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Journal Cover Foot & Ankle International
   Journal TOC RSS feeds Export to Zotero [11 followers]  Follow    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
     ISSN (Print) 1071-1007
     Published by Sage Publications Homepage  [740 journals]   [SJR: 1.021]   [H-I: 62]
  • Extensor Apparatus of the Lesser Toes: Anatomy With Clinical
           Implications--Topical Review
    • Authors: Dalmau-Pastor, M; Fargues, B, Alcolea, E, Martinez-Franco, N, Ruiz-Escobar, P, Vega, J, Golano, P.
      Pages: 957 - 969
      Abstract: Lesser toe deformities are one of the most common conditions faced by orthopedic surgeons. Knowledge of the anatomy of the lesser toes is important for ensuring correct diagnosis and treatment of deformities, which are caused by factors such as muscle imbalance between the extensor apparatus and flexor tendons. However, this apparatus has not received sufficient attention in the literature. In addition, the large number of inaccurate and erroneous descriptions means that gaining an understanding of these structures is problematic. The objective of the present article is to clarify the anatomy of the extensor apparatus by means of a pictorial essay, in which the structures involved will be grouped and discussed in detail. The most relevant clinical implications will be addressed. Level of Evidence: Level V, expert opinion.
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714546189|hwp:master-id:spfai;1071100714546189
      Issue No: Vol. 35, No. 10 (2014)
       
  • Posterior Facet Cartilage Injury in Operatively Treated Intra-articular
           Calcaneus Fractures
    • Authors: Rothberg, D. L; Yoo, B. J.
      Pages: 970 - 974
      Abstract: Background: Direct visualization of the posterior facet in displaced intra-articular calcaneus fractures (DIACF) frequently shows partial or full thickness cartilage delamination. This is felt to be secondary to the depression of an osteoarticular segment of the posterior facet within the calcaneal body and the subsequent contact with fracture edges as it impacts caudally. The purpose of this study was to determine the frequency of cartilage injury and if it correlates with fracture classification. Methods: A single surgeon prospective, observational series of 28 patients with 28 DIACFs was reviewed for patient demographic and injury data, radiographic fracture characterization, and intraoperative observation of articular injury size, depth, and location over the time period of February 2010 to December 2012. Observations were correlated with the OTA and Sanders classification systems. Results: Age, sex, mechanism of injury, and depth and location of cartilage injury were not significantly different between the 13 OTA/Sanders type 2 and 15 type 3 DIACFs evaluated in this study. Posterior facet articular cartilage delamination was found in 77% of type 2 and 100% of type 3 fractures (P = .09). Location of cartilage injury was common (56%) along the distal, lateral aspect of the posterior facet (P < .05). The percentage area of cartilage injury was significantly larger in type 3 fractures (3.1%) then type 2 (1.3%) (P < .02). Conclusions: DIACFs had a consistent location of posterior facet articular cartilage delamination along the distal lateral aspect of the osteoarticular fragment. This lesion was larger in OTA/Sanders classification type 3 fractures compared to type 2 fractures. Level of Evidence: Level IV, prospective, observational series.
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714540889|hwp:master-id:spfai;1071100714540889
      Issue No: Vol. 35, No. 10 (2014)
       
  • Prognostic Value of Computed Tomography Classification Systems for
           Intra-articular Calcaneus Fractures
    • Authors: Swords, M. P; Alton, T. B, Holt, S, Sangeorzan, B. J, Shank, J. R, Benirschke, S. K.
      Pages: 975 - 980
      Abstract: Background: There are several published computed tomography (CT) classification systems for calcaneus fractures, each validated by a different standard. The goal of this study was to measure which system would best predict clinical outcomes as measured by a widely used and validated musculoskeletal health status questionnaire. Methods: Forty-nine patients with isolated intra-articular joint depression calcaneus fractures more than 2 years after treatment were identified. All had preoperative CT studies and were treated with open reduction and plate fixation using a lateral extensile approach. Four different blinded reviewers classified injuries according to the CT classification systems of Crosby and Fitzgibbons, Eastwood, and Sanders. Functional outcomes evaluated with a Musculoskeletal Functional Assessment (MFA). The mean follow-up was 4.3 years. Results: The mean MFA score was 15.7 (SD = 11.6), which is not significantly different from published values for midfoot injuries, hindfoot injuries, or both, 1 year after injury (mean = 22.1, SD = 18.4). The classification systems of Crosby and Fitzgibbons, Eastwood, and Sanders, the number of fragments of the posterior facet, and payer status were not significantly associated with outcome as determined by the MFA. The Sanders classification trended toward significance. Anterior process comminution and surgeon’s overall impression of severity were significantly associated with functional outcome. Conclusions: The amount of anterior process comminution was an important determinant of functional outcome with increasing anterior process comminution significantly associated with worsened functional outcome (P = .04). In addition, the surgeon’s overall impression of severity of injury was predictive of functional outcome (P = .02), as determined by MFA. Level of Evidence: Level III, comparative series.
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714548196|hwp:master-id:spfai;1071100714548196
      Issue No: Vol. 35, No. 10 (2014)
       
  • Bone Marrow-derived Cells and Biophysical Stimulation for Talar
           Osteochondral Lesions: A Randomized Controlled Study
    • Authors: Cadossi, M; Buda, R. E, Ramponi, L, Sambri, A, Natali, S, Giannini, S.
      Pages: 981 - 987
      Abstract: Background: Osteochondral lesions of the talus (OLT) frequently occur after ankle sprains in young patients participating in sports activities. These injuries may lead to chronic pain, joint swelling, and finally osteoarthritis, therefore, surgical repair is frequently needed. A collagen scaffold seeded with bone marrow–derived cells (BMDCs) harvested from patient’s iliac crest and implanted into the OLT through a single arthroscopic procedure has been recently proposed as an effective treatment option. Nevertheless, BMDCs, embedded in an inflammatory environment, tend to differentiate toward a fibroblast phenotype with a consequential loss of mechanical characteristics. Biophysical stimulation with pulsed electromagnetic fields (PEMFs) has been shown to promote anabolic chondrocyte activity, stimulate proteoglycan synthesis, and reduce the release of the most relevant pro-inflammatory cytokines. The aim of this randomized controlled trial was to evaluate the effects of PEMFs on clinical outcome in patients who underwent BMDCs transplantation for OLT. Methods: Thirty patients affected by grade III and IV Outerbridge OLT underwent BMDCs transplantation. After surgery, patients were randomly assigned to either experimental group (PEMFs 4 hours per day for 60 days starting within 3 days after operation) or control group. Clinical outcome was evaluated with (American Orthopaedic Foot and Ankle Society) AOFAS score, Visual Analog Scale (VAS), and Short Form-36 (SF-36). Results: Significantly higher AOFAS score was recorded in the experimental group both at 6 or 12 months follow-up. At 60 days and 6 and 12 months follow-up, significant lower pain was observed in the experimental group. No significant difference was found in SF-36 between groups. Conclusion: A superior clinical outcome was found in the experimental group with more than 10 points higher AOFAS score at final follow-up. Biophysical stimulation started soon after surgery aided patient recovery leading to pain control and a better clinical outcome with these improvements lasting more than 1 year after surgery. Level of Evidence: Level II, prospective comparative study.
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714539660|hwp:master-id:spfai;1071100714539660
      Issue No: Vol. 35, No. 10 (2014)
       
  • Syndesmotic Fixation in Supination-External Rotation Ankle Fractures: A
           Prospective Randomized Study
    • Authors: Kortekangas, T. H. J; Pakarinen, H. J, Savola, O, Niinimaki, J, Lepojarvi, S, Ohtonen, P, Flinkkila, T, Ristiniemi, J.
      Pages: 988 - 995
      Abstract: Background: This study compared mid-term functional and radiologic results of syndesmotic transfixation with no fixation in supination external rotation (SER) ankle fractures with intraoperatively confirmed syndesmosis disruption. Our hypothesis was that early-stage good functional results would remain and unfixed syndesmosis disruption in SER IV ankle fractures would not lead to an increased incidence of osteoarthritis. Methods: A prospective study of 140 operatively treated patients with Lauge-Hansen SER IV (Weber B) ankle fractures was performed. After bony fixation, the 7.5-Nm standardized external rotation stress test for both ankles was performed under fluoroscopy. A positive stress examination was defined as a difference of more than 2 mm side-to-side in the tibiotalar or tibiofibular clear spaces on mortise radiographs. The patients were randomized to either syndesmotic screw fixation (13 patients) or no syndesmotic fixation (11 patients). After a minimum of 4 years of follow-up (mean, 58 months), ankle function and pain (Olerud-Molander, a 100-mm visual analogue scale [VAS] for ankle function and pain) and quality of life (RAND-36) of all 24 patients were assessed. Ankle joint congruity and osteoarthritis were assessed using mortise and lateral projection plain weight-bearing radiographs and magnetic resonance imaging (MRI; 3T) scans. Results: Improvement in Olerud-Molander score, VAS, and RAND-36 showed no significant difference between groups during the follow-up. In the syndesmotic transfixation group, improvements in all functional parameters and pain measurements were not significant, whereas in the group without syndesmotic fixation, the Olerud-Molander score improved from 84 to 93 (P = .007) and the pain (VAS) score improved from 11 to 4 (P = .038) from 1 year to last follow-up. X-ray or MRI imaging showed no difference between groups at the last follow-up visit. Conclusion: With the numbers available, no significant difference in functional outcome or radiologic findings could be detected between syndesmosis transfixation and no-fixation patients with SER IV ankle fracture after a minimum of 4 years of follow-up. Level of Evidence: Level II, prospective comparative study.
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714540894|hwp:master-id:spfai;1071100714540894
      Issue No: Vol. 35, No. 10 (2014)
       
  • Charcot Arthropathy of the Foot and Ankle in Patients With Idiopathic
           Neuropathy
    • Authors: Bariteau, J. T; Tenenbaum, S, Rabinovich, A, Brodsky, J. W.
      Pages: 996 - 1001
      Abstract: Background: Charcot neuroarthropathy in the developed countries is primarily associated with diabetic neuropathy. This study investigated a series of patients with Charcot arthropathy associated with idiopathic peripheral neuropathy to evaluate the natural history in these patients and to evaluate the efficacy of a treatment protocol used for diabetic Charcot joints. Methods: The records and radiographs of patients with Charcot arthropathy of the foot and ankle treated between 1986 and 2009 were retrospectively reviewed. Patients with known causes of or risk factors for peripheral neuropathy were excluded, identifying 82 feet in 59 patients with idiopathic neuropathy. Twenty-three (39%) were bilateral. The average age was 76 years and the average follow-up was 60 months. Data were analyzed for medical history and diagnoses, medications, anatomic classification of Charcot arthropathy, history of ulcerations, ambulatory status, shoe wear and bracing, and operative interventions. Patient care was based on previous published treatment algorithms, based on conservative management with operative intervention reserved for nonhealing ulcers, infection, and/or nonplantigrade, unbraceable feet. Therapeutic success was a plantigrade foot with healed soft tissue envelope that allowed weight-bearing. Results: In all, 55% involved the midfoot (type 1), 34% the hindfoot (type 2), and 11% the ankle, (type 3A). Seventy-one of 82 feet were successfully treated at the time of last follow-up. Thirty-six feet (43%) were treated nonoperatively with success in 33 (92%). Forty-six of 82 feet required operative intervention, with success at last follow-up in 38 (83%). There were 8 operative failures resulting in 2 transtibial amputations and 6 feet with persistent ulceration. Conclusions: This series of patients with Charcot arthropathy associated with idiopathic neuropathy demonstrated a wider spectrum of Charcot arthropathy of the foot and ankle than has been previously recognized or documented. At the present time, heightened awareness is needed to promote accurate diagnosis and appropriate treatment in nondiabetic patients with Charcot arthropathy. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714543649|hwp:master-id:spfai;1071100714543649
      Issue No: Vol. 35, No. 10 (2014)
       
  • Role of MRI in Detection of Morton's Neuroma
    • Authors: Claassen, L; Bock, K, Ettinger, M, Waizy, H, Stukenborg-Colsman, C, Plaass, C.
      Pages: 1002 - 1005
      Abstract: Background: Distinguishing between patients with a true Morton’s neuroma and other forefoot pathology can be difficult. The aim of this study was to evaluate the diagnostic accuracy of routine magnetic resonance imaging (MRI) when compared to clinical examination for Morton’s neuroma. Methods: We retrospectively identified 71 patients who underwent operative treatment due to the diagnosis of Morton’s neuroma between 2007 and 2013. All patients had a MRI preoperative. Our study group comprised 58 female and 13 male patients with a mean age of 57 (range, 38-92) years. We compared the results of preoperative MRI and the patient’s clinical assessment with postoperative histopathological results. Results: Typical clinical signs were found in 65 cases. Most common symptoms were plantar pain (92%) and increased pain on walking (89%). A Morton’s neuroma was detected on MRI in 59 of 71 cases. Its sensitivity was 0.84 and its specificity was 0.33. The positive and negative predictive values were 0.97 and 0.08, respectively. For the presence of main clinical symptoms we found a sensitivity of 0.94 and a specificity of 0.33. The positive predictive value was 0.97 and the negative predictive value was 0.20. Conclusion: MRI under routine conditions had a good detection rate for the evaluation of Morton’s neuroma. However, its accuracy was not as high as the accuracy of clinical assessment. Level of Evidence: Level IV, retrospective series.
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714540888|hwp:master-id:spfai;1071100714540888
      Issue No: Vol. 35, No. 10 (2014)
       
  • Accessory Talar Facet Impingement in Pathologic Conditions of the
           Peritalar Region in Adults
    • Authors: Niki, H; Hirano, T, Akiyama, Y, Beppu, M.
      Pages: 1006 - 1014
      Abstract: Introduction: Associations between accessory anterolateral talar facet (AALTF) and sinus tarsi pain in adults have not been reported. This study aimed to investigate the clinical and imaging characteristics of pathologic conditions of the peritalar region in adults with painful accessory talar facet impingement (ATFI). Methods: We included 31 patients (aged 19-75 years) with persistent sinus tarsi pain who underwent surgery and had pathologic conditions of the peritalar region, including adult acquired flatfoot deformity (AAFD; 18 patients), ankle osteoarthritis (8 patients), and ankle instability (5 patients). Continuity between the articular surface of the posterior facet of the talus and AALTF was identified on preoperative computed tomography and magnetic resonance imaging (MRI) of the cartilage. In addition, focal abutting bone marrow edema (FABME) of the talus and calcaneal neck around the AALTF on short TI inversion recovery sequence MRI was confirmed. Subtalar arthroscopy was used to evaluate the AALTF surface characteristics. Pre- and postoperative objective scores were compared. Eight pre- and postoperative radiographic parameters were compared to confirm the effect of foot alignment changes after reconstructions on sinus tarsi pain with ATFI. Pre- and postoperative changes in FABME were compared with 17.1 (7-60) months of follow-up. Results: Subjects underwent accessory facet resection with balancing reconstruction. Arthroscopically, 66% of patients showed a focal defect on the AALTF cartilage surface, and 83% showed attenuation of the posterior capsular ligament. All x-ray parameters in AAFD patients showed significant improvement postoperatively (P < .001). Mean objective scores improved from 54.0 preoperatively to 91.0 postoperatively (P < .001). Sinus tarsi pain and FABME were absent in all cases at the final follow-up. Conclusion: AALTF represents a new etiology of subsequent painful intra-articular talocalcaneal impingement. When addressing sinus tarsi pain, it is important to detect the signs of AALTF on MRI of the cartilage and accompanying FABME. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714540891|hwp:master-id:spfai;1071100714540891
      Issue No: Vol. 35, No. 10 (2014)
       
  • Minimally Invasive Reconstruction of the Lateral Ankle Ligaments Using
           Semitendinosus Autograft or Tendon Allograft
    • Authors: Xu, X; Hu, M, Liu, J, Zhu, Y, Wang, B.
      Pages: 1015 - 1021
      Abstract: Background: The purpose of the study was to retrospectively compare the therapeutic effect between semitendinosus autograft and tendon allograft for lateral ankle ligaments reconstruction. Methods: From September 2006 to June 2011, 68 patients (41 males, 27 females) with chronic ankle instability underwent anatomical reconstruction of the lateral ligaments using semitendinosus autograft (autograft group, 32 patients) or tendon allograft (allograft group, 36 patients) via a minimally invasive approach. All patients were followed up for at least 12 months. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale score (AOFAS score) and stress tests were used to evaluate the clinical outcomes. Operation time, time to heal and complications were also recorded. Results: Compared with allograft group, the average operation time was significantly increased (85.5 ± 11.5 minutes vs 58.1 ± 10.2 minutes, P < .0001), but the mean time to heal was significantly shorter (11.2 ± 4.1 months vs 13.5 ± 5.2 months, P = .0458) in the autograft group. Although the mean AOFAS score was significantly increased at the final follow-up in the autograft group (95.1 ± 7.5 vs 62.3 ± 8.2, P = .0001) and allograft group (94.8 ± 5.5 vs 60.2 ± 8.4, P < .0001), no significant difference in AOFAS was found between these 2 groups. Similarly, there was no significant difference in talar tilt or shift between autograft and allograft groups. In addition, no patients complained of weakness or disability at the donor site in the autograft group, while incisional swelling was observed in 4 patients in the allograft group, which was resolved via dressing change, oral use of indomethacin or dexamethasone. Conclusion: Reconstruction of the lateral ankle ligaments using a semitendinosus tendon autograft and a minimally invasive approach was safe and effective for ankle instability with a relatively short time for healing and minimal donor site problems. Level of Evidence: Level III, comparative case series.
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714540145|hwp:master-id:spfai;1071100714540145
      Issue No: Vol. 35, No. 10 (2014)
       
  • Comparison of Lag Screw Versus Buttress Plate Fixation of Posterior
           Malleolar Fractures
    • Authors: Erdem, M. N; Erken, H. Y, Burc, H, Saka, G, Korkmaz, M. F, Aydogan, M.
      Pages: 1022 - 1030
      Abstract: Background: The goal of this study was to report the results of selective open reduction and internal fixation of fractures of the posterior malleolus with a posterolateral approach and to compare the results of the 2 techniques. Methods: We prospectively evaluated 40 patients who underwent posterior malleolar fracture fixation between 2008 and 2012. The patients were treated with a posterolateral approach. We assigned alternating patients to receive plate fixation and the next screw fixation, consecutively, based on the order in which they presented to our institution. Fixation of the posterior malleolus was made with lag screws in 20 patients and a buttress plate in 20 patients. We used American Orthopaedic Foot and Ankle Society (AOFAS) scores, range of motion (ROM) of the ankle, and radiographic evaluations as the main outcome measurements. The mean follow-up was 38.2 (range, 24-51) months. Results: Full union without any loss of reduction was obtained in 38 of the 40 patients. We detected a union with a step-off of 3 mm in 1 patient in the screw group and a step-off of 2 mm in 1 patient in the plate group. At the final follow-up, the mean AOFAS score of the patients regardless of fixation type was 94.1 (range, 85-100). The statistical results showed no significant difference between the patients regardless of the fixation type of the posterior malleolus in terms of AOFAS scores and ROM of the ankle (P > .05). Conclusions: Good (AOFAS score of 94/100) and equivalent (within 3 points) results were obtained using the 2 techniques (screws or plate) for fixation after open reduction of posterior malleolar fragments. Level of Evidence: Level II, prospective case series.
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714540893|hwp:master-id:spfai;1071100714540893
      Issue No: Vol. 35, No. 10 (2014)
       
  • Comparison of the Self-Reported Foot and Ankle Score (SEFAS) and the
           American Orthopedic Foot and Ankle Society Score (AOFAS)
    • Authors: Coster, M. C; Rosengren, B. E, Bremander, A, Brudin, L, Karlsson, M. K.
      Pages: 1031 - 1036
      Abstract: Background: The Self-reported Foot and Ankle Score (SEFAS) is a patient-reported outcome measure, while the American Orthopedic Foot and Ankle Society Score (AOFAS) is a clinician-based score, both used for evaluation of foot and ankle disorders. The purpose of this study was to compare the psychometric properties of these 2 scoring systems. Methods: A total of 95 patients with great toe disorders and 111 patients with ankle or hindfoot disorders completed the 2 scores before and after surgery. We evaluated time to complete the scores in seconds, correlations between scores with Spearman’s correlation coefficient (r s), floor and ceiling effects by proportion of individuals who reached the minimum or maximum values, test–retest reliability and interobserver reliability by intraclass correlation coefficient (ICC), internal consistency by Cronbach’s coefficient alpha (CA), and responsiveness by effect size (ES). Data are provided as correlation coefficients, means, and standard deviations. Results: SEFAS was completed 3 times faster than AOFAS. The scores correlated with an r s of .49 for great toe disorders and .67 for ankle/hindfoot disorders (both P < .001). None of the scores had any floor or ceiling effect. SEFAS test–retest ICC values measured 1 week apart were .89 for great toe and .92 for ankle/hindfoot disorders, while the corresponding ICC values for AOFAS were .57 and .75. AOFAS interobserver reliability ICC values were .70 for great toe and .81 for ankle/hindfoot disorders. SEFAS CA values were .85 for great toe and .86 for ankle/hindfoot disorders, while the corresponding CA values for AOFAS were .15 and .42. SEFAS ES values were 1.15 for great toe and 1.39 for ankle/hindfoot disorders, while the corresponding ES values for AOFAS were 1.05 and 1.73. Conclusion: As SEFAS showed similar or better outcome in our tests and was completed 3 times faster than AOFAS, we recommend SEFAS for evaluation of patients with foot and ankle disorders. Level of Evidence: Level II, prospective comparative study.
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714543647|hwp:master-id:spfai;1071100714543647
      Issue No: Vol. 35, No. 10 (2014)
       
  • The Use of Multimedia as an Adjunct to the Informed Consent Process for
           Morton's Neuroma Resection Surgery
    • Authors: Wang, C; Ammon, P, Beischer, A. D.
      Pages: 1037 - 1044
      Abstract: Background: The purpose of this study was to assess if a computer-based multimedia education module (MEM) improved patients’ comprehension when used as an adjunct to the standard verbal consent process for Morton’s neuroma resection surgery. Methods: Nineteen patients (15 females and 4 males) considered candidates for Morton’s neuroma resection surgery were prospectively recruited. A standardized verbal discussion was had with each patient regarding risks and benefits of surgery, alternative treatments, and the usual postoperative course. Patient understanding was then assessed with a questionnaire. Each patient subsequently viewed the MEM and the questionnaire was repeated. Patients also rated ease of understanding and satisfaction with both methods of patient education. Results: Patients answered a significantly greater proportion of correct answers after viewing the MEM module (85%), compared to verbal discussion alone (61%) (P = .002). Patients rated both the ease of understanding of the module and amount of information provided by the module as a mean of 9.3 cm on a 10 cm Visual Analog Scale (VAS). The majority of patients (76%) rated the multimedia tool as having answered their questions about surgery as well or better than the treating surgeon. Conclusion: An interactive multimedia educational tool was a useful adjunct to the informed consent process for patients considering Morton’s neuroma resection surgery. Levels of Evidence: Level II, prospective cohort study.
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714543644|hwp:master-id:spfai;1071100714543644
      Issue No: Vol. 35, No. 10 (2014)
       
  • Comparative Analysis of Gene Expression in Normal and Degenerative Human
           Tendon Cells: Effects of Cyclic Strain
    • Authors: Choi, W. J; Park, M. S, Park, K. H, Courneya, J.-P, Cho, J. S, Schon, L. C, Lee, J. W.
      Pages: 1045 - 1056
      Abstract: Background: Tendinopathy is a clinical problem for which treatment shows mixed results and treatment options are limited. Gene expression signatures early in the mechanotransduction pathway can accurately predict risk and correlate with different clinical outcomes. Studies aimed at elucidating the molecular mechanisms of tendinopathy have focused on small cohorts of genes that show an incomplete picture of the degeneration process. This study compared the effect of cyclic strain on gene expression in tendon cells from normal tendon and chronically painful areas of tendinopathy in 3 patients. Methods: We measured a panel of mechanotransduction genes and cytoskeletal tensional balance with and without cyclic strain, which disrupts connective tissue synthetic-degradative equilibrium. Normal and degenerative tendons were obtained from patients undergoing surgery to treat chronic painful tendinopathy. A cyclic strain model was established to measure cytoskeletal tensional homeostasis. Results: Prior to cyclic strain, the normal tendon cells exhibited varying patterns of elevated expression of 7 genes compared with degenerative tendon cells. In response to cyclic strain, gene expression of COL1A1, ITGA6, CTNNA1, and CLEC3B was up-regulated in normal tendon cells. Cyclic strain had no effect on degenerative tendon cells. Cyclic strain exacerbated the inhibition of protein synthesis in both cell types, especially in the degenerative tendon cells. Conclusion: Alterations in the pattern of gene expression are suggestive of a dynamic equilibrium between synthesis and degradation, whereby cell adhesion molecules are predominantly up-regulated to facilitate cellular reorientation in response to their altered functional environment. Clinical Relevance: These data might have future applications, including the identification of markers for early diagnosis, targets for drug design, and indicators for treatment responsiveness and prognosis.
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714540885|hwp:master-id:spfai;1071100714540885
      Issue No: Vol. 35, No. 10 (2014)
       
  • Subtalar Joint Configuration on Weightbearing CT Scan
    • Authors: Colin, F; Horn Lang, T, Zwicky, L, Hintermann, B, Knupp, M.
      Pages: 1057 - 1062
      Abstract: Background: Standard values that describe the morphology of the subtalar (ST) joint have previously been obtained from cadaveric studies or by using conventional unloaded radiographs. It is known that these parameters differ significantly from those measured in vivo and in loaded images, limiting the diagnostic value of the previously published morphological parameters in the literature. However, the morphology of the ST joint clearly affects its function. The objective of this study was to determine the morphology of the posterior facet of the ST joint using loaded computed tomography (CT) images and to describe the different configurations found in asymptomatic patients. Methods: A weightbearing CT scan was performed on 59 patients without any history of hindfoot and ankle pathology. The shape of the posterior facet and the subtalar vertical angle (SVA) were measured in 3 different coronal planes of the ST joint. Results: The posterior facet was concave in 88% and flat in 12%. The posterior facet was oriented in valgus in 90% and varus in 10% when measured in the middle coronal plane. However, the SVA changed depending on which coronal plane it was measured in. Conclusion: We believe it is important to get a better insight into the morphological parameters of the ST joint. Clinical Relevance: Knowledge of subtalar joint morphology could help clarify why certain failures have occurred in reconstructive hindfoot surgery and thus might help plan the surgical procedure to reduce these failures in the future.
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714540890|hwp:master-id:spfai;1071100714540890
      Issue No: Vol. 35, No. 10 (2014)
       
  • An Anatomical Study Comparing Two Surgical Approaches for Isolated
           Talonavicular Arthrodesis
    • Authors: Higgs, Z; Jamal, B, Fogg, Q. A, Kumar, C. S.
      Pages: 1063 - 1067
      Abstract: Background: Two operative approaches are commonly used for isolated talonavicular arthrodesis: the medial and the dorsal approach. It is recognized that access to the lateral aspect of the talonavicular joint can be limited when using the medial approach, and it is our experience that using the dorsal approach addresses this issue. We performed an anatomical study using cadaver specimens, to compare the amount of articular surface that can be accessed by each operative approach. Methods: Medial and dorsal approaches to the talonavicular joint were performed on each of 11 cadaveric specimens (10 fresh frozen, 1 embalmed). Distraction of the joint was performed as used intraoperatively and the accessible area of articular surfaces was marked for each of the 2 approaches using a previously reported technique. Disarticulation was performed and the marked surface area was quantified using an immersion digital microscribe, allowing a 3-dimensional virtual model of the articular surfaces to be assessed. Results: The median percentage of total accessible talonavicular articular surface area for the medial and dorsal approaches was 71% and 92%, respectively (Wilcoxon signed-rank test, P < .001). Conclusion: This study provides quantifiable measurements of the articular surface accessible by the medial and dorsal approaches to the talonavicular joint. Clinical Relevance: These data support for the use of the dorsal approach for talonavicular arthrodesis, particularly in cases where access to the lateral half of the joint is necessary.
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714540886|hwp:master-id:spfai;1071100714540886
      Issue No: Vol. 35, No. 10 (2014)
       
  • Difference in Postural Control Between Patients With Functional and
           Mechanical Ankle Instability
    • Authors: Chen, H; Li, H.-Y, Zhang, J, Hua, Y.-H, Chen, S.-Y.
      Pages: 1068 - 1074
      Abstract: Background: Lateral ankle sprain is one of the most common injuries. Since the structural and pathological differences in mechanical ankle instability (MAI) and functional ankle instability (FAI) may not be the same, it may be better to treat these as separate groups. The purpose of this study was to compare the difference in postural sway between MAI and FAI in patients with chronic ankle instability (CAI). Methods: Twenty-six patients with CAI and 14 healthy control participants were included in the study. The CAI patients were subdivided into MAI (15 patients) and FAI (11 patients) groups. Patients who were diagnosed with lateral ankle ligaments rupture by magnetic resonance imaging and ultrasonography were assigned to the MAI group. All participants performed single-limb postural sway tests 3 times on each leg with eyes closed and open. The average distances from the mean center of pressure position in the mediolateral and anteroposterior directions were recorded and compared among the 3 groups. Results: The unstable ankles in the MAI group showed significantly greater postural sway in the anterior, posterior, and medial directions compared with those in the control group with eyes closed. With eyes open, significantly greater postural sway was found in the anterior direction. In the FAI group, no difference was found in postural sway compared with those in the control group. The MAI group showed significantly greater postural sway in the anterior direction compared with the FAI group with eyes closed and open. No significant difference in postural sway was found between the unstable and stable ankles in the MAI or FAI groups, with or without vision. Conclusions: Patients with MAI have deficits in postural control, especially in anterior-posterior directions. However, no difference was found in postural sway in patients with FAI compared with healthy people. Clinical Relevance: As MAI patients suffer from deficits in postural control, balance training should be applied in those patients. In addition, special training should also include the contralateral side after a unilateral ankle ligament injured.
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714539657|hwp:master-id:spfai;1071100714539657
      Issue No: Vol. 35, No. 10 (2014)
       
  • Metatarsophalangeal Arthritis Following Fourth Metatarsal Lengthening
           Treated With Distraction Arthroplasty: Case Report
    • Authors: Haleem, A. M; Mintz, D. N, Rozbruch, S. R.
      Pages: 1075 - 1081
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714543648|hwp:master-id:spfai;1071100714543648
      Issue No: Vol. 35, No. 10 (2014)
       
  • Percutaneous Lateral Ankle Ligament Reconstruction Using a Split Peroneus
           Longus Tendon Free Graft: Technical Tip
    • Authors: Kim, H. N; Dong, Q, Hong, D. Y, Yoon, Y. H, Park, Y. W.
      Pages: 1082 - 1086
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714540892|hwp:master-id:spfai;1071100714540892
      Issue No: Vol. 35, No. 10 (2014)
       
  • Arthroscopic Treatment of Talus Osteochondral Lesions With Particulated
           Juvenile Allograft Cartilage
    • Authors: Giza, E; Delman, C, Coetzee, J. C, Schon, L. C.
      Pages: 1087 - 1094
      Abstract: Osteochondral lesions of the talus (OLT) are commonly associated with traumatic injury to the ankle joint. Treatment options depend on the grade, location, and size of the lesion. Operative intervention is frequently required with initial management involving marrow stimulation techniques, such as microfracture/curettage. Larger lesions often require a secondary procedure, such as osteochondral transplantation or autologous chondrocyte implantation. The advent of particulated juvenile articular cartilage (PJAC) provides an alternative method for OLTs refractory to traditional treatments. This article describes the technique of PJAC transplantation for the treatment of osteochondral lesions of the talus. Level of Evidence: Level V, expert opinion.
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714548704|hwp:master-id:spfai;1071100714548704
      Issue No: Vol. 35, No. 10 (2014)
       
  • Limitations of Percutaneous Osteotomy for Malunited Tongue-Type Calcaneal
           Fractures
    • Authors: Li, B; Yang, Y.-f, Chen, D.-w, Yu, G.-r.
      Pages: 1095 - 1095
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714547220|hwp:resource-id:spfai;35/10/1095
      Issue No: Vol. 35, No. 10 (2014)
       
  • Response to Li et al, "Limitations of Percutaneous Osteotomy for Malunited
           Tongue-Type Calcaneal Fractures"
    • Authors: Heng, M; Kwon, J. Y.
      Pages: 1096 - 1096
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714547345|hwp:resource-id:spfai;35/10/1096
      Issue No: Vol. 35, No. 10 (2014)
       
  • Education Calendar
    • Pages: 1097 - 1097
      PubDate: 2014-10-07T10:58:50-07:00
      DOI: 10.1177/1071100714554206|hwp:resource-id:spfai;35/10/1097
      Issue No: Vol. 35, No. 10 (2014)
       
 
 
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