalar joint axis in AAFD via MP-WB, and showed that the subtalar joint had increased valgus orientation in AAFD compared to controls. This may allow for identification of patients at risk for developing AAFD, and could potentially be used in guiding operative reconstruction. Level of Evidence: Level III, comparative series.
      PubDate: 2015-03-02T14:20:51-08:00
      DOI: 10.1177/1071100714557861
      Issue No: Vol. 36, No. 3 (2015)
  • Reliability of a New Radiological Method for Assessment of the
           Postoperative Immobilization of the First Metatarsophalangeal Joint
    • Authors: Moraiti, C; Klouche, S, Stiglitz, Y, Hardy, P, Bauer, T.
      Pages: 310 - 317
      Abstract: Background: The success of the operative treatment of mild to moderate hallux valgus (HV) relies greatly on the osseous union of the osteotomies at the desired position. Full weight-bearing is often allowed immediately postoperatively with special forefoot off-loading shoes. No precise methodology exists for the estimation of foot immobilization inside those shoes. The aim of this study was to assess the reliability of a new radiological measurement method to assess the immobilization of the first metatarsophalangeal (M1P1) joint inside a postoperative forefoot off-loading rocker shoe. Methods: A prospective single-center study was conducted during 2012. Patients operated on for mild or moderate HV deformity with a percutaneous technique by the same surgeon were included. Twenty-four patients (33 feet) fulfilled the inclusion criteria, all women and mean age of 56.6 ± 12.7 years. Standard lateral foot X-rays were obtained 1 week postoperatively with the patient standing in 2 positions, wearing the same forefoot off-loading rocker shoe: the foot flat on the ground (imitating midstance) and on the toes (imitating propulsion). The main evaluation criterion was the immobilization of the M1P1 joint estimated through the difference between the values of the M1P1 angle in the sagittal plane in these positions. Validity and reliability of this new measurement were assessed with Pearson’s correlation coefficients (r) and intraclass correlation (ICC, ) coefficients. Results: The inter- and intraobserver reliability of the measurement was excellent to good. The mean M1P1 angle was 17.5 ± 7 degrees in the position imitating the midstance and 20.7 ± 7.5 degrees in the position imitating propulsion (P < 10–5). Conclusion: This new radiological measurement for assessing immobilization of the M1P1 joint was a valid and reliable method. Level of Evidence: Level II, diagnostic study.
      PubDate: 2015-03-02T14:20:51-08:00
      DOI: 10.1177/1071100714555713
      Issue No: Vol. 36, No. 3 (2015)
  • Salvage of Failed Total Ankle Replacement Using Tantalum Trabecular Metal:
           Case Series
    • Authors: Sagherian, B. H; Claridge, R. J.
      Pages: 318 - 324
      Abstract: Background: Although newer generations of total ankle arthroplasty designs have better clinical outcomes, failure due to aseptic loosening remains a frequent major complication. Arthrodesis is the most common salvage procedure for a failed total ankle replacement. There are several arthrodesis techniques each with its advantages and disadvantages. We present a technique of ankle arthrodesis for failed total ankle replacements using tantalum Trabecular Metal™ (Zimmer, Warsaw, IN) with internal fixation, thus sparing the subtalar joint. Methods: Three patients who had undergone arthrodesis for a failed total ankle replacement using tantalum Trabecular Metal were retrospectively reviewed. The mean follow-up period was 57 (range, 31-86) months. The mean age at ankle arthroplasty was 57 (range, 33-72) years and at ankle arthrodesis was 63 (range, 44-74) years. The mean time from arthroplasty to arthrodesis was 7 (range, 2-11) years. Results: The American Orthopaedic Foot and Ankle Society (AOFAS) score improved from 30.7 (range, 20-39) preoperatively to 72.7 (range, 65-77) postoperatively at the time of last follow-up. Arthrodesis was achieved at a mean of 3 months, and there were no complications. Conclusion: The technique described has several advantages when compared to other methods of salvage ankle arthrodesis. The subtalar joint is not included in the fusion unless it is degenerative and symptomatic. Height of the ankle is maintained throughout the fusion process. Furthermore, Trabecular Metal is abundantly available; it avoids donor site morbidity and eliminates the risk of transmissible diseases. Level of Evidence: Level V, expert opinion.
      PubDate: 2015-03-02T14:20:51-08:00
      DOI: 10.1177/1071100714556760
      Issue No: Vol. 36, No. 3 (2015)
  • Management of Congenital Fourth Brachymetatarsia by Additive Autologous
           Lengthening Osteotomy (AALO): A Case Series
    • Authors: Smolle, E; Scheipl, S, Leithner, A, Radl, R.
      Pages: 325 - 329
      PubDate: 2015-03-02T14:20:51-08:00
      DOI: 10.1177/1071100714557520
      Issue No: Vol. 36, No. 3 (2015)
  • Technical Tip and Cost Analysis for Lesser Toe Plantar Plate Repair With a
           Curved Suture Needle
    • Authors: Clement, R. C; Eskildsen, S. M, Tennant, J. N.
      Pages: 330 - 334
      PubDate: 2015-03-02T14:20:51-08:00
      DOI: 10.1177/1071100714558510
      Issue No: Vol. 36, No. 3 (2015)
  • Exposure via Sequential Release of the Metatarsophalangeal Joint for
           Plantar Plate Repair Through a Dorsal Approach Without an Intraarticular
    • Authors: Jastifer, J. R; Coughlin, M. J.
      Pages: 335 - 338
      Abstract: Background: Traditionally, plantar plate repairs have been performed from either a direct plantar approach or through a dorsal approach utilizing an intraarticular metatarsal osteotomy. It is unknown if a plantar plate repair can be reliably performed through a dorsal approach without an osteotomy. Methods: The second through fourth metatarsal phalangeal (MTP) joints of 4 fresh frozen cadavers were sequentially dissected and the exposure of the plantar plate was quantified with a digital micrometer. A suture passer was then utilized to pass a suture through the released plantar plate without a metatarsal osteotomy. Results: The mean plantar plate exposure after capsulotomy was 1.1 mm, after capsulotomy and release of the collateral ligaments exposure was 2.5 mm, after the addition of a release of plantar structures with a McGlamry elevator exposure was 4.1 mm, and after the addition of a plantar plate takedown the exposure was 5.3 mm. Every specimen had a minimum of 4 mm of exposure. Two sutures were successfully passed through every plantar plate with the exposure obtained. Conclusion: Significant improvement in exposure of the plantar plate was achieved with each successive structure released . Clinical Relevance: Successful plantar plate repair can be reliably performed through a dorsal approach without a metatarsal osteotomy in a cadaveric model.
      PubDate: 2015-03-02T14:20:51-08:00
      DOI: 10.1177/1071100714553791
      Issue No: Vol. 36, No. 3 (2015)
  • Dry Arthroscopy With a Retraction System for Matrix-Aided Cartilage Repair
           of Osteochondral Lesions of the Talus
    • Authors: Sadlik, B; Blasiak, A, Barg, A, Valderrabano, V, Wiewiorski, M.
      Pages: 339 - 343
      PubDate: 2015-03-02T14:20:51-08:00
      DOI: 10.1177/1071100714557521
      Issue No: Vol. 36, No. 3 (2015)
  • Mortality and Morbidity
    • Authors: Pinzur; M. S.
      Pages: 344 - 344
      PubDate: 2015-03-02T14:20:51-08:00
      DOI: 10.1177/1071100714557796
      Issue No: Vol. 36, No. 3 (2015)
  • Education Calendar
    • Pages: 345 - 345
      PubDate: 2015-03-02T14:20:51-08:00
      DOI: 10.1177/1071100715575728
      Issue No: Vol. 36, No. 3 (2015)
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