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Sang-Min Lee, Seong-Il Bin, Jong-Min Kim, Bum-Sik Lee, Chang-Rack Lee, Dong-Wook Son, Jun-Gu Park
BACKGROUND: Meniscal allograft transplantation (MAT) is a widely performed surgical technique used to reconstruct meniscal deficiencies after meniscectomy. However, the long-term effects of extrusion on clinical and radiologic outcomes are unclear. HYPOTHESIS: In long-term follow-up, extrusion after MAT would show poorer outcomes than nonextrusion and would lead to faster progression of arthritic changes. STUDY DESIGN: Cohort study; Level of evidence, 3...
February 14, 2019: American Journal of Sports Medicine
Megan Balsdon, Colin Dombroski, Kristen Bushey, Thomas R Jenkyn
BACKGROUND: Foot orthoses have proven to be effective for conservative management of various pathologies. Pathologies of the lower limb can be caused by abnormal biomechanics such as irregular foot structure and alignment, leading to inadequate support. OBJECTIVES: To compare biomechanical effects of different foot orthoses on the medial longitudinal arch during dynamic gait using skeletal kinematics. STUDY DESIGN: This study follows a prospective, cross-sectional study design...
February 14, 2019: Prosthetics and Orthotics International
Nicola Krähenbühl, Travis L Bailey, Maxwell W Weinberg, Nathan P Davidson, Beat Hintermann, Angela P Presson, Chelsea McCarty Allen, Heath B Henninger, Charles L Saltzman, Alexej Barg
BACKGROUND: The diagnosis of subtle injuries to the distal tibiofibular syndesmosis remains elusive. Conventional radiographs miss a large subset of injuries that present without frank diastasis. This study evaluated the impact of torque application on the assessment of syndesmotic injuries when using weightbearing computed tomography (CT) scans. METHODS: Seven pairs of male cadavers (tibia plateau to toe-tip) were included. CT scans with axial load application (85 kg) and with (10 Nm) or without torque to the tibia (corresponding to external rotation of the foot and ankle) were taken during 4 test conditions...
February 14, 2019: Foot & Ankle International
Susanna Aufwerber, Annette Heijne, Karin Grävare Silbernagel, Paul W Ackermann
BACKGROUND: Mechanical loading is essential for tendon healing and may explain variability in patient outcomes after Achilles tendon rupture (ATR) repair. However, there is no consensus regarding the optimal postoperative regimen, and the actual amount of loading during orthosis immobilization is unknown. PURPOSE: The primary aim of this study was to assess the number of steps and the amount of loading in a weightbearing orthosis during the first 6 weeks after surgical ATR repair...
February 11, 2019: American Journal of Sports Medicine
Chi-Yu Wang, Chien-Ju Wu, Yu-Jen Shih, Tzi-Shiang Chu, Hung-Hui Liu, Chun-Yu Chen, Kuo-Feng Hsu, Shyi-Gen Chen, Yuan-Sheng Tzeng
INTRODUCTION: Ischial pressure ulcers are considered the most difficult type of pressure ulcers (PUs) to treat. OBJECTIVE: The authors report the use of a pedicled anterolateral thigh (pALT) myocutaneous flap as an alternative for covering an ischial PU. MATERIALS AND METHODS: The authors retrospectively collected the data of 21 patients with an indurated recurrent ischial ulcer or a fresh ischial ulcer. A pALT myocutaneous flap was harvested without intramuscular dissection and skeletonization of the perforators for the ischial defect reconstruction...
January 31, 2019: Wounds: a Compendium of Clinical Research and Practice
Helen R Petty, Trishna Rathod-Mistry, Hylton B Menz, Edward Roddy
Background: Gout frequently affects the foot yet relatively little is known about the effects of gout on foot structure, pain and functional ability. This study aimed to describe the impact of gout in a UK primary care population. Methods: A cross-sectional study was nested within an observational cohort study of adults aged ≥50 years with foot pain. Participants with gout were identified through their primary care medical records and each matched on age (±2 years) and gender to four participants without gout...
2019: Journal of Foot and Ankle Research
Erin M Macri, Agnes G d'Entremont, Kay M Crossley, Harvi F Hart, Bruce B Forster, David R Wilson, Charles R Ratzlaff, Charlie H Goldsmith, Karim M Khan
Patellofemoral (PF) osteoarthritis (OA) is a prevalent and clinically important knee OA subgroup. Malalignment may be an important risk factor for PF OA. However, little is known about alignment in PF OA, particularly in an upright, weightbearing environment. Using a vertically-oriented open-bore MR scanner, we evaluated 3D knee alignment in 15 PF OA cases and 15 individually matched asymptomatic controls. We imaged one knee per participant while they stood two-legged at four flexion angles ((0°, 15°, 30°, 45°), and also while they stood one-legged at 30 <remove picture pageno 2° knee flexion...
January 28, 2019: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Akira Taniguchi, Yasuhito Tanaka
Avascular necrosis tends to occur in the talus because of poor blood supply caused by the extended coverage to the articular cartilage on its surface. Treatment is conservative in the earlier stage of this disease; however, surgical treatment is usually indicated in the advanced stage. Nonunion, leg length discrepancy, or hindfoot instability may occur in patients treated with ankle or tibio-talo-calcaneal fusion. Arthroplasty using a customized total talar prosthesis designed using the computed tomography image of contralateral talus has the potential advantages of weightbearing in the earlier postoperative phase, prevention of lower extremity discrepancy, and maintenance of joint function...
March 2019: Foot and Ankle Clinics
Matthew S Conti, Jonathan H Garfinkel, Grace C Kunas, Jonathan T Deland, Scott J Ellis
BACKGROUND: Residual supination of the midfoot during reconstruction of the stage II adult-acquired flatfoot deformity (AAFD) is often addressed with a medial cuneiform (Cotton) osteotomy after adequate correction of the hindfoot valgus deformity. The purpose of this study was to determine if there was a correlation between postoperative alignment of the medial cuneiform and patient-reported outcomes. METHODS: Sixty-three feet in 61 patients with stage II AAFD who underwent a Cotton osteotomy as part of a flatfoot reconstruction were included the study...
January 18, 2019: Foot & Ankle International
Nicola Krahenbuhl, Amy L Lenz, Rich Lisonbee, Manja Deforth, Lukas Zwicky, Beat Hintermann, Charles L Saltzman, Andrew E Anderson, Alexej Barg
Evaluation of the subtalar joint using conventional radiographs is difficult. The purpose of this study was to assess how the posterior facet of the subtalar joint is projected on eight standard radiographic views of the foot and ankle. Weightbearing computed tomography (CT) scans of 27 volunteers without ankle pathology were performed. Eight standard views of the foot and ankle (antero-posterior [AP] view, mortise view, subtalar view, four different Broden views) were reconstructed using digitally reconstructed radiographs (DRRs)...
January 14, 2019: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Sherif Dabash, Emmanuel D Eisenstein, Eric Potter, Nicholas Kusnezov, Ahmed M Thabet, Amr A Abdelgawad
Open reduction internal fixation is the gold standard for unstable ankle fracture fixation; however, complications in patients with multiple medical comorbidities are common. Intramedullary nail fixation of the fibula can help to mitigate these difficulties. A retrospective chart review was performed on all patients who underwent fixation for unstable ankle fracture between January 2015 and March 2016 at our level I trauma center. Comorbidities in the patient sample included were one or several of diabetes, renal disease, hypertension, advanced age with osteoporosis, hemorrhagic blisters, and alcoholism...
January 3, 2019: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Joe Wagener, Christine Schweizer, Tamara Horn Lang, Lukas Zwicky, Dirk Johannes Schaefer, Beat Hintermann
Surgical treatment options in a chondroblastoma of the talus breaching the subchondral layer with imminent risk of talar collapse in the weightbearing area are limited. A joint-preserving surgery should be advocated. Because current treatment options such as curettage, cryosurgery, or radiofrequency ablation may not be able to prevent a talar dome breakdown in large defects, nonvascularized bone grafting has been advocated to fill the void. To overcome the lack of vitality, a vascularized bone autograft might be an attractive alternative...
January 3, 2019: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Andrew Stiene, Charles E Renner, Tian Chen, Jiayong Liu, Nabil A Ebraheim
The goal of the present work was to perform a systematic review of the literature of the past 10 years regarding dynamic and static fixation of the distal tibiofibular syndesmosis to determine any clinical differences between the 2 procedures. A literature search of the PubMed MEDLINE database was conducted to identify relevant studies related to distal tibiofibular syndesmosis. Studies before January 1, 2007, were excluded to limit the project to the recent literature. Clinical outcomes, device removal rates, time to weightbearing after the initial procedure, and the cost effectiveness of each device were explored...
January 3, 2019: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Michael A Howell, Timothy P McConn, Karl R Saltrick, Alan R Catanzariti
Calcific insertional Achilles tendinopathy (CIAT) is a relatively common musculoskeletal entity that results in significant pain and disability, as well as posterior muscle group weakness. There is a lack of evidence criteria to support the timing of operative intervention, choice of procedures, or whether equinus requires treatment. The purpose of this study was to retrospectively review 45 patients (48 feet) who have undergone surgical management of CIAT with concomitant posterior muscle group weakness with the single heel rise testing...
January 3, 2019: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Kenneth J Hunt, Helder Pereira, Judas Kelley, Nicholas Anderson, Richard Fuld, Todd Baldini, Pam Kumparatana, Pieter D'Hooghe
BACKGROUND: Acute inversion ankle sprains are among the most common musculoskeletal injuries. Higher grade sprains, including anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) injury, can be particularly challenging. The precise effect of CFL injury on ankle instability is unclear. HYPOTHESIS: CFL injury will result in decreased stiffness, decreased peak torque, and increased talar and calcaneal motion and will alter ankle contact mechanics when compared with the uninjured ankle and the ATFL-only injured ankle in a cadaveric model...
December 20, 2018: American Journal of Sports Medicine
Julie J Willeumier, Mustafa Kaynak, Peer van der Zwaal, Sven A G Meylaerts, Nina M C Mathijssen, Paul C Jutte, Panagiotis Tsagozis, Rikard Wedin, Michiel A J van de Sande, Marta Fiocco, P D Sander Dijkstra
BACKGROUND: Actual and impending pathologic fractures of the femur are commonly treated with intramedullary nails because they provide immediate stabilization with a minimally invasive procedure and enable direct weightbearing. However, complications and revision surgery are prevalent, and despite common use, there is limited evidence identifying those factors that are associated with complications. QUESTIONS/PURPOSES: Among patients treated with intramedullary nailing for femoral metastases, we asked the following questions: (1) What is the cumulative incidence of local complications? (2) What is the cumulative incidence of implant breakage and what factors are associated with implant breakage? (3) What is the cumulative incidence of revision surgery and what factors are associated with revision surgery? METHODS: Between January 2000 and December 2015, 245 patients in five centers were treated with intramedullary nails for actual and impending pathologic fractures of the femur caused by bone metastases...
September 2018: Clinical Orthopaedics and related Research
Henryk Liszka, Artur Gądek
BACKGROUND: The objective of the study was to assess the influence of the type of fixation of the Akin osteotomy when used during hallux valgus surgery. METHODS: Between 2013 and 2016, we performed 138 Akin osteotomy procedures employing a staple (group A, 43 patients), screw (group B, 47 patients), and single or double transosseous suture stabilization (group C, 48 patients). We assessed the pre- and postoperative interphalangeal angle (IPA), hallux valgus angle (HVA), and intermetatarsal angle (IMA) on dorsoplantar and lateral foot weightbearing x-rays and used the American Orthopaedic Foot & Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale for preoperative and 12-month postoperative follow-up clinical assessment...
December 19, 2018: Foot & Ankle International
Narelle Wyndow, Natalie J Collins, Bill Vicenzino, Kylie Tucker, Kay M Crossley
Study design: Controlled laboratory study; cross-sectional design. Background: Foot and ankle characteristics and dynamic knee valgus differ in people with and without patellofemoral (PF) pain. However, it is unknown if these characteristics are evident in people with PF osteoarthritis (OA), compared to pain-free older adults. Objectives: To compare foot and ankle mobility, foot posture and dynamic knee valgus, measured as the frontal plane projection angle (FPPA) during single-leg squatting, between individuals with and without PFOA...
2018: Journal of Foot and Ankle Research
Scott A Vincent, Paul A Anderson
Instability of the spine is a complex clinical entity that exists on a wide spectrum encompassing many aspects of spinal pathology including traumatic, neoplastic, infectious, and degenerative processes. The importance of determining stability is paramount in the decision-making process regarding the need for operative or nonoperative care. Defining clinical instability can be a challenging and requires careful attention to the pathology involved, findings of necessary imaging, and a thorough clinical exam...
December 2018: Seminars in Ultrasound, CT, and MR
Jessica Zanovello, Barbara Bertani, Redento Mora, Gabriella Tuvo, Mario Mosconi, Luisella Pedrotti
Metatarsal fractures make up the greatest portion of foot fractures in children. Most of them are treated with closed reduction and non-weightbearing cast immobilization.Usually, these fractures heal uneventfully and delay union and pseudoarthrosis are rare. We report a case of a 10-year-old child with non-union of the second metatarsal following a traumatic fracture, caused by an accident 10 months before, and treated successfully by osteosynthesis with plate and screws. Good clinical outcome was achieved at 2 years follow-up...
October 19, 2018: La Pediatria Medica e Chirurgica: Medical and Surgical Pediatrics
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