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Journal Cover   Foot & Ankle International
  [SJR: 1.202]   [H-I: 68]   [11 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1071-1007
   Published by Sage Publications Homepage  [819 journals]
  • Prospective Randomized Controlled Trial of Hindfoot and Ankle Fusions
           Treated With rhPDGF-BB in Combination With a {beta}-TCP-Collagen Matrix
    • Authors: Daniels, T. R; Younger, A. S. E, Penner, M. J, Wing, K. J, Le, I. L. D, Russell, I. S, Lalonde, K.-A, Evangelista, P. T, Quiton, J. D, Glazebrook, M, DiGiovanni, C. W.
      Pages: 739 - 748
      Abstract: Background: Ankle and hindfoot arthrodesis is often supplemented with autograft to promote bony union. Autograft harvest can lead to increased perioperative morbidity. Purified recombinant human platelet-derived growth factor BB homodimer (rhPDGF-BB) has stimulated bone formation in mandibular defects and hindfoot fusion. This randomized controlled trial evaluated the efficacy and safety of rhPDGF-BB combined with an injectable, osteoconductive beta-tricalcium phosphate (β-TCP)–collagen matrix versus autograft in ankle and hindfoot fusions. Methods: Seventy-five patients requiring ankle or hindfoot fusion were randomized 5:1 for rhPDGF-BB/β-TCP-collagen (treatment, n = 63) or autograft (control, n = 12). Prospective analysis included 142 autograft control subjects from another clinical trial with identical study protocols. Standardized operative and postoperative protocols were used. Patients underwent standard internal fixation augmented with autograft or 0.3 mg/mL rhPDGF-BB/β-TCP-collagen. Radiologic, clinical, and quality-of-life outcomes were assessed over 52 weeks. Primary outcome was joint fusion (50% or more osseous bridging on computed tomography) at 24 weeks. Secondary outcomes included radiographs, clinical healing status, visual analog scale pain score, American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale score, Foot Function Index score, and Short Form-12 score. Noninferiority P values were calculated. Results: Complete fusion of all involved joints at 24 weeks as indicated by computed tomography was achieved in 53 of 63 (84%) rhPDGF-BB/β-TCP-collagen-treated patients and 100 of 154 (65%) autograft-treated patients (P < .001). Mean time to fusion was 14.3 ± 8.9 weeks for rhPDGF-BB/β-TCP-collagen patients versus 19.7 ± 11.5 weeks for autograft patients (P < .01). Clinical success at 52 weeks was achieved in 57 of 63 (91%) rhPDGF-BB/β-TCP-collagen patients and 120 of 154 (78%) autograft patients (P < .001). Safety-related outcomes were equivalent. Autograft controls had 2 bone graft harvest infections. Conclusions: Application of rhPDGF-BB/β-TCP-collagen was a safe, effective alternative to autograft for ankle and hindfoot fusions, eliminating the pain and morbidity associated with autograft harvesting. Level of Evidence: Level I, prospective randomized study.
      PubDate: 2015-06-29T14:09:14-07:00
      DOI: 10.1177/1071100715576370
      Issue No: Vol. 36, No. 7 (2015)
  • Outcomes of a Stepcut Lengthening Calcaneal Osteotomy for Adult-Acquired
           Flatfoot Deformity
    • Authors: Demetracopoulos, C. A; Nair, P, Malzberg, A, Deland, J. T.
      Pages: 749 - 755
      Abstract: Background: Lateral column lengthening is used to correct abduction deformity at the midfoot and improve talar head coverage in patients with flatfoot deformity. It was our hypothesis that following a stepcut lengthening calcaneal osteotomy (SLCO), patients would have adequate correction of the deformity, a high union rate of the osteotomy, and improvement in clinical outcome scores. Methods: We retrospectively reviewed 37 consecutive patients who underwent SLCO for the treatment of stage IIB flatfoot deformity with a minimum 2-year follow-up. Deformity correction was assessed using preoperative and postoperative weight-bearing radiographs. Healing of the osteotomy was assessed by computed tomography. Clinical outcomes included the FAOS and SF-36 questionnaires. The Wilcoxon signed-rank test was used to compare clinical outcome scores. An alpha level of .05 was deemed statistically significant. Results: Healing of the osteotomy occurred at a mean of 7.7 weeks postoperatively. The talonavicular (TN) coverage angle improved from 34.0 to 8.8 (P < .001), the percentage of TN uncoverage improved from 40.9% to 17.7% (P < .001), and the TN incongruency angle improved from 68.1 to 8.7 (P < .001). In addition, there was an improvement in FAOS pain (P < .001), daily activities (P < .001), sport activities (P = .006), and quality of life scores (P < .001). Overall SF-36 scores also showed improvement postoperatively (P < .001). There was no incidence of delayed union, nonunion, or graft collapse. Conclusion: Following SLCO, patients demonstrated excellent healing, good correction of the deformity, and improvement in clinical outcomes scores. The SLCO is an alternative to the Evans osteotomy for lateral column lengthening. Level of Evidence: Level IV, retrospective case review.
      PubDate: 2015-06-29T14:09:14-07:00
      DOI: 10.1177/1071100715574933
      Issue No: Vol. 36, No. 7 (2015)
  • High Rate of Recurrence Following Proximal Medial Opening Wedge Osteotomy
           for Correction of Moderate Hallux Valgus
    • Authors: Iyer, S; Demetracopoulos, C. A, Sofka, C. M, Ellis, S. J.
      Pages: 756 - 763
      Abstract: Background: The proximal medial opening wedge (PMOW) osteotomy has become more popular to treat moderate to severe hallux valgus with the recent development of specifically designed, low-profile modular plates. Despite the promising results previously reported in the literature, we have noted a high incidence of recurrence in patients treated with a PMOW. The purpose of this study was to report the clinical and radiographic outcomes of an initial cohort of patients treated with a PMOW osteotomy for moderate hallux valgus. Methods: We retrospectively analyzed prospectively gathered data on a cohort of 17 consecutive patients who were treated by the senior author using a PMOW osteotomy for moderate hallux valgus deformity. Average time to follow-up was 2.4 years (range, 1.0-3.5 years). The intermetatarsal angle (IMA), the hallux valgus angle (HVA), and the distal metatarsal articular angle (DMAA) were assessed on standard weightbearing radiographs of the foot preoperatively and at all follow-up visits. The Foot and Ankle Outcome Score (FAOS) was collected on all patients preoperatively and at final follow-up. Results: Despite demonstrating good correction of their deformity initially, 11 of the 17 patients (64.7%) had evidence of recurrence of their hallux valgus deformity at final follow-up. Patients who recurred had a greater preoperative HVA (P = .023) and DMAA (P = .049) than patients who maintained their correction. Improvement in the quality-of-life subscale of the FAOS was noted at final follow-up for all patients (P = .05). There was no significant improvement in any of the other FAOS subscales. Conclusions: There was a high rate of recurrence of the hallux valgus deformity in this cohort of patients. Recurrence was associated with greater preoperative deformity and an increased preoperative DMAA. The PMOW without a concomitant distal metatarsal osteotomy may be best reserved for patients with mild hallux valgus deformity without an increased DMAA. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2015-06-29T14:09:14-07:00
      DOI: 10.1177/1071100715577195
      Issue No: Vol. 36, No. 7 (2015)
  • Effect of Intraoperative Three-Dimensional Imaging During the Reduction
           and Fixation of Displaced Calcaneal Fractures on Articular Congruence and
           Implant Fixation
    • Authors: Eckardt, H; Lind, M.
      Pages: 764 - 773
      Abstract: Background: Operative treatment of displaced calcaneal fractures should restore joint congruence, but conventional fluoroscopy is unable to fully visualize the subtalar joint. We questioned whether intraoperative 3-dimensional (3D) imaging would aid in the reduction of calcaneal fractures, resulting in improved articular congruence and implant positioning. Method: Sixty-two displaced calcaneal fractures were operated on using standard fluoroscopic views. When the surgeon had achieved a satisfactory reduction, an intraoperative 3D scan was conducted, malreductions or implant imperfections were revised, the calcaneus was rescanned, and this sequence was repeated until the optimal operative result was achieved. Results: Five fractures underwent 1 intraoperative scan, 39 fractures underwent 2 scans, 13 fractures underwent 3 scans, and 5 fractures underwent 4 scans. The average number of scans was 2.3. Intraoperative scanning led to re-reduction and improvement of reduction in 13 fractures, change of plate position in 1 patient, optimizing of the screw directions in 5 fractures, and shortening of screws that were intra-articular or protruding medially in 6 fractures. The postoperative articular displacement was 0 mm in 69% of the Sanders type 2 fractures and 57% of the Sanders type 3 fractures. Operation duration averaged 118 minutes, and there were no reoperations due to misplaced screws or plates. The average absorbed radiation dose per patient was 288 mGy·cm. Conclusion: Intraoperative 3D imaging improved the articular reduction of the posterior facet and secured optimal implant position in displaced calcaneal fractures. Radiation dose to the patient was less than that of a normal foot computed tomography scan. Level of Evidence: Level IV, case series.
      PubDate: 2015-06-29T14:09:14-07:00
      DOI: 10.1177/1071100715576518
      Issue No: Vol. 36, No. 7 (2015)
  • A Comparative Study With In Vitro Ultrasonographic and Histologic Grading
           of Metatarsal Head Cartilage in Rheumatoid Arthritis
    • Authors: Onodera, T; Kasahara, Y, Kasemura, T, Suzuki, Y, Kondo, E, Iwasaki, N.
      Pages: 774 - 779
      Abstract: Background: Ultrasonography is among the valid methods to assess articular cartilage in the foot. This study aimed to evaluate the validity of ultrasonographic grading to assess metatarsal head articular cartilage for rheumatoid forefoot deformity in vivo and to compare the findings with in vitro ultrasonographic and histologic gradings. Methods: Participants were 15 patients scheduled to undergo resection arthroplasty of the metatarsal heads of the lesser toes because of rheumatoid arthritis of the metatarsophalangeal joints. Ultrasonographic examination was performed in vivo the day before surgery. Specimens of the second to fifth metatarsal heads taken intraoperatively were graded from in vitro ultrasonographic and histologic evaluations. Correlations among in vivo ultrasonographic, in vitro ultrasonographic, and histologic gradings were analyzed. Results: In 46 metatarsal heads, the distribution of grading ranged from grade 1 to 6 for in vivo ultrasonographic examinations and from grade 1 to 4 for histologic examinations. In vivo ultrasonographic grading showed significant correlation to both in vitro ultrasonographic grading (P < .001, R = 0.74) and histologic grading (P < .001, R = 0.67). Conclusions: The significant correlations between in vivo ultrasonographic and histologic gradings suggest that a semiquantitative in vivo ultrasonographic assessment of forefoot deformity in rheumatoid arthritis may be possible. Ultrasonographic grading may prove useful for pre- and postoperative evaluation of remaining joint function in rheumatoid forefoot deformity. An ultrasonographic grading system for remaining joint surfaces might be helpful in selecting surgical procedures such as joint-sparing osteotomy and metatarsal head resection. Level of Evidence: Level IV, case series.
      PubDate: 2015-06-29T14:09:14-07:00
      DOI: 10.1177/1071100715575021
      Issue No: Vol. 36, No. 7 (2015)
  • Occupational Outcomes and Return to Running Following Internal Fixation of
           Ankle Fractures in a High-Demand Population
    • Authors: Orr, J. D; Kusnezov, N. A, Waterman, B. R, Bader, J. O, Romano, D. M, Belmont, P. J.
      Pages: 780 - 786
      Abstract: Background: Literature evaluating surgical outcomes after ankle fixation in an active patient population is limited. This study determined occupational outcomes and return to running following ankle fracture fixation in a military cohort. Methods: All service members undergoing ankle fracture fixation at a single military hospital from August 2007 to August 2012 were reviewed. Univariate analysis determined the association between patient demographic information, type of fracture fixation, and the development of posttraumatic ankle arthritis and functional outcomes, including medical separation, return to running, and reoperation. Seventy-two primary ankle fracture fixation procedures were performed on patients with mean age of 29.1 years. The majority of patients were male (88%), were 25 years of age or older (61%), were of junior rank (57%), underwent unimalleolar fracture fixation (78%), and did not require syndesmotic fixation (54%). The average follow-up was 35.9 months. Results: The mean time to radiographic union was 8.6 weeks. Twelve service members (17%) were medically separated from the military due to refractory pain following ankle fracture fixation with a minimum of 2-year occupational follow-up. Among military service members undergoing ankle fracture fixation, 64% returned to running. Service members with higher occupational demands had a statistical trend to return to running (odds ratio [OR] 2.49; 95% CI, 0.93-6.68). Junior enlisted rank was a risk factor for medical separation (OR 11.00; 95% CI, 1.34-90.57). Radiographic evidence of posttraumatic ankle osteoarthritis occurred in 8 (11%) service members. Conclusions: At mean 3-year follow-up, 83% of service members undergoing ankle fracture fixation remained on active duty or successfully completed their military service, while nearly two-thirds returned to occupationally required daily running. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2015-06-29T14:09:14-07:00
      DOI: 10.1177/1071100715575497
      Issue No: Vol. 36, No. 7 (2015)
  • Use of Negative Pressure Wound Therapy on Closed Surgical Incision After
           Total Ankle Arthroplasty
    • Authors: Matsumoto, T; Parekh, S. G.
      Pages: 787 - 794
      Abstract: Background: Wound healing problems of the anterior ankle incision are among the most common complications after total ankle arthroplasty, possibly resulting in exposure of the prostheses and infection. The aim of this study was to investigate the role of negative pressure wound therapy (NPWT) in decreasing the rate of wound healing problems after total ankle arthroplasty. Methods: This is a retrospective cohort study including consecutive patients who underwent total ankle arthroplasty by a single surgeon at a single institution between 2009 and 2013. The incisional negative pressure dressing was applied to all patients who underwent total ankle arthroplasty between 2012 and 2013 with a continuous application of –80 mm Hg negative pressure for 6 days postoperatively. The control group consisted of patients who underwent total ankle arthroplasty between 2009 and 2012 with a conventional nonadherent gauze dressing. Seventy-four patients were involved in this study: 37 in the control group and 37 in the incisional NPWT group. Results: All patients tolerated the incisional NPWT to completion without any dressing failures or skin problems. Both groups showed similar distributions in demographics and perioperative risk factors for wound healing. There were 9 (24%) wound healing problems in the control group and 1 (3%) in the incisional NPWT group. Incisional NPWT was found to reduce wound healing problems with an odds ratio of 0.10 (95% CI, 0.01-0.50; P = .004). Conclusions: Our study demonstrated that there was a decreased incidence of wound healing problems following total ankle arthroplasty with incisional NPWT dressings. This is the first study evaluating the efficacy of incisional NPWT as an adjunct treatment for wound healing after total ankle arthroplasty. Level of Evidence: Level III, retrospective comparative study.
      PubDate: 2015-06-29T14:09:15-07:00
      DOI: 10.1177/1071100715574934
      Issue No: Vol. 36, No. 7 (2015)
  • Remodeling of the Proximal Tibia Subsequent to Bone Graft Harvest:
           Postoperative CT Study
    • Authors: Vanryckeghem, V; Vandeputte, G, Heylen, S, Somville, J.
      Pages: 795 - 800
      Abstract: Background: Proximal tibia bone autograft (PTBG) is regularly used in reconstructive foot, ankle, and maxillofacial surgery. Although many surgeons prefer PTBG rather than the conventional iliac crest, little is known about the remodeling capacity of the proximal tibia after harvesting cancellous bone. Methods: Via bilateral postoperative computed tomography of 17 harvesting sites, comparing the defect side with the healthy side, we measured the repair capacity of the proximal tibia in response to bone defect created by the harvest at medium-term follow-up (mean 29 months; range, 7-55 months). Results: 16 of 17 (94%) cortical defects showed complete consolidation. Cancellous remodeling was graded 0 to 3, with 2 defects showing complete remodeling (grade 3), 4 defects partial remodeling (more than 50%), 8 defects partial remodeling (less than 50%) and 3 defects no remodeling at all (grade 0). Conclusion: The proximal tibia has the potential to form new cancellous bone after cancellous bone graft harvesting. More data are required to identify possible variables influencing this remodeling capacity. When performing knee surgery, knee surgeons should take into account the relatively small defect size and the consolidation of the cortical window after proximal tibia bone harvesting. Level of Evidence: Level IV, case series.
      PubDate: 2015-06-29T14:09:15-07:00
      DOI: 10.1177/1071100715573747
      Issue No: Vol. 36, No. 7 (2015)
  • Costs Versus Benefits of Routine Histopathological Examination in Total
           Ankle Replacement
    • Authors: Soukup, D. S; O'Malley, M. J, Ellis, S. J.
      Pages: 801 - 805
      Abstract: Background: Routine histopathological examination has previously been scrutinized as a source of extraneous cost in orthopedic foot and ankle care. As an increasingly prevalent joint replacement operation, total ankle replacement poses a notable cost to the health care market in an era of cost containment. The purpose of this study was to compare the costs and benefits of routine histopathological examination of specimens removed during total ankle replacement. We hypothesized that a new diagnosis would rarely be found and such examination would seldom alter patient care. Methods: A retrospective review was conducted of all total ankle replacement operations between 2006 and July 2014 at the investigators’ institution. Medical records for 90 patients, undergoing a total of 95 total ankle replacement operations, were reviewed to determine the clinical and pathological diagnoses for each operation and, subsequently, the rates of discrepancy and discordance. Professional charges were determined using estimated reimbursement rates for the Current Procedural Terminology (CPT) codes billed: 88304 (level III microscopic examination), 88305 (level IV microscopic examination), and 88311 (decalcification). Results: Degenerative joint disease was diagnosed by the pathologist in 93.7% of cases (89/95), pseudogout in 4.2% (4/95), and rheumatoid arthritis in 2.1% (2/95). The 4 diagnoses of pseudogout were the only cases of new diagnoses based on pathological review. A total of $16 536.81 was spent for examination of all specimens, for an estimated $4 134.20 spent per discrepant diagnosis. Patient care was unaffected by pathological examination. Conclusion: A new diagnosis was rarely found by histopathological examination, and patient care remained unaltered in all cases. The costs of routine histopathological examination of tissue specimens removed during total ankle replacement, therefore, outweigh clinical benefits, and such examination should be left to the discretion of the operating surgeon. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2015-06-29T14:09:15-07:00
      DOI: 10.1177/1071100715576371
      Issue No: Vol. 36, No. 7 (2015)
  • Forklift-Related Crush Injuries of the Foot and Ankle
    • Authors: Hong, C. C; Nashi, N, Kuan, W. S, Teh, J. W. D, Tan, K. J.
      Pages: 806 - 811
      Abstract: Background: Forklift-related crush injuries of the foot and ankle are relatively common in cities with shipping and construction industries. There is a paucity of literature on the incidence and sequelae of such injuries. We aimed to describe the incidence, patterns of injuries, sequelae, and morbidity associated with this type of injury. Methods: A retrospective review of all patients with forklift-related crush injuries of the foot and ankle for 4 years was conducted. Patients’ demographics, mechanisms and patterns of injury, fracture type, compartment syndrome, number of reconstructive operations, operative details, length of hospital stay, medical leave, repeat evaluation in emergency room, and complications were recorded and analyzed. Results: There were 113 (2.17%) patients with forklift-related crush injuries out of 5209 patients seen in our institution for injuries of the foot and ankle. Crush injury from the wheels of the forklift truck was the most common mechanism at 71 (62.8%) patients. The forefoot was the most commonly injured region, followed by the midfoot, hindfoot, and ankle, with almost one-third (28.3%) of the patients having multiple injuries to the foot. Nine (8%) had open fractures, while 5 (4.4%) had compartment syndromes. Forty (35.4%) patients required hospitalization, and 35 (87.5%) of those hospitalized required operative intervention. Those who had surgery were more likely to have complications compared with those who did not require operative intervention (16 [45.7%] of 35 patients vs 7 [9%] of 78 patients; P < .05) and more likely to require longer medical leave (mean, 183 vs 30 days, P < .05). Conclusion: Forklift-related crush injuries of the foot and ankle are increasingly common in industrialized cities. The forefoot is commonly affected with involvement of multiple regions. Up to one-third of affected patients required hospitalization and multiple operative interventions resulting in loss of productivity, income, and significant morbidity. The possibility of residual disabilities must be clearly defined to the patients and their employers to manage potential workplace limitations and long-term expectations. Level of Evidence: Level IV retrospective case series.
      PubDate: 2015-06-29T14:09:15-07:00
      DOI: 10.1177/1071100715576486
      Issue No: Vol. 36, No. 7 (2015)
  • Functional Outcomes of Tibialis Posterior Tendoscopy With Comparison to
           Magnetic Resonance Imaging
    • Authors: Gianakos, A. L; Ross, K. A, Hannon, C. P, Duke, G. L, Prado, M. P, Kennedy, J. G.
      Pages: 812 - 819
      Abstract: Background: The purpose of the current study was to report functional outcomes of tendoscopy for treatment of tibialis posterior tendon pathology as well as compare its diagnostic capability with magnetic resonance imaging (MRI). Methods: Clinical records and MRI of 12 patients who underwent tendoscopy of the tibialis posterior tendon (TPT) were retrospectively reviewed. Mean follow-up was 31 months (range, 26-43 months). Preoperative MRI findings were compared with tendoscopic findings to assess the diagnostic agreement between each modality. Functional outcomes were assessed using the Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) General Health Questionnaire pre- and postoperatively. Mean patient age was 43 years (range, 17-63 years). Mean duration of preoperative symptoms was 15.5 months (range, 3-36 months). Results: Pathologies addressed via tendoscopy included tenosynovitis, tendinosis, stenosis, tendon subluxation, and partial thickness tear (via mini-arthrotomy). Preoperative MRI findings were in agreement with tendoscopic findings in 8 of 12 cases (67%). Tendoscopy diagnosed and allowed access for treating pathology that was missed on MRI in the remaining four cases. The FAOS improved from a mean preoperative score of 58 (range, 36-78) to a mean postoperative score of 81 (range, 44-98) (P < .01). The SF-12 score improved from a mean preoperative score of 34 (range, 13-51) to a mean postoperative score of 51 (range, 21-76) (P = .01). Conclusions: Although MRI is considered an effective imaging technique for tendon pathology, tendoscopy may be a more sensitive diagnostic tool. Tendoscopy was an effective minimally invasive tool to diagnose and treat tibialis posterior tendon pathology resulting in functional improvements in the short-term for early stage TPT dysfunction. Further studies comparing tendoscopy with traditional open approaches are warranted. Level of Evidence: Level IV case series.
      PubDate: 2015-06-29T14:09:15-07:00
      DOI: 10.1177/1071100715576485
      Issue No: Vol. 36, No. 7 (2015)
  • Radiographic Outcomes of Postoperative Taping Following Hallux Valgus
    • Authors: Ponzio, D. Y; Pedowitz, D. I, Verma, K, Maltenfort, M. G, Winters, B. S, Raikin, S. M.
      Pages: 820 - 826
      Abstract: Background: Traditionally, hallux valgus operative correction has been accompanied by serial spica taping of the great toe during the postoperative period. Methods: We retrospectively reviewed 187 adult patients who underwent proximal first metatarsal osteotomy with a modified McBride procedure in 2008-2009 (n = 83) and 2011-2012 (n = 104). Postoperatively, to maintain the corrected position of the hallux, patients from 2008 through 2009 underwent weekly spica taping, while patients from 2011 through 2012 utilized a toe separator. The hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured using anteroposterior weight-bearing preoperative, 2-week postoperative non-weight-bearing, and 3-month weight-bearing final follow-up radiographs. A mixed-effects linear regression model identified differences between the treatment groups over time, and a t test compared actual radiographic differences at final follow-up. Results: The mixed-effects model revealed no significant difference in the HVA over time when comparing patients taped to those not taped at the preoperative (33 ± 6 vs 33 ± 6), 2-week postoperative (10 ± 7 vs 9 ± 6), and 3-month follow-up (14 ± 6 vs 11 ± 7) visits (P = .08). At final follow-up, the HVA was lower for the group that was not taped, but the difference (2.5 degrees) was below the minimal clinically important difference (MCID) (P = .015, 95% CI 0.5-4.5). For IMA, there was improved maintenance of correction over time in the patients that were not taped compared to those taped at the preoperative (15 ± 3 vs 15 ± 3), 2-week postoperative (2 ± 2 vs 3 ± 3), and 3-month follow-up (5 ± 4 vs 7 ± 4) visits (P = .002). At final follow-up, the IMA was lower for the group that was not taped, but the difference (1.7 degrees) was below the MCID (P = .004, 95% CI 0.7-2.9). Conclusions: We report no radiographic benefit of postoperative taping after hallux valgus correction. The present study challenges the previous dogma of postoperative spica taping as the protocol is cost and time intensive for the patient and surgeon. Level of Evidence: Level III, comparative series.
      PubDate: 2015-06-29T14:09:15-07:00
      DOI: 10.1177/1071100715573748
      Issue No: Vol. 36, No. 7 (2015)
  • Ankle Arthroscopy Simulation Improves Basic Skills, Anatomic Recognition,
           and Proficiency During Diagnostic Examination of Residents in Training
    • Authors: Martin, K. D; Patterson, D, Phisitkul, P, Cameron, K. L, Femino, J, Amendola, A.
      Pages: 827 - 835
      Abstract: Background: The purpose of this study was to determine whether low-fidelity arthroscopic simulation training improves basic ankle arthroscopy performance and efficiency among orthopedic trainees. Methods: Twenty-nine orthopedic surgery trainees with varying levels of experience in ankle arthroscopy were randomized into either simulation or standard practice groups. At baseline testing, all participants performed simulator-based testing and a cadaveric diagnostic ankle arthroscopy with video recording. The simulation group subsequently received 4 one-on-one, 15-minute simulation training sessions over a 4-month period, while the standard practice group received no additional simulation training or exposure. After intervention, both groups were reevaluated with simulator testing and a second recorded cadaveric diagnostic ankle arthroscopy. Two blinded, independent experts evaluated each randomized arthroscopic performance using the 15-point checklist, Arthroscopic Surgery Skill Evaluation Tool (ASSET), and total elapsed time, and all outcome measures were compared within and between groups. Results: Baseline arthroscopic experience, simulator task performance measures, and ASSET scores were equivalent between the simulation and standard practice groups. After completion of training, the simulation group outscored the control group in total ASSET score (34.9 vs 19.6; P < .001) and checklist score (14.5 vs 8.4; P < .001) and achieved nearly expert ASSET Safety scores (4.7 vs 2.9; P < .001) on the simulator model. Cadaver testing also demonstrated significant improvements in total ASSET score (28.8 vs 16.8; P < .001), checklist score (12.6 vs 7.1; P < .001), and ASSET Safety score (3.9 vs 2.6; P < .001). Conclusion: These results demonstrate that low-fidelity ankle arthroscopy simulation training can improve basic surgical skills, efficiency of movement, and anatomic recognition. The results suggest greater patient safety during ankle arthroscopy following simulation training. Level of Evidence: Level I, prospective comparative study.
      PubDate: 2015-06-29T14:09:15-07:00
      DOI: 10.1177/1071100715576369
      Issue No: Vol. 36, No. 7 (2015)
  • Biomechanical Analysis of an Arthroscopic Brostrom Ankle Ligament Repair
           and a Suture Anchor-Augmented Repair
    • Authors: Giza, E; Whitlow, S. R, Williams, B. T, Acevedo, J. I, Mangone, P. G, Haytmanek, C. T, Curry, E. E, Turnbull, T. L, LaPrade, R. F, Wijdicks, C. A, Clanton, T. O.
      Pages: 836 - 841
      Abstract: Background: Secondary surgical repair of ankle ligaments is often indicated in cases of chronic lateral ankle instability. Recently, arthroscopic Broström techniques have been described, but biomechanical information is limited. The purpose of the present study was to analyze the biomechanical properties of an arthroscopic Broström repair and augmented repair with a proximally placed suture anchor. It was hypothesized that the arthroscopic Broström repairs would compare favorably to open techniques and that augmentation would increase the mean repair strength at time zero. Methods: Twenty (10 matched pairs) fresh-frozen foot and ankle cadaveric specimens were obtained. After sectioning of the lateral ankle ligaments, an arthroscopic Broström procedure was performed on each ankle using two 3.0-mm suture anchors with #0 braided polyethylene/polyester multifilament sutures. One specimen from each pair was augmented with a 2.9-mm suture anchor placed 3 cm proximal to the inferior tip of the lateral malleolus. Repairs were isolated and positioned in 20 degrees of inversion and 10 degrees of plantarflexion and loaded to failure using a dynamic tensile testing machine. Maximum load (N), stiffness (N/mm), and displacement at maximum load (mm) were recorded. Results: There were no significant differences between standard arthroscopic repairs and the augmented repairs for mean maximum load and stiffness (154.4 ± 60.3 N, 9.8 ± 2.6 N/mm vs 194.2 ± 157.7 N, 10.5 ± 4.7 N/mm, P = .222, P = .685). Conclusions: Repair augmentation did not confer a significantly higher mean strength or stiffness at time zero. Clinical Relevance: Mean strength and stiffness for the arthroscopic Broström repair compared favorably with previous similarly tested open repair and reconstruction methods, validating the clinical feasibility of an arthroscopic repair. However, augmentation with an additional proximal suture anchor did not significantly strengthen the repair.
      PubDate: 2015-06-29T14:09:15-07:00
      DOI: 10.1177/1071100715576539
      Issue No: Vol. 36, No. 7 (2015)
  • Jump Landing Biomechanics During a Laboratory Recorded Recurrent Ankle
    • Authors: Terada, M; Gribble, P. A.
      Pages: 842 - 848
      PubDate: 2015-06-29T14:09:15-07:00
      DOI: 10.1177/1071100715576517
      Issue No: Vol. 36, No. 7 (2015)
  • Double-Row Bridging Suture Fixation Augmented With Double Krackow Suture
           for the Repair of Avulsion of the Ossified Achilles Tendon: A Technical
    • Authors: Yamaguchi, S; Endo, J, Yamamoto, Y, Sasho, T.
      Pages: 849 - 852
      PubDate: 2015-06-29T14:09:15-07:00
      DOI: 10.1177/1071100715575001
      Issue No: Vol. 36, No. 7 (2015)
  • Beaming for Charcot Foot Reconstruction
    • Authors: Jones; C. P.
      Pages: 853 - 859
      Abstract: Charcot arthropathy commonly affects the midfoot and is often an extremely difficult and challenging surgical problem. Operative treatment with medial column arthrodesis using large intramedullary bolts or screws is an evolving and increasingly popular technique called "beaming." The technique is described here. Level of Evidence: Level V, expert opinion.
      PubDate: 2015-06-29T14:09:15-07:00
      DOI: 10.1177/1071100715588637
      Issue No: Vol. 36, No. 7 (2015)
  • Value-Based Health Care
    • Authors: Pinzur; M. S.
      Pages: 860 - 860
      PubDate: 2015-06-29T14:09:15-07:00
      DOI: 10.1177/1071100715575015
      Issue No: Vol. 36, No. 7 (2015)
  • Education Calendar
    • Pages: 861 - 861
      PubDate: 2015-06-29T14:09:15-07:00
      DOI: 10.1177/1071100715594179
      Issue No: Vol. 36, No. 7 (2015)
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