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Spindler FT, Ettinger S, Arbab D, Baumbach SF. Patient-reported outcome measures in studies on hallux valgus surgery: what should be assessed. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05523-y. [PMID: 39249134 DOI: 10.1007/s00402-024-05523-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 08/26/2024] [Indexed: 09/10/2024]
Abstract
INTRODUCTION In recent years, there has been an increasing demand for patient-reported outcome measures (PROMs) to assess the outcome following orthopedic surgery. But, we are lacking a standard set of PROMs to assess the outcome of hallux valgus surgery. The aim of this study was to analyze the chosen patient rated outcome scores used in studies reporting on hallux valgus surgery. MATERIALS AND METHODS The study was based on a previously published living systematic review. Included were prospective, comparative studies of different surgical procedures or the same procedure for different degrees of deformity. Four common databases were searched for the last decade. Study selection, data extraction, and risk of bias assessment were made by two independent reviewers. Data assessed were the individual PROMs used to assess the outcome of hallux valgus surgery. RESULTS 46 studies (30 RCTs and 16 non-randomized prospective studies) met the inclusion criteria. The most commonly used clinical outcome measures were the AOFAS (55%) and the VAS (30%). No differences were found between frequency of the individual scores per the level of evidence or the type of osteotomy. CONCLUSION Based on a systematic literature review, the AOFAS and VAS are the most frequently used outcome tools in studies assessing the outcome following hallux valgus surgery. Based on the literature available, the MOXFQ is a more valid alternative. LEVEL OF EVIDENCE Level I; systematic review of prospective comparative (level II) and randomized controlled trials (level I).
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Affiliation(s)
- F T Spindler
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany
| | - S Ettinger
- University Hospital for Orthopaedics and Trauma Surgery, Pius-Hospital Oldenburg, Georgstrasse 12, 26121, Oldenburg, Germany
| | - D Arbab
- Department of Orthopedic and Trauma Surgery, St. Elisabeth-Hospital Herten, Member Faculty of Health Witten/Herdecke University, Im Schlosspark 12, 45699, Herten, Germany
| | - S F Baumbach
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Ziemssenstraße 5, 80336, Munich, Germany.
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Mercurio M, Minici R, Spina G, Cofano E, Laganà D, Familiari F, Galasso O, Gasparini G. Clinical and Radiological Outcomes of combined Arthroscopic Microfracture and Mesenchymal Stem Cell Injection Versus Isolated Microfracture for Osteochondral Lesions of the Talus: A Meta-Analysis of Comparative Studies. J Foot Ankle Surg 2024:S1067-2516(24)00210-2. [PMID: 39182822 DOI: 10.1053/j.jfas.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 08/01/2024] [Accepted: 08/17/2024] [Indexed: 08/27/2024]
Abstract
We aimed to systematically evaluate the clinical and radiological outcomes reported in comparative studies evaluating combined arthroscopic microfracture and mesenchymal stem cell (MSC) injection versus isolated microfracture for osteochondral lesions of the talus (OLT). A total of 5 studies were included. Demographics, American Orthopaedic Foot and Ankle Society (AOFAS) score, Tegner activity scale score, Foot and Ankle Outcome Scale (FAOS), visual analogue scale (VAS), and Magnetic Resonance Observation of Cartilage Repair Tissue Score (MOCART) were analyzed. A total of 348 patients were evaluated, 171 of whom underwent combined microfracture and MSC injection and 177 of whom underwent isolated microfracture. The frequency-weighted mean ages were 38.9 ± 13.5 and 36.9 ± 11.4 years and the mean follow-up were 36.7 ± 13.3 and 36.2 ± 16.2 months in the combined microfracture and MSC injection and isolated microfracture groups, respectively. The combined microfracture and MSC injection group showed significantly better postoperative AOFAS score (81.5 ± 7.4 vs 68.2 ± 5.1, p < .001), and MOCART score (74.3 ± 16.3 vs 63.9 ± 15.5, p < .001) with differences beyond the minimum clinically important difference. The combination of arthroscopic microfracture and MSC injection significantly improved functionality and radiological outcomes compared to those of isolated microfracture for OLT.
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Affiliation(s)
- Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100, Catanzaro, Italy; Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy.
| | - Roberto Minici
- Radiology Unit, Department of Experimental and Clinical Medicine, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100 Catanzaro, Italy
| | - Giovanna Spina
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100, Catanzaro, Italy
| | - Erminia Cofano
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100, Catanzaro, Italy
| | - Domenico Laganà
- Radiology Unit, Department of Experimental and Clinical Medicine, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100 Catanzaro, Italy
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100, Catanzaro, Italy; Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100, Catanzaro, Italy; Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Salerno, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Renato Dulbecco" University Hospital, 88100, Catanzaro, Italy; Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy
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Vanlommel J, Beek NV, Van Riet A, Verfaillie S. Lateral plantar fasciopathy: An frequently overlooked cause of atraumatic pain at the fifth metatarsal base. Foot (Edinb) 2024; 60:102125. [PMID: 39190961 DOI: 10.1016/j.foot.2024.102125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/29/2024] [Accepted: 08/11/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Lateral cord plantar fasciitis (LCPF) causes atraumatic pain at the fifth metatarsal base. This study assesses the outcomes of a conservative treatment (PRP + casting) on LCPF. METHODS Medical history, clinical diagnosis, and ultrasound imaging were used to determine LPCF. All patients received a leucocyte-poor PRP injection at the proximal part of the fifth metatarsal base, followed by three weeks in a walking cast. Follow-up questionnaires, encompassing NRS, AOFAS, and Foot Functioning Index (FFI), were administered at 6 weeks, 12 weeks, and 2 years post-treatment. RESULTS Ten patients were enrolled in the study. Ultrasound findings revealed hyposonant and thickened lateral fascia plantaris at the MT 5 insertion point with normal peronei tendons. There was a notable reduction in pain from pre-treatment (NRSrest 55.1 ± 29.6, NRSactivity 79.20 ± 15.5) to 6 weeks post-treatment (NRSrest: 22.4 ± 23.6, p = 0.03; NRSactivity: 38.6 ± 30.3, p = 0.005). FFI indicated an improvement between 12 weeks (25.7 ± 25.7) and 2 years (9.1 ± 8.5) compared to pre-treatment (42.6 ± 16.7). CONCLUSION Ultrasound stands out as the preferred diagnostic method for identifying LCPF. A PRP injection followed by a walking cast proves effective in relieving LCPF symptoms within six weeks with sustained relief up to two years. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jens Vanlommel
- Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium.
| | - Nathalie van Beek
- Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium.
| | - Anne Van Riet
- Department of Orthopaedic Surgery, AZ Herentals, Herentals, Belgium.
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St Mart JP, Goh EL, Hay D, Pilkington I, Bednarczuk N, Ahluwalia R. Contemporary modern total ankle arthroplasty (TAA): A systematic review and meta-analysis of indications, survivorship and complication rates. Surgeon 2024; 22:174-181. [PMID: 38360453 DOI: 10.1016/j.surge.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/28/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND This study evaluates the clinical outcomes of contemporary total ankle arthroplasty (TAAs) to primarily establish the current benefits and risks to facilitate informed decision making to secondarily establish if improvements are seen between subsequent generations of implants, bearing philosophy, and associated surgical technique. METHODS A systematic review and meta-analysis of published data from January 2000 to January 2020 was conducted following PRISMA guidelines. INCLUSION CRITERIA English language papers, adult population, ≥20 ankles with a minimum follow up ≥24 months, pre- and post-operative functional scores available. Ankle implants were characterised by generations, which were determined from the original studies and confirmed based on literature set definitions. RESULTS A total of 4642 TAAs in 4487 patients from 51 studies were included. The mean age was 61.9-years and follow up 57.8-months. Overall, 10-year survivorship rates were 77.63 %, with mobile bearing designs showing a small but significant advantage. Improved survivorship favoured the most modern implants at both two (p < 0.05), and 10-years (p < 0.01). The relative risk of a complication occurring improved with the evolution of implants e.g., nerve injury, and post-operative complications such as fracture, wound complications (e.g., dehiscence or heamatoma) and radiological abnormalities (e.g., radiolucencies, heterotopic bone formation and aseptic loosening). However, surgical site infection, and intra-operative fracture rates remain implant independent. CONCLUSIONS Modern TAA offers improved survivorship, even with a trend to lower mean implantation age, similar complexity and ever changing indications. It would appear that implant evolution has reduced risks, especially those associated with revision, without affecting functional outcomes.
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Affiliation(s)
- Jean-Pierre St Mart
- Department of Trauma and Orthopaedics, King's College Hospital NHS Foundation Trust, London, UK
| | - En Lin Goh
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Daniel Hay
- Department of Trauma and Orthopaedics, King's College Hospital NHS Foundation Trust, London, UK
| | - Isobel Pilkington
- Department of Trauma and Orthopaedics, King's College Hospital NHS Foundation Trust, London, UK
| | - Nadja Bednarczuk
- Department of Trauma and Orthopaedics, King's College Hospital NHS Foundation Trust, London, UK
| | - Raju Ahluwalia
- Department of Trauma and Orthopaedics, King's College Hospital NHS Foundation Trust, London, UK.
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Zhang S, Cai G, Ge Z. The Efficacy of Anterior Cruciate Ligament Reconstruction with Peroneus Longus Tendon and its Impact on Ankle Joint Function. Orthop Surg 2024; 16:1317-1326. [PMID: 38650179 PMCID: PMC11144498 DOI: 10.1111/os.14060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE Peroneus Longus Tendon (PLT), a viable anterior cruciate ligament (ACL) graft, shares similar biomechanics, making it suitable for reconstruction. Controversy exists over whether PLT transplants affects the donor ankle joint. The purpose of this study was to examine the recovery of knee joint function following arthroscopic ACL restoration using autologous PLT and its influence on the donor ankle joint. METHODS A retrospective analysis was conducted on 65 patients with ACL rupture who underwent PLT graft reconstruction in our hospital from January 2016 to December 2021. A three-dimensional gait analysis of the bilateral knee and ankle joints was performed postoperatively using an Opti_Knee three-dimensional motion measurement and analysis system-Yidong Medical Infrared Motion Gait Analyzer. Knee function scores and changes in the range of motion of the bilateral knee and ankle joints were collected. The analysis of preoperative and postoperative joint function scores, bilateral knee and ankle mobility was performed by t-tests. RESULTS One year after surgery, the patients' International Knee Documentation Committee (IKDC) scores, Knee Injury and Osteoarthritis Outcome Scores (KOOSs), and Lysholm scores were significantly improved compared to preoperative scores, with statistically significant differences (p < 0.05). There was no statistical difference in the American Orthopedic Foot and Ankle Society (AOFAS) score of the donor ankle joint before and after surgery (p > 0.05). During different gait cycles, there was no statistical difference in knee joint mobility between the affected and healthy sides (p > 0.05), but there was a statistical difference in the inversion and eversion angle of the donor ankle joint during the support phase (p < 0.05). CONCLUSION ACL reconstruction using the PLT can yield satisfactory knee joint function. However, it does affect inversion and eversion in the donor ankle joint, necessitating postoperative exercises. Similar subjective function ratings for both operated and non-operated feet, despite increased inversion-eversion motion in the operated foot, may be influenced by the subjective nature and margin of error in the AOFAS Ankle-hindfoot score, along with the relatively small variation in ankle inversion-eversion angles.
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Affiliation(s)
- Shichao Zhang
- Department of OrthopaedicsJinshan Hospital of Fudan UniversityShanghaiChina
| | - Guoping Cai
- Department of OrthopaedicsJinshan Hospital of Fudan UniversityShanghaiChina
| | - Zhe Ge
- Department of OrthopaedicsJinshan Hospital of Fudan UniversityShanghaiChina
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Tsai CS, Huang MT, Jou IM, Wu PT, Ko PY. Arthroscopic modified Broström may improve function while anatomic reconstructions could enhance stability for chronic lateral ankle instability: A network meta-analysis. Foot Ankle Surg 2024:S1268-7731(24)00114-0. [PMID: 38811273 DOI: 10.1016/j.fas.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/18/2024] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE The purpose of this systematic review and network meta-analysis was to compare the efficacy of different surgical treatments, including open and arthroscopic modified Broström procedures (MB), anatomical reconstructions, and suture tape augmentations (STA), for chronic lateral ankle instability (CLAI). METHODS We conducted a systematic search for comparative studies that included adult patients with CLAI who underwent open MB, arthroscopic MB, reconstruction with autografts or allografts, and STA. We used a random-effects model to present the NMA results, with mean differences and 95 % confidence intervals (CI) for continuous measures and relative ratios with 95 % CI for dichotomous variables. Surface under the cumulative ranking curve analysis (SUCRA) was used for treatment ranking. RESULTS The results, based on surface under the cumulative ranking curve analysis, showed that arthroscopic MB likely improves functional outcomes the most as measured by change in American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores. Anatomical graft reconstructions with allografts or autografts demonstrated greater reduction in anterior talar translation (ATT) and talar tilt angle (TTA). Arthroscopic MB and STA were associated with fewer complications. CONCLUSIONS Arthroscopic MB may be associated with better functional outcomes, while anatomical reconstructions appear to provide greater improvements in stability for CLAI. Additionally, arthroscopic techniques seem to have lower complication risks compared to open procedures. These potential differences in outcomes and risks between techniques could help guide surgical decision-making.
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Affiliation(s)
- Chun-Sheng Tsai
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | | | - I-Ming Jou
- GEG Orthopedic Clinic, Tainan, Taiwan; Department of Orthopedics, E-Da Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Po-Ting Wu
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedics, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Yen Ko
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Yang HY, Kang JK, Kim JW, Yoon TW, Seon JK. Preoperative Hindfoot Alignment and Outcomes After High Tibial Osteotomy for Varus Knee Osteoarthritis: We Walk on Our Heel, Not Our Ankle. J Bone Joint Surg Am 2024; 106:896-905. [PMID: 38386715 DOI: 10.2106/jbjs.23.00720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
UPDATE This article was updated on May 15, 2024 because of previous errors, which were discovered after the preliminary version of the article was posted online. On page 898, in the section entitled "Materials and Methods," the sentence that had read "The WBL ratio of the knee joint was defined as the point where the GA or MA passed through the width of the tibia and intersected a line from the center of the femoral head to the center of the calcaneus (for the GA) or talus (for the MA), with the medial edge defined as 0% and the lateral edge as 100%." now reads "The WBL ratio of the knee joint was defined as the point where the GA or MA passed through the width of the tibia and intersected a line from the center of the femoral head to the lowest point of the calcaneus (for the GA) or the center of the talus (for the MA), with the medial edge defined as 0% and the lateral edge as 100%." Likewise, in the legend for Figure 3 on page 899, the sentence that had read "Depiction of the ground mechanical axis (GA), defined as the line (represented by the solid red line) from the center of the femoral head to the ground reaction point at the center of the calcaneus, passing lateral to the traditional mechanical axis (MA; represented by the dashed red line)." now reads "Depiction of the ground mechanical axis (GA), defined as the line (represented by the solid red line) from the center of the femoral head to the ground reaction point at the lowest point of the calcaneus, passing lateral to the traditional mechanical axis (MA; represented by the dashed red line)." Finally, on page 903, "HKA" was changed to "HKA angle" in Table III. BACKGROUND The hip-to-calcaneus axis, previously known as the ground mechanical axis (GA), ideally passes through the center of the knee joint in the native knee. The aim of this study was to elucidate, with use of hip-to-calcaneus radiographs, changes in knee and hindfoot alignment and changes in outcomes following high tibial osteotomy (HTO). METHODS We reviewed the records for 128 patients who underwent HTO between 2018 and 2020. Patients were stratified into 2 groups, a hindfoot valgus group (n = 94) and a hindfoot varus group (n = 34), on the basis of their preoperative hindfoot alignment. The hindfoot alignment was evaluated with use of the hindfoot alignment angle (HAA). To evaluate lower-limb alignment, full-length standing posteroanterior hip-to-calcaneus radiographs were utilized to measure 4 radiographic parameters preoperatively and 2 years postoperatively: the hip-knee-ankle (HKA) angle, hip-knee-calcaneus (HKC) angle, and the weight-bearing line (WBL) ratios of the mechanical axis (MA) and GA. RESULTS The mean HAA improved significantly from 5.1° valgus preoperatively to 1.9° valgus postoperatively in the hindfoot valgus group (p < 0.001). In contrast, in the hindfoot varus group, the HAA showed no meaningful improvement in the coronal alignment of the hindfoot following HTO (p = 0.236). The postoperative mean HKC angle in the hindfoot varus group was 2° more varus than that in the hindfoot valgus group (1.0° versus 3.0°; p = 0.001), and the GA in the hindfoot varus group passed across the knee 8.0% more medially than that in the hindfoot valgus group (55% versus 63% from the most medial to the most lateral part of the tibial plateau). The hindfoot varus group had worse postoperative clinical outcomes than the hindfoot valgus group in terms of the mean Knee injury and Osteoarthritis Outcome Score for pain and American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score. CONCLUSIONS Although our findings did not provide sufficient evidence to establish clinically relevant differences between the groups, they indicated that the group with a preoperative fixed hindfoot varus deformity had a higher rate of undercorrection and worse clinical outcomes, especially pain, following HTO. Therefore, modification of the procedure to shift the GA more laterally may be required for these patients. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hong Yeol Yang
- Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, College of Medicine, Chonnam National University, Seoyang, Republic of Korea
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Hermus JPS, Stam P, van Kuijk SMJ, Witlox MA, van Rhijn LW, Arts JJC, Poeze M. Does anxiety influence outcome measurements in ankle replacement patients? Foot Ankle Surg 2024; 30:231-238. [PMID: 37996295 DOI: 10.1016/j.fas.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) is increasingly used to treat end-stage ankle arthritis to restore ankle functional outcomes and alleviate pain. This treatment outcome may be influenced by pre-morbid patient anxiety. METHODS Twenty-five Infinity TAA implants were prospectively followed post-operatively with a mean follow-up time of 34.18 months. Demographic, clinical, and functional outcomes were assessed. Analysis was performed on the effect of anxiety, reported by the HADS, on patient-perceived postoperative pain, functioning, and quality of life. RESULTS Postoperative the PROMs and Range of Motion (ROM) improved significantly. Linear regression analysis and Pearson correlation showed a significant negative effect of anxiety on the postoperative patient-reported outcome measurements (EQ-5D-5L, VAS, and MOxFQ) at the end of follow-up. CONCLUSION Good functional, clinical, and radiographic results were observed in this prospective cohort study. Anxiety had a negative influence on the outcome of the patient-reported outcome measurements (EQ-5D-5L and MOxFQ) postoperatively. LEVEL OF EVIDENCE Level III, prospective cohort study.
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Affiliation(s)
- J P S Hermus
- Department of Orthopaedic Surgery, Research school CAPHRI, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - P Stam
- Department of Orthopaedic Surgery, Research school CAPHRI, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - M A Witlox
- Department of Orthopaedic Surgery, Research school CAPHRI, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - L W van Rhijn
- Department of Orthopaedic Surgery, Research school CAPHRI, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - J J C Arts
- Department of Orthopaedic Surgery, Research school CAPHRI, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - M Poeze
- Department of Traumasurgery, Maastricht University Medical Center+, Maastricht, the Netherlands
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Rikken QG, Dahmen J, Gianakos AL, Bejarano-Pineda L, Waryasz G, DiGiovanni CW, Stufkens SA, Kerkhoffs GM. Talonavicular Osteochondral Lesions: Surgical Technique and Clinical Outcomes from the Boston and Amsterdam Perspectives. Cartilage 2024; 15:26-36. [PMID: 37750492 PMCID: PMC10985397 DOI: 10.1177/19476035231200334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE The primary purpose of the present study was to assess the patient-reported outcomes, complications, and reoperation rate of patient who underwent surgical treatment for symptomatic osteochondral lesions of the talonavicular joint (TNJ). METHODS Patients undergoing surgical treatment for symptomatic osteochondral lesions of the TNJ with a minimum of 12-month follow-up were included. Outcomes included clinical patient-reported outcome measures (PROMs), return to sports and work outcomes, and postoperative complications or reoperations. Medical records were screened by 2 independent reviewers. Patients were contacted by phone and underwent an in-depth interview. Additionally, operative techniques for both arthroscopic and open surgical approaches for treating TNJ osteochondral lesions were described. DESIGN Retrospective Case Series (Level IV) and Surgical Technique. RESULTS A total of 7 patients were included with a final follow-up time of 25.4 (SD: 15.2) months follow-up. PROMs were considered satisfactory for 5 out of 7 patients, 6 out of 7 patients returned to any level of sports at a mean of 3.7 (SD: 4.2) months, and 5 out of 6 patients returned to preinjury level of sports at a mean of 14 (SD: 7.5) months. All patients returned to work at an average of 5.4 (SD: 3.6) weeks. No complications or reoperations after index surgery were reported. CONCLUSION Surgical treatment of TNJ osteochondral lesions is a feasible procedure that may offer successful clinical, sport, and work outcomes in the majority of patients. Both open and arthroscopic surgical treatments are available and can be considered in a patient-specific treatment plan.
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Affiliation(s)
- Quinten G.H. Rikken
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Arianna L. Gianakos
- Foot & Ankle Research and Innovation Lab, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lorena Bejarano-Pineda
- Foot & Ankle Research and Innovation Lab, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory Waryasz
- Foot & Ankle Research and Innovation Lab, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher W. DiGiovanni
- Foot & Ankle Research and Innovation Lab, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sjoerd A.S. Stufkens
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
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Eskew J, Reynolds Z, Jenkins J, Sridhar M. Primary total talus arthroplasty for Hawkins type IV talar neck fracture dislocation. BMJ Case Rep 2024; 17:e259005. [PMID: 38423577 PMCID: PMC10910409 DOI: 10.1136/bcr-2023-259005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
A woman in her 40s was involved in a motor vehicle collision and sustained a closed Hawkins type IV talar neck fracture dislocation. The injury was treated with reduction, percutaneous pinning and spanning external fixation, followed by definitive treatment with total talus arthroplasty (TTA) 2 months following injury. This is a unique example of definitive management for a severe talar neck fracture dislocation with arthroplasty in the subacute setting. TTA is perhaps a primary option for these injuries at high risk for avascular necrosis, non-union, malunion and post-traumatic arthritis.
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Affiliation(s)
- Joshua Eskew
- Orthopedic Surgery, Prisma Health Upstate, Greenville, South Carolina, USA
| | - Zachary Reynolds
- Orthopedic Surgery, Prisma Health Upstate, Greenville, South Carolina, USA
| | - Joshua Jenkins
- University of South Carolina School of Medicine Greenville Campus, Greenville, South Carolina, USA
| | - Michael Sridhar
- Orthopedic Surgery, Prisma Health Upstate, Greenville, South Carolina, USA
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Balesar VV, Bruin LL, van Liebergen M, Deenik AR, Keizer SB. MICA Procedure vs Open Chevron Osteotomy for Hallux Valgus Correction: A Prospective Cohort Study. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114231224725. [PMID: 38288288 PMCID: PMC10823862 DOI: 10.1177/24730114231224725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
Background Currently, more than 150 surgical techniques have been described for the treatment of hallux valgus. The abundance of techniques indicates that there is no technique that has been designated as a gold standard. In recent years, a particular interest in the use of minimally invasive techniques has grown. The aim of this study was to prospectively compare clinical, radiologic, and postoperative outcomes between the MICA technique and open chevron technique over a 1-year follow-up period. Methods Between January 2016 and August 2020, data were prospectively collected from consecutive patients preoperatively and at 6 weeks, 3 months, and 12 months following minimally invasive chevron and Akin (MICA) or open chevron osteotomies. Radiographic outcomes were measured using weightbearing radiographs preoperatively and at 3 and 12 months postoperatively. Clinical outcomes were measured using the American Orthopaedic Foot & Ankle Society (AOFAS), Manchester-Oxford Foot Questionnaire (MOXFQ), VAS (visual analog scale), Foot Function Index (FFI), Foot and Ankle Outcome Score (FAOS), and Euro-QoL-5D (EQ5D) questionnaires. Results Of the 68 patients, 42 patients (62%) underwent a MICA surgery and 26 patients (38%) underwent open chevron osteotomy. Both groups showed significant improvement in HVA, IMA, and DMAA at the 1-year follow-up. Our findings show that both clinical and radiologic outcomes of the MICA technique are comparable to the conventional open technique. No significant differences were found in clinical outcomes (VAS, AOFAS, MOXFQ, FFI, and FAOS), complication rate, and operative times. Conclusion These results show that MICA is a safe alternative for chevron osteotomy. The clinical and radiologic outcomes of these 2 techniques by 12 months are comparable. Level of Evidence Level II, prospective cohort study.
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Affiliation(s)
- Vinay V. Balesar
- Department of Orthopaedic Surgery, Medisch Centrum Haaglanden, the Hague, the Netherlands
| | - Luca L. Bruin
- Department of Orthopaedic Surgery, Medisch Centrum Haaglanden, the Hague, the Netherlands
| | - Margo van Liebergen
- Department of Radiology, Medisch Centrum Haaglanden, the Hague, the Netherlands
| | - Axel R. Deenik
- Department of Orthopaedic Surgery, Medisch Centrum Haaglanden, the Hague, the Netherlands
| | - Stefan B. Keizer
- Department of Orthopaedic Surgery, Medisch Centrum Haaglanden, the Hague, the Netherlands
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12
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Ziroglu N, Birinci T, Koluman A, Şahbaz Y, Çiftçi MU, Baca E, Duramaz A. Reliability and Validity of the Turkish Version of the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joint Scale. Foot Ankle Spec 2023:19386400231214285. [PMID: 38018560 DOI: 10.1177/19386400231214285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND The American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP) scale is one of the most widely used outcome measures to evaluate hallux pathologies. This study aimed to translate the AOFAS Hallux MTP-IP scale into Turkish and investigate its psychometric properties. METHODS The psychometric properties of the Turkish version of the AOFAS Hallux MTP-IP (AOFAS Hallux MTP-IP-T) scale were tested in 66 patients with hallux pathologies (52 women; mean age, 47.64 ± 12.75 years). Cronbach's alpha was used to assess internal consistency. The intraclass correlation coefficient (ICC) was used to estimate test-retest. Construct validity was analyzed with the Turkish version of the Manchester-Oxford Foot Questionnaire (MOXFQ), Visual Analogue Scale (VAS), and 12-item Short-Form Health Survey(SF-12). RESULTS The AOFAS Hallux MTP-IP-T scale had adequate internal consistency (α = 0.71) and test-retest reliability (ICC2,1 = 0.93 for pain, ICC2,1 = 0.97 for function, and ICC2,1 = 0.97 for total score). The AOFAS Hallux MTP-IP-T total score has a moderate to strong correlation with VAS-activity and MOXFQ (ρ = -0.77, P = .001; ρ = -0.69, P = .001, respectively). The weakest correlation was found between the AOFAS Hallux MTP-IP-T and the SF-12 mental component scale (ρ = 0.31, P = .01). CONCLUSION AOFAS Hallux MTP-IP-T has sufficient reliability and validity to evaluate Turkish-speaking individuals with a variety of forefoot pathologies including the hallux. LEVELS OF EVIDENCE Level II.
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Affiliation(s)
- Nezih Ziroglu
- Department of Orthopedics and Traumatology, Atakent Hospital, Acibadem University, Istanbul, Turkey
| | - Tansu Birinci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey
| | - Alican Koluman
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Yasemin Şahbaz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Beykent University, Istanbul, Turkey
| | - Mehmet Utku Çiftçi
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Emre Baca
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Altuğ Duramaz
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
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13
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Jiang G, Li J, Zhang X, Shu S, Ma Y, Zhang P, Wang G, Liao H, Hu J. Limb Reconstruction System Assisted Reduction and Internal Fixation for Intra-Articular Calcaneal Fractures: A New Application. Orthop Surg 2023; 15:2540-2548. [PMID: 37526145 PMCID: PMC10549802 DOI: 10.1111/os.13828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Minimally invasive reduction and fixation of intra-articular calcaneal fractures poses great challenges for orthopaedic surgeons. The aim of the present study was to report the technical points, evaluate the efficacy of minimally invasive reduction and internal fixation assisted by the temporary limb reconstruction system (LRS) external fixator for intra-articular calcaneal fractures, and propose the indications of our protocol. METHODS In this retrospective study, a series of 34 consecutive closed and displaced intra-articular calcaneal fractures involving the articular surface were treated by this technology between June 2016 and April 2018. X-ray and computed tomography (CT) scans were performed before and after surgery to measure Bohler's angle; the length, height, and width of the calcaneus; and the mechanical axis of the hindfoot. Postoperative complications were recorded. Imaging and clinical outcomes were comprehensively evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle scoring system. After testing the normality of the data, Bohler's angle and the length of calcaneus were compared using the Wilcoxon signed-rank test. The height, width of the calcaneus, and the mechanical axis of the hindfoot were compared using the Paired-Samples t-test. RESULTS Thirty-two fractures were followed up for an average of 20.66 months (from 12 to 32 months). All fractures achieved stable reduction and bony union. The articular surface was reduced and fixed with direct vision through the sinus tarsi incision. No failure of internal fixation or loss of reduction was detected during follow-up. There were no soft tissue complications. Bohler's angle; the length, height, and width of the calcaneus; and the mechanical axis of the hindfoot improved significantly. The AOFAS scores averaged 84.12 points; seven cases were rated excellent, 20 good, four fair, and one poor. CONCLUSIONS For intra-articular calcaneal fractures, minimally invasive surgery assisted with temporary LRS external fixation can reconstruct the calcaneal shape and the sub-talar articular surface. This simple surgical modality with limited complications may be helpful in the surgical treatment of most type II and III calcaneal fractures except comminuted fractures of the calcaneal tuberosity.
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Affiliation(s)
- Guiyong Jiang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Jie Li
- Department of OrthopaedicsSouthern Medical University Zengcheng Branch of Nanfang HospitalGuangzhouPeople's Republic of China
| | - Xiaolong Zhang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Shan Shu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Yunfei Ma
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Ping Zhang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Gang Wang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
| | - Hua Liao
- Department of Human Anatomy, School of Basic Medical SciencesSouthern Medical UniversityGuangzhouChina
| | - Jijie Hu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
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14
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Artioli E, Mazzotti A, Langone L, Zielli SO, Arceri A, Bonelli S, Faldini C. First Metatarsal Hemiepiphysiodesis for the Treatment of Juvenile Hallux Valgus: A Systematic Review. J Pediatr Orthop 2023; 43:584-589. [PMID: 37526093 DOI: 10.1097/bpo.0000000000002485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Juvenile hallux valgus (JHV) is a pediatric deformity characterized by the varus deviation of the first metatarsal and valgus deviation of the proximal phalanx. Among the several surgical techniques available, hemiepiphysiodesis consists of the unilateral growth arrest of the first metatarsal physis. Despite this technique has been proposed over 70 years ago, only a few studies including clinical and radiological outcomes have been published, making the procedure unclear in terms of results. This systematic review aimed to evaluate the outcomes of hemiepiphysiodesis of the first metatarsal in the treatment of JHV. METHODS Google Scholar, Embase, PubMed, and Cochrane databases were searched for all the articles reporting on clinical and radiological results of hemiepiphysiodesis of the first metatarsal in the treatment of JHV. The selected articles were reviewed to extract demographic data, surgical techniques, complications, clinical outcomes, and radiological parameters. RESULTS Six articles were included in the qualitative analysis. A total of 85 patients with 144 halluces valgus were treated through hemiepiphysiodesis of the first metatarsal. The mean age at surgery was 10.7 years (range 5 to 15). The mean follow-up was 2.7 years (range 1 to 7.5). Hemiepiphysiodesis was performed through 2 different techniques. Eighteen (12.5%) complications occurred. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score increased from 70.6 (range 49 to 93) preoperatively to 89.4 (range 72 to 100) postoperatively. The mean HVA improved from 28.3 (range 14 to 46) to 24.03 degrees (range 0 to 54), and the mean IMA improved from 13 (range 8 to 33) to 10.9 degrees (range 8 to 33). CONCLUSIONS This review showed that hemiepiphysiodesis of the first metatarsal is a safe treatment for JHV. Improvement in both clinical and radiological results has been observed in all the studies, sometimes being statistically significant. Despite the improvement, mean postoperative radiological angles remained altered and consistent with mild-moderate hallux valgus. This suggests that hemiepiphysiodesis plays a bigger role in preventing the worsening of the deformity rather than correcting it. Randomized controlled trials with longer follow-up and a larger number of patients are needed to further investigate the efficacy and safety of this treatment.
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Affiliation(s)
- Elena Artioli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli
| | - Antonio Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Laura Langone
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli
| | | | - Alberto Arceri
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli
| | - Simone Bonelli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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15
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Stark NEP, Streamer J, Queen R. Patients with unilateral ankle arthritis have decreased discrete and time-series limb symmetry compared to healthy controls. J Orthop Res 2023; 41:1953-1964. [PMID: 36866826 PMCID: PMC10440243 DOI: 10.1002/jor.25541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/01/2023] [Indexed: 03/04/2023]
Abstract
Patients with ankle arthritis (AA) have side-to-side limb differences at the ankle and in spatiotemporal measures; however, the degree of symmetry between limbs has not been compared to a healthy population. The purpose of this study was to determine differences in limb symmetry during walking for discrete and time-series measures when comparing patients with unilateral AA to healthy participants. Thirty-seven AA and 37 healthy participants were age, gender, and body mass index matched. Three-dimensional gait mechanics and ground reaction force (GRF) were captured during four to seven walking trails. GRF and hip and ankle mechanics were extracted bilaterally for each trial. The Normalized Symmetry Index and Statistical Parameter Mapping were used to assess discrete and time-series symmetry, respectively. Discrete symmetry was analyzed using linear mixed-effect models to determine significant differences between groups (α = 0.05). Compared to healthy participants, patients with AA had decreased weight acceptance (p = 0.017) and propulsive (p < 0.001) GRF, ankle plantarflexion (p = 0.021), ankle dorsiflexion (p = 0.010), and ankle plantarflexion moment (p < 0.001) symmetry. Significant regions of difference were found between limbs and groups throughout the stance phase for the vertical GRF force (p < 0.001), the ankle angle during push-off (p = 0.047), the plantarflexion moment (p < 0.001), and the hip extension angle (p = 0.034) and moment (p = 0.010). Patients with AA have decreased symmetry in the vertical GRF and at the ankle and hip during the weight acceptance and propulsive portions of the stance phase. Therefore, clinicians should try a non improving symmetry focusing on changing hip and ankle mechanics during the weight acceptance and propulsive phases of gait.
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Affiliation(s)
- Nicole E-P. Stark
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 495 Old Turner Street Blacksburg, VA, 24060, USA
| | - Jill Streamer
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 495 Old Turner Street Blacksburg, VA, 24060, USA
| | - Robin Queen
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 495 Old Turner Street Blacksburg, VA, 24060, USA
- Department of Orthopaedic Surgery, Virginia Tech – Carilion School of Medicine, Roanoke, VA, USA
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16
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Mohd J, Bhat NA, Lone ZA, Bhat TA, Afzal T, Dev B, Butt MF, Gupta S. Outcome of a Simple Novel Technique to Reduce Soft Tissue Complications in Open Tendoachilles Injury: A Series of 20 Patients. Malays Orthop J 2023; 17:49-56. [PMID: 37583530 PMCID: PMC10424994 DOI: 10.5704/moj.2307.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 12/06/2022] [Indexed: 08/17/2023] Open
Abstract
Introduction Open tendoachilles injuries are rare and associated with significant soft tissues complications. The objective of the present study was to assess the clinical outcome and safety of a simple and minimally invasive technique, with a goal to assess if it may help minimise flap and wound related complications in open tendoachilles injuries. Materials and methods This prospective study of four years duration included 20 patients with open tendoachilles injuries managed with a simple minimally invasive tunnel technique. The primary outcome variable was occurrence of a major soft tissue complication. The secondary outcome variables included functional outcome measured using AOFAS Ankle hind foot score, re-rupture of tendoachilles and need for revision surgery. Results None of the patients in the present series developed a serious soft tissue complication. Based upon the AOFAS hind foot scoring system, good to excellent outcome was achieved in 19 (95%) patients. All the patients were able to perform tip toe walking at six months post-surgery. None of the patients had a re-rupture of the tendoachilles and no patient needed a revision surgery. The complications encountered include thickening of the tendon at the repair site (15%), superficial wound infection (5%), stitch granuloma (5%) and hypertrophic scar (5%). Conclusion This technique seems to be promising in reducing the soft tissue complications associated with the surgical management of open tendoachilles injuries. Most patients had a good final clinical outcome. The technique is safe, simple and reproducible. However, further randomised control studies with a larger sample size assessing the technique are recommended.
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Affiliation(s)
- J Mohd
- Department of Orthopaedics, Government Medical College Anantnag, Anantnag, India
| | - N A Bhat
- Department of Orthopaedics, Government Medical College Anantnag, Anantnag, India
| | - Z A Lone
- Department of Orthopaedics, Government Medical College Jammu, Jammu, India
| | - T A Bhat
- Department of Orthopaedics, Government Medical College Jammu, Jammu, India
| | - T Afzal
- Department of Orthopaedics, Government Medical College Jammu, Jammu, India
| | - B Dev
- Department of Orthopaedics, Government Medical College Jammu, Jammu, India
| | - M F Butt
- Department of Orthopaedics, Government Medical College Jammu, Jammu, India
| | - S Gupta
- Department of Orthopaedics, Government Medical College Jammu, Jammu, India
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17
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Luo B, Wang Y, Wang D. Effect of buttress plate in Herscovici type D vertical medial malleolar fractures and peripheral fractures: a retrospective comparative cohort study. J Orthop Surg Res 2023; 18:411. [PMID: 37280598 DOI: 10.1186/s13018-023-03889-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/29/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The purpose of current retrospective study was to review the surgical methods and to evaluate the clinical efficacy of supporting plate for the treatment of vertical medial malleolus fractures on the basis of stable fixation of ipsilateral fibula. METHODS This retrospective study included a total of 191 patients with vertical medial malleolus fractures. Patients enrolled were divided into simple vertical medial malleolus fractures and complex types of fractures. General demographic information and surgical information, including age, sex, surgical procedure and postoperative complications, were collected. The functional prognosis of patients was evaluated by American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS) and Visual Analog Scale (VAS). RESULT Among patients with simple vertical fractures, the respective incidence of internal fixation failure in screw group, buttress plate group, and screw combined buttress plate fixation group (combined fixation group) was 10/61 (16.4%),1/54 (7.4%) and 1 (1.9%), and the difference was statistically significant (P = 0.024). The incidence of abnormal fracture growth and healing in screw group, buttress plate group and combined fixation group was, respectively, 13/61 (21.3%), 6/54 (12.5%) and 2 (3.85%), with statistically significant difference (P = 0.019). In the patients with complex types of fractures, after 2 years of postoperative follow-up, the AOFAS score and VAS score of the following subgroups had good results: 91.18 ± 6.05 and 2.18 ± 1.08 in patients with joint surface collapse, and 92.50 ± 4.80 and 2.50 ± 1.29 in patients with tibial fractures, with 100% excellent and good rate. CONCLUSION For simple and complex vertical medial malleolus fractures, buttress plate showed excellent fixation. Despite poor wound healing and extensive soft tissue dissection with this approach, buttress plate may provide a novel insight into medial malleolar fractures, especially for extremely unstable medial malleolar fractures.
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Affiliation(s)
- Bing Luo
- Weifang Medical University, No. 7166 Baotong West Street, Weicheng District, Weifang, 261053, China
| | - Yuqi Wang
- Jinzhou Medical University, Jinzhou, China
| | - Dewei Wang
- Weifang Medical University, No. 7166 Baotong West Street, Weicheng District, Weifang, 261053, China.
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18
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Fernández-Gorgojo M, Salas-Gómez D, Sánchez-Juan P, Laguna-Bercero E, Pérez-Núñez MI. Analysis of Dynamic Plantar Pressure and Influence of Clinical-Functional Measures on Their Performance in Subjects with Bimalleolar Ankle Fracture at 6 and 12 Months Post-Surgery. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23083975. [PMID: 37112316 PMCID: PMC10142754 DOI: 10.3390/s23083975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 05/20/2023]
Abstract
Recovery after ankle fracture surgery can be slow and even present functional deficits in the long term, so it is essential to monitor the rehabilitation process objectively and detect which parameters are recovered earlier or later. The aim of this study was (1) to evaluate dynamic plantar pressure and functional status in patients with bimalleolar ankle fracture 6 and 12 months after surgery, and (2) to study their degree of correlation with previously collected clinical variables. Twenty-two subjects with bimalleolar ankle fractures and eleven healthy subjects were included in the study. Data collection was performed at 6 and 12 months after surgery and included clinical measurements (ankle dorsiflexion range of motion and bimalleolar/calf circumference), functional scales (AOFAS and OMAS), and dynamic plantar pressure analysis. The main results found in plantar pressure were a lower mean/peak plantar pressure, as well as a lower contact time at 6 and 12 months with respect to the healthy leg and control group and only the control group, respectively (effect size 0.63 ≤ d ≤ 0.97). Furthermore, in the ankle fracture group there is a moderate negative correlation (-0.435 ≤ r ≤ 0.674) between plantar pressures (average and peak) with bimalleolar and calf circumference. The AOFAS and OMAS scale scores increased at 12 months to 84.4 and 80.0 points, respectively. Despite the evident improvement one year after surgery, data collected using the pressure platform and functional scales suggest that recovery is not yet complete.
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Affiliation(s)
- Mario Fernández-Gorgojo
- Movement Analysis Laboratory, Escuelas Universitarias Gimbernat (EUG), Physiotherapy School Cantabria, University of Cantabria, 39300 Torrelavega, Spain
| | - Diana Salas-Gómez
- Movement Analysis Laboratory, Escuelas Universitarias Gimbernat (EUG), Physiotherapy School Cantabria, University of Cantabria, 39300 Torrelavega, Spain
- Correspondence:
| | - Pascual Sánchez-Juan
- Alzheimer’s Centre Reina Sofia-CIEN Foundation, 28031 Madrid, Spain
- Neurodegenerative Disease Network Biomedical Research Center (CIBERNED), 28029 Madrid, Spain
| | - Esther Laguna-Bercero
- Traumatology Service and Orthopedic Surgery, University Hospital “Marqués de Valdecilla” (UHMV), 39008 Santander, Spain
| | - María Isabel Pérez-Núñez
- Traumatology Service and Orthopedic Surgery, University Hospital “Marqués de Valdecilla” (UHMV), 39008 Santander, Spain
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19
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Nair V, Solunke S, Patil VS, Jawa S, Abhyankar R. A Case of Chronic Rupture of Achilles Tendon Managed Using a Combination of Multiple Surgical Techniques. Cureus 2023; 15:e37171. [PMID: 37153276 PMCID: PMC10162694 DOI: 10.7759/cureus.37171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 04/08/2023] Open
Abstract
Achilles tendon rupture is a common injury that occurs due to sudden dorsiflexion of the plantar-flexed foot. Both acute and chronic ruptures are frequently misdiagnosed and mistreated. Acute Achilles tendon rupture commonly occurs in middle-aged individuals (30-40 years). Although several operative procedures are available for Achilles tendon repair, the management of choice remains controversial and debatable. A 27-year-old male came to our clinic complaining of pain over the left ankle for the last five months. History revealed trauma caused by a heavy metal object five months ago. Physical examination revealed tenderness and swelling over the left heel. Ankle plantar flexion was restricted, and painful and squeeze test was positive. Magnetic resonance imaging was suggestive of a tear of the Achilles tendon in the left ankle. Surgical management was done with multiple techniques which included flexor hallucis longus tendon graft augmentation, end-to-end suturing (Krackow technique), V-Y plasty, and bioabsorbable suture anchor. Although complications such as scar stiffness and wound gaping are common in such cases, the postoperative outcome was excellent in our case according to the American Orthopedic Foot and Ankle Score.
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20
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Van Vehmendahl R, Nelen SD, El Hankouri M, Edwards MJR, Pull ter Gunne AF, Smeeing DPJ. Effectiveness of Postoperative Physiotherapy Compared to Postoperative Instructions by Treating Specialist Only in Patients With an Ankle Fracture: A Systematic Review. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231173680. [PMID: 37197389 PMCID: PMC10184230 DOI: 10.1177/24730114231173680] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
Background In current literature, the benefit of postoperative physiotherapy versus postoperative instructions by treating specialist only remains unclear. The aim of this review is to systematically assess existing literature regarding the functional outcome of postoperative physiotherapy compared to postoperative instructions by treating specialist only in the rehabilitation of patients with an ankle fracture. The secondary aim is to determine if there is a difference in ankle range of motion, strength, pain, complications, quality of life, and patient's satisfaction between these 2 rehabilitation methods. Methods For this review, the PubMed/MEDLINE, PEDro, Embase, Cochrane, and CINAHL databases were searched for studies that compared postoperative rehabilitation groups. Results The electronic data search detected 20 579 articles. After exclusion, 5 studies with a total of 552 patients were included. Overall, no significant benefit in functional outcome of postoperative physiotherapy was seen compared to the instructions-only group. One study even found a significant benefit in favor of the instructions-only group. An exemption for beneficial effect of the use of physiotherapy could be made for younger patients, as 2 studies described younger age as a factor for better outcomes (functional outcome and ankle range of motion) in the postoperative physiotherapy group. Patients' satisfaction, described by one study, was found to be significantly higher in the physiotherapy group (P = .047). All other secondary aims showed no significant difference. Conclusion Because of the limited number of studies and the heterogeneity among studies, a valid conclusion about the general effect of physiotherapy cannot be formed. However, we identified limited evidence suggesting a possible benefit of physiotherapy in younger patients with an ankle fracture in functional outcome and ankle range of motion.
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Affiliation(s)
- Robyn Van Vehmendahl
- Department of Trauma Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Stijn D. Nelen
- Department of Trauma Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Mouhcine El Hankouri
- Department of Trauma Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Michael J. R. Edwards
- Department of Trauma Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
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21
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Sharma R, Chaudhary NK, Karki M, Sunuwar DR, Singh DR, Pradhan PMS, Gyawali P, Duwal Shrestha SK, Bhandari KK. Effect of platelet-rich plasma versus steroid injection in plantar fasciitis: a randomized clinical trial. BMC Musculoskelet Disord 2023; 24:172. [PMID: 36882804 PMCID: PMC9989576 DOI: 10.1186/s12891-023-06277-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Plantar fasciitis (PF) is a common orthopaedic problem, with heel pain worsening the quality of life. Although steroid injection is often used if the conservative treatment fails, Platelet-Rich Plasma (PRP) injection is gaining popularity due to its safety and long-lasting effect. However, the effect of PRP versus steroid injection in PF has not been studied yet in Nepal. Therefore, this study aimed to assess the effect of PRP compared with steroid injection in the treatment of PF. METHODS This study was a single-center, hospital-based, open-label, parallel-group randomized clinical trial to compare the effect of PRP injection with steroid injection in plantar fasciitis between August 2020 and March 2022. A total of 90 randomly selected participants aged 18 to 60 years suffering from plantar fasciitis with failed conservative treatment were intervened. The American Orthopaedic Foot and Ankle Society (AOFAS) and the Visual Analog Scale (VAS) scoring system were used to evaluate functional mobility and pain before and after the intervention for three and six months, respectively. Statistical analyses were performed using a Student's two-sample t-test. P-value < 0.05 was considered statistically significant. RESULTS The PRP injection showed a better outcome than the steroid injection in six months follow-up. The mean (± SD) VAS score was significantly decreased in the PRP group (1.97 + 1.13) than in the steroid group (2.71 ± 0.94) with the group difference of -0.73 (95% CI: -1.18 to -0.28) at six months. Similarly, there was a significant increase in the AOFAS scores in the PRP group (86.04 ± 7.45) compared to the steroid group (81.23 ± 9.60) at six months of follow-up with a group difference of 4.80 (95% CI: 1.15 to 8.45). There was also a significant reduction of plantar fascia thickness in the PRP group compared to that of the steroid group (3.53 ± 0.81 versus 4.58 ± 1.02) at six months of follow-up with the group difference of -1.04 (95% CI: -1.44 to -0.65). CONCLUSION The PRP injection showed better outcomes than steroid injection in plantar fasciitis treatment over the course of six months. Further research with a larger population and longer follow-up than six months is needed to generalize the findings and their long-term efficacy. TRIAL REGISTRATION NCT04985396. First registered on 02 August 2021. ( https://clinicaltrials.gov/ct2/show/NCT04985396 ).
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Affiliation(s)
| | | | | | - Dev Ram Sunuwar
- Department of Nutrition and Dietetics, Nepal Armed Police Force Hospital, Kathmandu, Nepal
| | - Devendra Raj Singh
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Pranil Man Singh Pradhan
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Tribhuvan, Nepal
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22
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Lameire DL, Abdel Khalik H, Del Balso C, Daniels T, Halai M. Transportal Tibiotalocalcaneal Nail Ankle Arthrodesis: A Systematic Review of Initial Series. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231156422. [PMID: 36891124 PMCID: PMC9986908 DOI: 10.1177/24730114231156422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
Background There is currently a scarcity of information and consensus for transportal (arthroscopic or fluoroscopic) joint preparation during tibiotalocalcaneal (TTC) fusion, and therefore this review aims to summarize the available techniques and to evaluate the outcomes after this procedure. Methods A systematic electronic search of MEDLINE, EMBASE, and Web of Science was performed for all English-language studies published from their inception to April 4, 2022. All articles addressing arthroscopy in TTC nailing were eligible for inclusion. The PRISMA Checklist guided the reporting and data abstraction. Descriptive statistics are presented. Result A total of 5 studies with 65 patients were included for analysis. All studies used arthroscopic portals for tibiotalar and subtalar joint preparation (in 4 studies) prior to TTC nailing, with 4 studies using an arthroscope and 1 study using fluoroscopy. The overall major complication rate was 13.8%; however, there was only 1 instance of deep wound infection (1.5%) and 4 instances of surgical site infections (6.2%). Full fusion was achieved in 86% of patients with an average time to fusion of 12.9 weeks. The mean American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score preoperatively was 34.0 and postoperatively was 70.5. Conclusion Although limited by the number of studies, transportal joint preparation during TTC nail ankle fusion is associated with good rates of complications and successful fusion. Level of Evidence Level III, systematic review of Level III-IV studies.
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Affiliation(s)
- Darius Luke Lameire
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Hassaan Abdel Khalik
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Christopher Del Balso
- Department of Orthopaedic Surgery, London Health Sciences Centre, Western University, London, ON, Canada
| | - Timothy Daniels
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Unity Health Toronto-St Michael's Hospital, Toronto, ON, Canada
| | - Mansur Halai
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Unity Health Toronto-St Michael's Hospital, Toronto, ON, Canada
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23
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Molano Castro JD, Sardoth Álvarez R, Franco Betancur A, Vargas Montenegro GE. Translation, Cultural Adaptation, and Validation of the American Orthopedic Foot and Ankle Society Scale in Patients With Hallux Valgus in Colombia. J Foot Ankle Surg 2022; 62:511-518. [PMID: 36693770 DOI: 10.1053/j.jfas.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/10/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022]
Abstract
The American Orthopedic Foot and Ankle Society (AOFAS) scale for hallux metatarsophalangeal (MTP) and interphalangeal (IP) joints is used throughout the world for the clinical assessment of patients with hallux valgus, and it has 3 subscales: pain, function, and alignment. The objective of this prospective, observational study was to perform translation, cultural adaptation, and validation of this scale for Colombian Spanish. The Foot Function Index and Short Form-36 (SF-36) questionnaires were also used in the validation process. Patients who were 18 years or older, resided in the city of Bogota, were able to read and write in Spanish, and were within 4 years of corrective surgery for hallux valgus were included. A total of 79 patients were included in the study, 25 of whom were involved in the translation process and all of whom were involved in the validation process. Construct validity was demonstrated by significant positive Spearman's correlations between the AOFAS pain subscale and the AOFAS function subscale (rs = 0.483), total AOFAS scale (rs = 0.795), and SF-36 physical summary subscale (rs = 0.364); and between the AOFAS function subscale and the total AOFAS scale (rs = 0.894) and SF-36 physical summary subscale (rs = 0.310). The test-retest process for reliability yielded intraclass correlation coefficients between the AOFAS pain, function, and alignment subscales that were all 0.70 or higher. The AOFAS scale for hallux MTP and IP joints was successfully translated and adapted into Colombian Spanish, and this version demonstrated construct validity and reliability, rendering it suitable for clinical use in Colombian patients with hallux valgus.
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Affiliation(s)
- Julián David Molano Castro
- Medical Doctor, Specialized in Foot and Ankle Surgery, Hospital Universitario Mayor and Hospital Universitario Barrios Unidos of Corporación Hospitalaria Juan Ciudad Méderi, Bogota, Colombia.
| | | | - Andrea Franco Betancur
- Medical Doctor, Specialized in Orthopedics and Traumatology, Universidad del Rosario, Bogota, Colombia
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24
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Autologous Matrix-Induced Chondrogenesis (AMIC) for Osteochondral Defects of the Talus: A Systematic Review. Life (Basel) 2022; 12:life12111738. [PMID: 36362893 PMCID: PMC9693539 DOI: 10.3390/life12111738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022] Open
Abstract
Autologous matrix-induced chondrogenesis (AMIC) has been advocated for the management of talar osteochondral lesions (OCLs). This systematic review, which was conducted according to the PRISMA 2020 guidelines, investigated the clinical and imaging efficacy and safety of the AMIC technique in the management of OCLs of the talus. Only studies investigating AMIC for talar chondral defects that were published in peer-reviewed journals were considered. In September 2022, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. Data on the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Score (AOFAS), Tegner activity scale, and Foot Function Index (FFI) were retrieved. To evaluate the morphological MRI findings, data obtained from the magnetic resonance observation of cartilage repair tissue (MOCART) scores were evaluated. Data on hypertrophy, failures, and revision surgeries were also collected. Data from 778 patients (39% women, 61% men) were collected. The mean length of the follow-up was 37.4 ± 16.1 months. The mean age of the patients was 36.4 ± 5.1 years, and the mean BMI was 26.1 ± 1.6 kg/m2. The mean defect size was 2.1 ± 1.9 cm2. Following the AMIC technique, patients demonstrated an improved VAS (p < 0.001), AOFAS (p < 0.001), and FFI (p = 0.02) score. The MOCART score also improved from the baseline (p = 0.03). No difference was observed in the Tegner score (p = 0.08). No graft delamination and hypertrophy were reported in 353 patients. 7.8% (44 of 564) of patients required revision surgeries, and 6.2% (32 of 515) of patients were considered failures. The AMIC technique could be effective in improving symptoms and the function of chondral defects of the talus.
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25
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Migliorini F, Maffulli N, Baroncini A, Eschweiler J, Knobe M, Tingart M, Schenker H. Allograft Versus Autograft Osteochondral Transplant for Chondral Defects of the Talus: Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:3447-3455. [PMID: 34554880 PMCID: PMC9527449 DOI: 10.1177/03635465211037349] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND It is unclear whether the results of osteochondral transplant using autografts or allografts for talar osteochondral defect are equivalent. PURPOSE A systematic review of the literature was conducted to compare allografts and autografts in terms of patient-reported outcome measures (PROMs), MRI findings, and complications. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS This study was conducted according to the PRISMA guidelines. The literature search was conducted in February 2021. All studies investigating the outcomes of allograft and/or autograft osteochondral transplant as management for osteochondral defects of the talus were accessed. The outcomes of interest were visual analog scale (VAS) score for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Data concerning the rates of failure and revision surgery were also collected. Continuous data were analyzed using the mean difference (MD), whereas binary data were evaluated with the odds ratio (OR) effect measure. RESULTS Data from 40 studies (1174 procedures) with a mean follow-up of 46.5 ± 25 months were retrieved. There was comparability concerning the length of follow-up, male to female ratio, mean age, body mass index, defect size, VAS score, and AOFAS score (P > .1) between the groups at baseline. At the last follow-up, the MOCART (MD, 10.5; P = .04) and AOFAS (MD, 4.8; P = .04) scores were better in the autograft group. The VAS score was similar between the 2 groups (P = .4). At the last follow-up, autografts demonstrated lower rate of revision surgery (OR, 7.2; P < .0001) and failure (OR, 5.1; P < .0001). CONCLUSION Based on the main findings of the present systematic review, talar osteochondral transplant using allografts was associated with higher rates of failure and revision compared with autografts at midterm follow-up.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany,Filippo Migliorini, MD, PhD, MBA, Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 31, 52074 Aachen, Germany ()
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy,School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, England,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, England
| | - Alice Baroncini
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Matthias Knobe
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Markus Tingart
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Hanno Schenker
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
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26
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Cianni L, Vitiello R, Greco T, Sirgiovanni M, Ragonesi G, Maccauro G, Perisano C. Predictive Factors of Poor Outcome in Sanders Type III and IV Calcaneal Fractures Treated with an Open Reduction and Internal Fixation with Plate: A Medium-Term Follow-Up. J Clin Med 2022; 11:5660. [PMID: 36233528 PMCID: PMC9572188 DOI: 10.3390/jcm11195660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Consensus on the treatment for severely comminuted calcaneus fractures has yet to be found. This study aims to analyze the functional and radiological short- and medium-term outcomes of displaced calcaneus fractures of type III and IV treated with ORIF, and to identify, if present, the early predictors of unfavorable outcomes. METHODS Thirty-three calcaneal fractures were included, 23 type III and 10 type IV, according to Sanders classification. AOFAS scales for ankle and hindfoot and SF-12 were used. Böhler and Gissane angles were analyzed before and after surgery. RESULTS The minimum follow-up was six years. The mean AOFAS score at six months was 16.5 points (24.2 ± 10.8 vs 10.8 ± 9.5; p = 0.03) with better outcomes in patients with Sanders type III fractures. This difference decreased in the subsequent follow-up. Likewise, the mental and physical score of SF-12 had the same trend. Two wound infections and no deep infections were recorded in the Sanders type III fracture group. Instead, in the Sanders type IV group, there were four wound infections and one deep infection. CONCLUSIONS Clinical and radiological outcomes in Sanders Type III and Type IV calcaneus fractures treated with plate and screws were very similar in long-term follow-up. If ORIF provided better short- to medium-term follow-up in Sanders type III fracture, these benefits have been lost in six years. Polytrauma and psychiatric patients showed significantly lower clinical outcomes in long-term follow-up, appearing as the most reliable negative predictors.
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Affiliation(s)
- Luigi Cianni
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Orthopedics and Trauma Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Raffaele Vitiello
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Orthopedics and Trauma Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Tommaso Greco
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Orthopedics and Trauma Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Mattia Sirgiovanni
- Department of Pneumology, Allergology and Intensive Care Medicine, University of Saarland, 66421 Homburg, Germany
| | - Giulia Ragonesi
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Orthopedics and Trauma Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giulio Maccauro
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Orthopedics and Trauma Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Carlo Perisano
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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27
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Tian F, Wang J, Liu C, Li Y, Liang X, Wang X. Medial column reinforcement for the correction of flatfoot deformity with accessory navicular bone. Am J Transl Res 2022; 14:6368-6374. [PMID: 36247284 PMCID: PMC9556485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES This study aimed to evaluate the clinical effects of reinforcement of the medial column in the treatment of flatfoot deformity with accessory navicular bone. METHODS A retrospective analysis of 32 patients (46 feet) of flatfoot deformity with accessory navicular bone were reviewed. All patients underwent the reinforcement of their medial column in the midfoot, mainly including spring ligament repair, posterior tibial tendon reconstruction, and cotton osteotomy. Clinical evaluation adopted American Orthopaedic Foot and Ankle Society (AOFAS) score and pain visual analogue scale (VAS) was used to evaluate foot function and pain. Radiographic evaluation was performed, and Meary's angle, calcaneal pitch angle, talonavicular coverage angle (TCA), talar 2th metatarsal angle (T2MT) and calcaneal valgus angle (CVA) were measured. RESULTS All patients were followed up for an average duration of 24.3±3.6 months. At the final follow-up, the patient's foot pain was relieved and the foot deformity was improved. The data indicated that the mean functional AOFAS score was significantly improved and the mean VAS score was significantly decreased postoperatively at final follow-up. Additionally, Meary's angle, TCA, T2MT and CVA were all significantly decreased, and calcaneal pitch angle was significantly increased after surgery. CONCLUSION We found that reinforcement of the medial column can effectively maintain medial longitudinal arch, correct flatfoot deformity with accessory navicular bone.
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Affiliation(s)
- Feng Tian
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an, Shaanxi Province, P. R. China
| | - Junhu Wang
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an, Shaanxi Province, P. R. China
| | - Cheng Liu
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an, Shaanxi Province, P. R. China
| | - Yi Li
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an, Shaanxi Province, P. R. China
| | - Xiaojun Liang
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an, Shaanxi Province, P. R. China
| | - Xinwen Wang
- Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University Xi'an, Shaanxi Province, P. R. China
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28
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Su CH, Chen YC, Yang YH, Wang CY, Ko PW, Huang PJ, Liaw CC, Liao WL, Cheng TL, Lee DY, Lo LC, Hsieh CL. Effect of the traditional Chinese herb Helminthostachys zeylanica on postsurgical recovery in patients with ankle fracture: A double-blinded randomized controlled clinical trial. JOURNAL OF ETHNOPHARMACOLOGY 2022; 295:115435. [PMID: 35671862 DOI: 10.1016/j.jep.2022.115435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Helminthostachys zeylanica (HZ), which is also called "Dao-Di-U-Gon" in Taiwan, has anti-inflammatory and antiedema effects and is commonly used to treat edema in patients with fractures. The ugonin K component of HZ can induce osteogenesis and promote bone mineralization, its therapeutic effect, however, its therapeutic effect remains unclear. Therefore, the purpose of the present study was to investigate the effect of HZ on functional recovery in patients with ankle fractures requiring surgical treatment. METHODS A double-blinded, randomized, controlled study was conducted. A total of 45 patients with ankle fractures requiring surgical treatment were assigned to either the control group (n = 23 patients), which received the oral administration of HZ placebo 1.0 g t.i.d. for 42 days continuously, or to the treatment group (22 patients), which received HZ for 42 days. RESULTS The serum amino-terminal propeptide of type 1 procollagen (PINP) levels were similar in the first assessment (V1) between the control (45.90 ± 16.31 ng/mL) and treatment groups (52.61 ± 21.02 ng/mL; p = 0.240); the differences in PINP level between the third assessment (V3) and V1 were greater in the treatment group (35.84 ± 24.56 ng/mL) than in the control group (16.34 ± 11.97 ng/mL; p = 0.002). Radiographic healing time (RHT) was 9.09 ± 1.15 weeks in the treatment group, which was shorter than the 9.91 ± 0.79 weeks (p = 0.012) in the control group. CONCLUSION Oral administration of HZ for 42 days can increase serum PINP level and reduce the RHT. Therefore, HZ can be used to treat patients with ankle fractures requiring surgical treatment. However, a larger sample size is needed in future studies.
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Affiliation(s)
- Chin-Horng Su
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan; Orthopaedic Department, Yuan-Lin Christian Hospital, Changhua County, 510, Taiwan.
| | - Ya-Chih Chen
- Nursing Department, Yuan-Lin Christian Hospital, Changhua County, 510, Taiwan.
| | - Ya-Hui Yang
- Nursing Department, Yuan-Lin Christian Hospital, Changhua County, 510, Taiwan.
| | - Chun-Yi Wang
- Orthopaedic Department, Yuan-Lin Christian Hospital, Changhua County, 510, Taiwan.
| | - Po-Wei Ko
- Orthopaedic Department, Yuan-Lin Christian Hospital, Changhua County, 510, Taiwan.
| | - Peng-Ju Huang
- Orthopedic Department, Kaohsiung Medical University Hospital, Kaohsiung, 80708, Taiwan.
| | - Chih-Chuang Liaw
- Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, 804, Taiwan.
| | - Wen-Ling Liao
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan.
| | - Tsung-Lin Cheng
- Institute of Statistics and Information Science, National Changhua University of Education, Taiwan.
| | - Der-Yen Lee
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan.
| | - Lun-Chien Lo
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan; Department of Chinese Medicine, China Medical University Hospital, Taichung, 40447, Taiwan.
| | - Ching-Liang Hsieh
- Department of Chinese Medicine, China Medical University Hospital, Taichung, 40447, Taiwan; Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan; Chinese Medicine Research Center, China Medical University, Taichung, 40402, Taiwan.
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29
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Migliorini F, Maffulli N, Schenker H, Eschweiler J, Driessen A, Knobe M, Tingart M, Baroncini A. Surgical Management of Focal Chondral Defects of the Talus: A Bayesian Network Meta-analysis. Am J Sports Med 2022; 50:2853-2859. [PMID: 34543085 PMCID: PMC9354066 DOI: 10.1177/03635465211029642] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND No consensus has been reached regarding the optimal surgical treatment for focal chondral defects of the talus. PURPOSE A Bayesian network meta-analysis was conducted to compare the clinical scores and complications of mosaicplasty, osteochondral auto- and allograft transplant, microfracture, matrix-assisted autologous chondrocyte transplant, and autologous matrix-induced chondrogenesis (AMIC) for chondral defects of the talus at midterm follow-up. STUDY DESIGN Bayesian network meta-analysis; Level of evidence, 4. METHODS This Bayesian network meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions. PubMed, Embase, Google Scholar, and Scopus databases were accessed in February 2021. All clinical trials comparing 2 or more surgical interventions for the management of chondral defects of the talus were accessed. The outcomes of interest were visual analog scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, rate of failure, and rate of revision surgery. The network meta-analysis were performed through the routine for Bayesian hierarchical random-effects model analysis. The log odds ratio (LOR) effect measure was used for dichotomous variables, and the standardized mean difference (SMD) was used for continuous variables. RESULTS Data from 13 articles (521 procedures) were retrieved. The median length of the follow-up was 47.8 months (range, 31.7-66.8 months). Analysis of variance revealed no difference between the treatment groups at baseline in terms of age, sex, body mass index, AOFAS score, VAS score, and mean number of defects. AMIC demonstrated the greatest AOFAS score (SMD, 11.27) and lowest VAS score (SMD, -2.26) as well as the lowest rates of failure (LOR, 0.94) and revision (LOR, 0.94). The test for overall inconsistency was not significant. CONCLUSION At approximately 4 years of follow-up, the AMIC procedure for management of focal chondral defects of the talus produced the best outcome.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Aachen, Germany,Filippo Migliorini, MD, PhD, MBA, Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Clinic, Pauwelsstraße 30, 52074 Aachen, Germany ()
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (SA), Italy,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, England,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, England
| | - Hanno Schenker
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Aachen, Germany
| | - Arne Driessen
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Aachen, Germany
| | - Matthias Knobe
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Markus Tingart
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Aachen, Germany
| | - Alice Baroncini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Aachen, Germany
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Abstract
BACKGROUND An ankle sprain is a common joint sprain in sports injury, which is closely related to its physiological position and anatomical characteristics, and may progress into chronic ankle instability after improper early treatment or premature exercise. OBJECTIVE To analyze the tertiary rehabilitation effect of acute lateral ankle sprain caused by sports training. METHOD Ninety-six athletes with acute lateral ankle sprain diagnosed from January 2019 to June 2020 were included and divided into the control group and the rehabilitation group using the random number table grouping method, with 48 cases in each group. The two groups received standardized treatment, and the rehabilitation group additionally received tertiary rehabilitation. The American Orthopedic Foot and Ankle Society (AOFAS ) scores, degree of ankle swelling, pain, and re-injury rate were compared between the two groups. RESULTS The AOFAS scores of the two groups increased after treatment (P< 0.05). The degree of swelling in both groups after treatment was improved (P< 0.05). The Visual Analogue Scale (VAS) scores in both groups declined two weeks after treatment, with lower results observed in the rehabilitation group The two groups showed similar results of the follow-up visit (P< 0.05). CONCLUSION Rehabilitation exercise on acute lateral ankle sprain effectively relieves ankle swelling and pain.
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Amann P, Pastl K, Neunteufel E, Bock P. Clinical and Radiologic Results of a Human Bone Graft Screw in Tarsometatarsal II/+III Arthrodesis. Foot Ankle Int 2022; 43:913-922. [PMID: 35373594 DOI: 10.1177/10711007221081533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND For arthrodesis of the tarsometatarsal joints, there is the possibility of using a transplant screw made of allogenic human bone material (Shark Screw). This article investigates the clinical outcome and radiologic integration of the allogenic bone screw for arthrodesis of the tarsometatarsal joints II/+III. METHODS This is a prospective study involving 20 feet of 17 patients who received TMT II/+III arthrodesis with an allogenic bone screw. A visual analog scale (VAS pain and function), Foot Function Index (FFI), American Orthopaedic Foot & Ankle Society (AOFAS) midfoot score, and Foot and Ankle Outcome Score (FAOS) were used as measures to compare preoperative with postoperative results. Radiologic integration in the recipient bone was also evaluated. RESULTS A significant mean pre- to postoperative improvement of all evaluated scores has been observed (P < .05) after a mean follow-up of 15.87 months (minimum 12 months, maximum 33 months). VAS score (pain) decreased from 7.6 to 1.4 points as well as a decrease of the VAS (function) from 7.25 to 1.8 points. Further, a reduction of the FFI from 62.3% to 16.7% and an increase from 29.7 to 79.9 points of the AOFAS was detected. Analyzing the FAOS score, in all surveyed subscales, there was an increase in the score (Symptoms: 55.2 to 85.6 points; Pain: 30.5 to 86.9 points; Function: 33.1 to 88.3 points; Quality of life: 27.8 to 79.7 points). Moreover, in all cases, a complete radiologic integration into the receiving bone was appreciated, and after a minimum follow-up time from 12 months, the screw in 19 feet (95%) was no longer distinguishable from the original bone. CONCLUSION With these first results of the allogenic bone screw in TMT II/+III arthrodesis, a significant improvement from preoperative to postoperative was confirmed in the collected scores, and a full radiographic integration was demonstrated in all feet.
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Affiliation(s)
| | - Klaus Pastl
- Orthopedic Departement Klinik Diakonissen Linz, Linz, Austria
| | | | - Peter Bock
- Speising Orthopedic Hospital, Vienna, Austria
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Utilizing A Percutaneous Versus Open Achilles Tendon Repair Technique for Treating Acute Achilles Tendon Ruptures in Physically Active Adults: A Critically Appraised Topic. J Sport Rehabil 2022; 31:943-949. [PMID: 35413682 DOI: 10.1123/jsr.2021-0330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/05/2021] [Accepted: 03/02/2022] [Indexed: 11/18/2022]
Abstract
CLINICAL SCENARIO Acute Achilles tendon ruptures can be devastating injuries with the potential to significantly alter an individual's ability to perform functional activities. Given the rise in the incidence of acute Achilles tendon ruptures, it is important to determine whether percutaneous versus open Achilles tendon repair facilitates superior outcomes. CLINICAL QUESTION In physically active adults with an acute Achilles tendon rupture, does performing percutaneous Achilles tendon repair result in improved outcomes compared with open Achilles tendon repair? SUMMARY OF KEY FINDINGS Percutaneous Achilles tendon repair has similar efficacy as open Achilles tendon repair in facilitating return to activity/sport, and demonstrates improvement in short-term functional outcomes with potentially lower wound complication rates. CLINICAL BOTTOM LINE Evidence supports the utilization of percutaneous Achilles tendon repair in physically active adult patients with acute Achilles tendon ruptures. It is important to critically review the benefits, risks, and alternatives of each treatment option based on patient characteristics. In addition, postoperative expectations should be discussed with the patient to set appropriate goals for recovery and improve overall satisfaction. STRENGTH OF RECOMMENDATION A grade B recommendation can be made based on "fair" to "good" evidence from 2 level 2b studies and 1 Level 1b study to support the utilization of percutaneous Achilles tendon repair techniques.
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Tacktill JZ, Rasor Z, Adams J, Driver G, Shannon L, Hudzinski S, Carter MJ, Isaac AL, Zelen CM. Wound repair, safety, and functional outcomes in reconstructive lower extremity foot and ankle surgery using a dehydrated amnion/chorion allograft membrane. Int Wound J 2022; 19:2062-2070. [DOI: 10.1111/iwj.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Zachary Rasor
- Foot and Ankle Specialists of the Mid‐Atlantic Salem Virginia USA
| | - Josh Adams
- Professional Education and Research Institute Roanoke Virginia USA
| | - Gary Driver
- Professional Education and Research Institute Roanoke Virginia USA
| | - Logan Shannon
- Professional Education and Research Institute Roanoke Virginia USA
| | - Scott Hudzinski
- Professional Education and Research Institute Roanoke Virginia USA
| | | | - Adam L. Isaac
- Foot and Ankle Specialists of the Mid‐Atlantic Salem Virginia USA
| | - Charles M. Zelen
- Professional Education and Research Institute Roanoke Virginia USA
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34
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Mooya S, Kakakhel M, El-Amien A, Anto P. Anti-Glide Plate Fixation for Lateral Malleolus Fractures by Minimally Invasive Technique in Geriatric Patients. Cureus 2022; 14:e23160. [PMID: 35399481 PMCID: PMC8980190 DOI: 10.7759/cureus.23160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 11/15/2022] Open
Abstract
The objective was to evaluate the functional outcomes of anti-glide fixation by minimally invasive plate osteosynthesis (MIPPO) in lateral malleolus ankle fractures. The study was a retrospective cohort study conducted at a single trauma center. We reviewed 39 patients >60 years old with either isolated or non-isolated lateral malleolus Weber B ankle fractures. The main outcome measures were postoperative functional assessment performed with the American Orthopaedic Foot and Ankle Society (AOFAS) and Short Musculoskeletal Functional Assessment (SMFA) scores.
Our results showed that the mean time to surgery was 1 day. Seventeen patients underwent surgery within 24 hours after sustaining the injury. The mean AOFAS and SMFA scores were 87.8 and 209.7, respectively. No patient developed implant failure or wound complications. It was concluded that the anti-glide plating of the lateral malleolus had better functional outcomes compared to lateral plating by open reduction and internal fixation (ORIF), as shown by the higher AOFAS scores and fewer postoperative complications.
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35
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Vosoughi AR, Kordi Yoosefinejad A, Safaei Dehbarez Y, Kargarshouraki Z, Mahdaviazad H. Evaluating the Validity and Reliability of the Persian Version of American Orthopedic Foot and Ankle Society Midfoot Scale. Foot Ankle Spec 2022:19386400211068242. [PMID: 34991352 DOI: 10.1177/19386400211068242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The use of a valid and reliable outcome scoring system is crucial for evaluating the result of different treatment interventions. The aims of this study were to translate and culturally adapt the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scoring system into the Persian language and assess its validity and reliability. METHOD In total, 57 patients with midfoot injuries were enrolled. Forward-backward translation and cultural adaptation methods were used to develop the Persian version of AOFAS midfoot scoring system. Reliability and internal consistency were assessed using intraclass correlation coefficient (ICC) and Cronbach's alpha. The discriminant and convergent validities of the scoring system were assessed using the total score of the mental and physical component of SF-36. RESULTS The mean age of the participants was 46.2 ± 16.3 years. The intra-observer reliability of the totals core of the Persian version of AOFAS midfoot scoring system was 0.96 (confidence interval [CI]: 0.92-0.97) and the inter-observer reliability of the scoring system was 0.90 (CI: 0.86-0.95). The Persian version of AOFAS midfoot scoring system had acceptable convergence with physical component scoring system of SF-36 and its subscales (0.57); moreover, it had acceptable discriminant validity with the mental component of SF-36 and its subscales (0.36). CONCLUSION The Persian version of AOFAS midfoot is a reliable and valid instrument and could be used by Persian language clinicians and researchers. LEVEL OF CLINICAL EVIDENCE 3.
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Affiliation(s)
- Amir Reza Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Kordi Yoosefinejad
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Zeinab Kargarshouraki
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamideh Mahdaviazad
- Family Medicine Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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36
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Rikken QGH, Dahmen J, Reilingh ML, van Bergen CJA, Stufkens SAS, Kerkhoffs GMMJ. Outcomes of Bone Marrow Stimulation for Secondary Osteochondral Lesions of the Talus Equal Outcomes for Primary Lesions. Cartilage 2021; 13:1429S-1437S. [PMID: 34167358 PMCID: PMC8739575 DOI: 10.1177/19476035211025816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare clinical, sports, work, and radiological outcomes between primary and secondary osteochondral lesions of the talus (OLTs; <15 mm) treated with arthroscopic bone marrow stimulation (BMS). DESIGN Secondary OLTs were matched to primary OLTs in a 1:2 ratio to assess the primary outcome measure-the Numeric Rating Scale (NRS) during activities. Secondary outcomes included the pre- and 1-year postoperative NRS at rest, American Orthopaedic Foot and Ankle Society score, Foot and Ankle Outcome Score subscales, and the EQ-5D general health questionnaire. The rates and time to return to work and sports were collected. Radiological examinations were performed preoperatively and at final follow-up using computed tomography (CT). RESULTS After matching, 22 and 12 patients with small (<15 mm) OLTs were included in the primary and secondary groups, respectively. The NRS during activities was not different between primary cases (median: 2, interquartile range [IQR]: 1-4.5) and secondary cases (median: 3, IQR: 1-4), P = 0.5. Both groups showed a significant difference between all pre- and postoperative clinical outcome scores, but no significant difference between BMS groups postoperatively. The return to sport rate was 90% for primary cases and 83% for secondary cases (P = 0.6). All patients returned to work. Lesion filling on CT was complete (67% to 100%) in 59% of primary cases and 67% of secondary cases (P = 0.6). CONCLUSION No differences in outcomes were observed between arthroscopic bone marrow stimulation in primary and secondary OLTs at 1-year follow-up. Repeat BMS may therefore be a viable treatment option for failed OLTs in the short term.
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Affiliation(s)
- Quinten G. H. Rikken
- Department of Orthopaedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC—Location AMC, University of Amsterdam,
Amsterdam, The Netherlands,Academic Center for Evidence Based
Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands,Amsterdam Collaboration for Health and
Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC,
Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopaedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC—Location AMC, University of Amsterdam,
Amsterdam, The Netherlands,Academic Center for Evidence Based
Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands,Amsterdam Collaboration for Health and
Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC,
Amsterdam, The Netherlands
| | - Mikel L. Reilingh
- Department of Orthopedic Surgery,
Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Christiaan J. A. van Bergen
- Academic Center for Evidence Based
Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands,Amsterdam Collaboration for Health and
Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC,
Amsterdam, The Netherlands,Department of Orthopedic Surgery,
Amphia Hospital, Breda, The Netherlands
| | - Sjoerd A. S. Stufkens
- Department of Orthopaedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC—Location AMC, University of Amsterdam,
Amsterdam, The Netherlands,Academic Center for Evidence Based
Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands,Amsterdam Collaboration for Health and
Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC,
Amsterdam, The Netherlands
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopaedic Surgery,
Amsterdam Movement Sciences, Amsterdam UMC—Location AMC, University of Amsterdam,
Amsterdam, The Netherlands,Academic Center for Evidence Based
Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands,Amsterdam Collaboration for Health and
Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC,
Amsterdam, The Netherlands,Gino M. M. J. Kerkhoffs, Department of
Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC—Location AMC,
University of Amsterdam, Amsterdam, The Netherlands.
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37
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Casari FA, Germann C, Weigelt L, Wirth S, Viehöfer A, Ackermann J. The Role of Magnetic Resonance Imaging in Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: Analyzing MOCART 1 and 2.0. Cartilage 2021; 13:639S-645S. [PMID: 32741215 PMCID: PMC8808860 DOI: 10.1177/1947603520946382] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To determine the role of magnetic resonance imaging (MRI) MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 1 and 2.0 scores in the assessment of postoperative outcome after autologous matrix-induced chondrogenesis (AMIC) for the treatment of osteochondral lesions of the talus (OLTs). It was hypothesized that preoperative patient factors or OLT morphology are associated with postoperative MOCART scores; yet postoperative clinical outcome is not. STUDY DESIGN Cohort study; Level of evidence, 4. This study evaluated isolated AMIC that were implanted on the talus of 35 patients for the treatment of symptomatic OLT. Tegner and AOFAS (American Orthopaedic Foot and Ankle Society) scores were obtained at an average follow-up of 4.5 ± 1.8 years and postoperative MRI scored according to the MOCART 1 and 2.0. RESULTS OLT size showed significant correlation with postoperative MRI scores (MOCART 1: P = 0.006; MOCART 2.0: P = 0.004). Bone grafting was significantly associated with a MOCART 1 subscale (signal intensity of repair tissue; P = 0.038). Age and defect size showed significant correlations with MOCART 2.0 subscales (P < 0.05). Patients with shorter follow-up had a significantly higher MOCART 1 score and a trend toward better MOCART 2.0 scores than patients with longer follow-up (64.7 vs. 52.9 months, P = 0.02; 69.4 vs. 60.6 months, P = 0.058). No MOCART score was associated with postoperative patient-reported outcomes (n.s.). CONCLUSION Osteochondral lesion size is associated with postoperative MOCART scores in patients treated with AMIC for OLTs, with decreasing MOCART scores over time. Yet clinical outcome does not correlate with any MOCART score. Thus, MOCART assessment seems to have no significant role in the postoperative treatment of asymptomatic patients that underwent AMIC for OLTs.
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Affiliation(s)
- Fabio A. Casari
- Department of Orthopedics, University
Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Christoph Germann
- Department of Radiology, University
Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Lizzy Weigelt
- Department of Orthopedics, University
Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Stephan Wirth
- Department of Orthopedics, University
Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Arnd Viehöfer
- Department of Orthopedics, University
Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Jakob Ackermann
- Department of Orthopedics, University
Hospital Balgrist, University of Zurich, Zurich, Switzerland,Jakob Ackermann, Forchstrasse 340, Zurich
8008, Switzerland.
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38
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Ferranti S, Migliorini F, Liuni FM, Corzani M, Azzarà A, Polliano F, Tawfiq ASS, Maffulli N. Outcomes of Percutaneous Calcaneoplasty for Insertional Achilles Tendon Problems. Foot Ankle Int 2021; 42:1287-1293. [PMID: 34116596 DOI: 10.1177/10711007211004963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Percutaneous procedures have been used recently to treat insertional Achilles tendon problems. The present study reports our results of this treatment approach. METHODS Patients undergoing percutaneous calcaneoplasty for insertional Achilles tendon problems were retrieved. Patients completed the visual analog scale (VAS) for pain and the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire before the operative procedure and at the last follow-up. At the last follow-up, we asked the patients whether they were completely satisfied, moderately satisfied, or unsatisfied after the procedure. Complications were also recorded. RESULTS A total of 27 patients were enrolled. The average follow-up was 26.5 months (range 6-68). The mean age of patients was 56.2 years (24-82). The mean VAS score before surgery was 8.1 ± 0.9 decreasing by the last follow-up to 2.4 ± 2.3 (P < .0001). The mean VISA-A score improved from 20.7 ± 5.4 to 75.7 ± 25.5 at last follow-up, an improvement of 55% (P < .0001). At the last follow-up, 84.5% (22 of 27) patients were completely satisfied with the procedure, 7.4% (2 of 27) moderately satisfied, and 11.1% (3 of 27) were not satisfied. These last 3 patients presented recurrence of symptoms, requiring revision surgery. CONCLUSION For the selected patients, we found percutaneous calcaneoplasty to be an effective treatment for insertional Achilles tendon problems. LEVEL OF EVIDENCE Level III, retrospective study.
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Affiliation(s)
| | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Federico Maria Liuni
- Department of Orthopaedics and Traumatology, Santa Maria Hospital, Borgo Val di Taro, Italy
| | - Marco Corzani
- Department of Orthopaedics and Traumatology, University of Perugia, Italy
| | - Alfio Azzarà
- Orthopaedics and Traumatology, PBS Group, Perugia, Italy
| | | | | | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (SA), Italy.,Centre for Sports and Exercise Medicine, Mile End Hospital, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, United Kingdom
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39
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Jagtenberg EM, Kalmet PHS, de Krom MAP, Hermus JPS, Seelen HAM, Poeze M. Effectiveness of surgical treatments on healing of cartilage and function level in patients with osteochondral lesions of the tibial plafond: A systematic review. J Orthop 2021; 27:34-40. [PMID: 34483548 PMCID: PMC8397834 DOI: 10.1016/j.jor.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/14/2021] [Indexed: 12/29/2022] Open
Abstract
Background Osteochondral lesions of the tibial plafond (OLTPs) occur less frequently than those of the talus, and treatment guidelines have not been determined. The aim of the current review was to evaluate the effectiveness of surgical treatments on the healing of cartilage and on function level, i.e. pain reduction, reduced swelling and improved joint range of motion, in patients with OLTPs. Methods A comprehensive literature search in PubMed/MEDLINE, Cochrane Database of Systematic Reviews and Google Scholar was performed up to December 2020. The outcome measures were healing of cartilage and function level. Results Four studies investigating treatment of OLTPs were included. Three studies investigated treatment by means of microfracture. One of these studies showed an osteochondral defect filling in 52.0% of patients. All three studies showed an improvement in function level. Antegrade drilling was evaluated in one study, showing contrasting results in two patients. One-step bone marrow-derived cell transplantation was evaluated in one study, showing an osteochondral defect filling in 68.0% of patients and improvements in patients' function level. Conclusions Arthroscopic treatment of OLTPs by means of microfracture and bone marrow-derived cell transplantation (BMDCT) seem effective for the outcome at the patient's function level, while BMDCT showed more promising results regarding defect filling. However, this is based on the current available evidence with poor quality of methodology. Further research is of paramount importance to understand this injury and to evaluate the best treatments.
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Affiliation(s)
- Eline M Jagtenberg
- Maastricht University Medical Centre, Dept. of Trauma Surgery, Maastricht, the Netherlands
| | - Pishtiwan H S Kalmet
- Maastricht University Medical Centre, Dept. of Trauma Surgery, Maastricht, the Netherlands
| | - Maartje A P de Krom
- Maastricht University Medical Centre, Dept. of Trauma Surgery, Maastricht, the Netherlands
| | - Joris P S Hermus
- Maastricht University Medical Centre, Dept. of Orthopedic Surgery, Maastricht, the Netherlands
| | - Henk A M Seelen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands.,Research School CAPHRI, Dept. of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
| | - Martijn Poeze
- Maastricht University Medical Centre, Dept. of Trauma Surgery, Maastricht, the Netherlands.,Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
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40
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Migliorini F, Maffulli N, Baroncini A, Knobe M, Tingart M, Eschweiler J. Matrix-induced autologous chondrocyte implantation versus autologous matrix-induced chondrogenesis for chondral defects of the talus: a systematic review. Br Med Bull 2021; 138:144-154. [PMID: 33940611 DOI: 10.1093/bmb/ldab008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Chondral defects of the talus are common and their treatment is challenging. SOURCE OF DATA Recent published literatures. AREAS OF AGREEMENT Membrane-induced Autologous Chondrocyte Implantation (mACI) and Autologous Matrix-Induced Chondrogenesis (AMIC) have been proposed as management for chondral defects of the talus. AREAS OF CONTROVERSY It is debated whether AMIC provides greater outcomes compared to mACI for chondral regeneration. Several clinical studies showed controversial results, and the best treatment has not yet been clarified. GROWING POINTS To investigate whether AMIC provide superior outcomes than mACI at midterm follow-up. AREAS TIMELY FOR DEVELOPING RESEARCH AMIC exhibits similar clinical results to mACI. However, AMIC involves one single surgical procedure, no articular cartilage harvest and hence no morbidity from it, no need for chondrocyte expansion in a separate laboratory setting. For these reasons, AMIC may be preferred to mACI.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwellstr. 31, 52074 Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi SA, Italy.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, ST4 7QB Stoke on Trent, UK.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancro Road, London E1 4DG, UK
| | - Alice Baroncini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwellstr. 31, 52074 Aachen, Germany
| | - Matthias Knobe
- Department of Orthopedics and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000 Lucerne, Switzerland
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwellstr. 31, 52074 Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Pauwellstr. 31, 52074 Aachen, Germany
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41
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Nicholas PRM, Carter R, Chan P, Jamal B. A Systematic Review Of Primary Ankle Arthrodesis In The Treatment Of Pilon Fractures. Foot (Edinb) 2021; 47:101780. [PMID: 33962114 DOI: 10.1016/j.foot.2021.101780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pilon fractures are severe, intra-articular and comminuted fractures to the distal tibia. They are uncommon injuries and are often associated with fibular fractures. The optimal management of these fractures is widely debated. Open reduction and internal fixation (ORIF) and external fixation have been used to treat these fractures. Ankle arthrodesis is often used in the latter stages of management for end-stage ankle arthritis. The aim of this systematic review was to identify the outcomes associated with using primary ankle arthrodesis in pilon fractures. METHODS Ovid Medline and PubMed were searched from the inception of their databases until October 2018. Eligible literature for use in our review included patient cohorts that had been operated in the form of primary ankle arthrodesis. All relevant data was included that met the inclusion criteria. The demographic of the patients with pilon fractures and this operative management were identified. The outcomes of interest were fusion rate, infection rate, length of follow-up and patient reported outcomes. 8 papers were deemed eligible for review. RESULTS Of the 8 papers that were eligible, 6 were retrospective studies, 1 was a case report and 1 was an abstract. There were a total of 109 patients included. Fusion rate was 100% in 5 of the studies. 6 of the 7 studies that reported on infection rate had no post-operative infections. Outcome assessment scores were used in 5 of the studies. The SF-36 score, the FOAS and the AOFAS were used. CONCLUSIONS This review shows that primary ankle arthrodesis yields reasonable results in the management of pilon fractures. However, the quantity and quality of current literature is not sufficient and further studies with larger cohorts and longer follow-up times are warranted.
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Affiliation(s)
- P R M Nicholas
- Department of Surgery, University Hospital Ayr, Ayr, United Kingdom.
| | - R Carter
- Division of foot, ankle and limb reconstruction surgery, Department of Trauma and Orthopaedics, The Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - P Chan
- Division of foot, ankle and limb reconstruction surgery, Department of Trauma and Orthopaedics, The Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - B Jamal
- Division of foot, ankle and limb reconstruction surgery, Department of Trauma and Orthopaedics, The Queen Elizabeth University Hospital, Glasgow, United Kingdom
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Jiao L, Li H, Liao T, Han Z, Wu H, Jiang L. Impact of percutaneous poking reduction combined with minimally invasive plate internal fixation on foot function and complications of patients with Sanders type II and III calcaneal fractures. Am J Transl Res 2021; 13:5329-5335. [PMID: 34150126 PMCID: PMC8205695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the impact of percutaneous poking reduction (PPR) combined with minimally invasive plate internal fixation on foot function and complications of Sanders type II and III calcaneal fractures (CFs). METHODS In this prospective study, 76 patients with Sanders type II and III CFs were randomly divided into the control group (n=38, "L" incision open reduction and plate internal fixation) and the study group (n=38, PPR combined with minimally invasive plate internal fixation (MIPIF)). The operation related indexes, skin necrosis rate, Gissane angle, Bohler angle, calcaneal height and ankle-hindfoot score before and after the operation were compared between the two groups. Complications of the two groups were recorded. RESULTS Compared with the control group, the operation time of the study group was significantly prolonged, but the intraoperative blood loss was significantly reduced, and the fracture healing time and hospitalization time were significantly shortened (P<0.05). The skin necrosis rate of the study group was slightly lower than that of the control group without statistical significance (P>0.05). The Gissane angle, Bohler angle and calcaneal height of the two groups increased 6 months after the operation, and the changes in the study group were more obvious than those in the control group (P<0.05). Six months after the operation, the ankle-hindfoot scores of the two groups significantly increased, and the changes of the study group were more significant than that of the control group (P<0.05). The total incidence of postoperative complications in the study group was significantly lower than that in the control group (P<0.05). CONCLUSION PPR combined with MIPIF can significantly promote the healing of Sanders type II and III CFs and the recovery of the Gissane angle and Bohler angle, effectively improve the foot function of patients and induce fewer complications, which is worthy of clinical promotion.
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Affiliation(s)
- Libin Jiao
- Department of Orthopedics, Tian’s Hospital of Jinhua CityJinhua, Zhejiang Province, China
| | - Hua Li
- Fifth Department of Surgery, The People’s Hospital of PenglaiYantai, Shandong Province, China
| | - Tingkai Liao
- Department of Traumatology and Orthopedics, The People’s Hospital of LinqingLiaocheng, Shandong Province, China
| | - Zengwu Han
- Second Department of Orthopedics, Gucheng County Hospital of Hebei ProvinceHengshui, Hebei Province, China
| | - Hongbin Wu
- Second Department of Orthopedics, Changle County Hospital of Traditional Chinese MedicineWeifang, Shandong Province, China
| | - Lei Jiang
- First Department of Traumatology and Orthopedics, Zaozhuang Mining Group Zaozhuang HospitalZaozhuang, Shandong Province, China
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Ackermann J, Casari FA, Germann C, Weigelt L, Wirth SH, Viehöfer AF. Autologous Matrix-Induced Chondrogenesis With Lateral Ligament Stabilization for Osteochondral Lesions of the Talus in Patients With Ankle Instability. Orthop J Sports Med 2021; 9:23259671211007439. [PMID: 34036112 PMCID: PMC8127792 DOI: 10.1177/23259671211007439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/26/2021] [Indexed: 01/26/2023] Open
Abstract
Background: Autologous matrix-induced chondrogenesis (AMIC) has been shown to result in favorable clinical outcomes in patients with osteochondral lesions of the talus (OLTs). Though, the influence of ankle instability on cartilage repair of the ankle has yet to be determined. Purpose/Hypothesis: To compare the clinical and radiographic outcomes in patients with and without concomitant lateral ligament stabilization (LLS) undergoing AMIC for the treatment of OLT. It was hypothesized that the outcomes would be comparable between these patient groups. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-six patients (13 with and 13 without concomitant ankle instability) who underwent AMIC with a mean follow-up of 4.2 ± 1.5 years were enrolled in this study. Patients were matched 1:1 according to age, body mass index (BMI), lesion size, and follow-up. Postoperative magnetic resonance imaging and Tegner, American Orthopaedic Foot & Ankle Society (AOFAS), and Cumberland Ankle Instability Tool (CAIT) scores were obtained at a minimum follow-up of 2 years. A musculoskeletal radiologist scored all grafts according to the MOCART (magnetic resonance observation of cartilage repair tissue) 1 and MOCART 2.0 scores. Results: The patients’ mean age was 33.4 ± 12.7 years, with a mean BMI of 26.2 ± 3.7. Patients with concomitant LLS showed worse clinical outcome measured by the AOFAS (85.1 ± 14.4 vs 96.3 ± 5.8; P = .034) and Tegner (3.8 ± 1.1 vs 4.4 ± 2.3; P = .012) scores. Postoperative CAIT and AOFAS scores were significantly correlated in patients with concomitant LLS (r = 0.766; P = .002). A CAIT score >24 (no functional ankle instability) resulted in AOFAS scores comparable with scores in patients with isolated AMIC (90.1 ± 11.6 vs 95.3 ± 6.6; P = .442). No difference was seen between groups regarding MOCART 1 and 2.0 scores (P = .714 and P = .371, respectively). Conclusion: Concurrently performed AMIC and LLS in patients with OLT and ankle instability resulted in clinical outcomes comparable with isolated AMIC if postoperative ankle stability was achieved. However, residual ankle instability was associated with worse postoperative outcomes, highlighting the need for adequate stabilization of ankle instability in patients with OLT.
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Affiliation(s)
- Jakob Ackermann
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Fabio A Casari
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Christoph Germann
- Department of Radiology, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Lizzy Weigelt
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Stephan H Wirth
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Arnd F Viehöfer
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
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van den Heuvel SBM, Doorgakant A, Birnie MFN, Blundell CM, Schepers T. Open Ankle Arthrodesis: a Systematic Review of Approaches and Fixation Methods. Foot Ankle Surg 2021; 27:339-347. [PMID: 33419696 DOI: 10.1016/j.fas.2020.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/07/2020] [Accepted: 12/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Open ankle arthrodesis (OAA) remains the most widely used operation in end-stage ankle osteoarthritis. However, there is a large variation in terms of approach and fixation methods. The aim of this systematic review was to assess the effect of different approaches and fixation methods on the union rate, complication rate and functional outcome in OAA. METHODS A search of the online databases PubMed, Embase, and Cochrane library was performed to identify patients who underwent OAA with screw- and/or plate-fixation. RESULTS We identified 38 studies, including 1250 patients (1290 ankles). The union rate was 98% (95% CI 0.95-0.99) for the anterior, 96% (95% CI 0.92-0.98) for the lateral and 96% (95% CI 0.68-1.00) for the combined medial/lateral approach. Screw-fixation achieved an overall union rate of 96% (95% CI 0.93-0.98) and plate-fixation 99% (95% CI 0.96-0.99). The overall complication rate was 14%, 16% and 31% for the anterior, lateral and combined medial/lateral approaches respectively. It stood at 18% for screw-fixation and 9% for plate-fixation. The infection rate was 4%, 6% and 8% for the anterior, lateral and combined approaches respectively. Screw-fixation had an infection rate of 6% and plate-fixation 3%. The postoperative AOFAS scores were 76.8, 76.5 and 67.6 for the anterior, lateral and combined approaches respectively and 74.9 for screw- compared to 78.5 for plate-fixation. These differences did not reach statistical significance. CONCLUSION This study, the first of its kind, found little difference in terms of results between approach and fixation method used in OAA. LEVEL OF EVIDENCE Level IIa.
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Affiliation(s)
- Stein B M van den Heuvel
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands
| | - Ashtin Doorgakant
- Trauma and Orthopaedic Department, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, United Kingdom
| | - Merel F N Birnie
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands
| | - Chris M Blundell
- Sheffield Foot and Ankle Unit, Orthopaedic Department, Northern General Hospital, Sheffield, United Kingdom
| | - Tim Schepers
- Department of Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands.
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Kushida-Contreras BH, Gaxiola-García MA. Ultrathin free flaps for foot reconstruction: impact on ambulation, functional recovery, and patient satisfaction. J Plast Surg Hand Surg 2021; 55:380-387. [PMID: 33771082 DOI: 10.1080/2000656x.2021.1898974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Plantar reconstruction is a complex procedure due to the paucity of tissue around the foot. Tissues used for reconstruction should provide similar properties, which can be accomplished by using ultra-thin flaps. Validated functional scales may provide essential information regarding patients' evolution. METHODS Information concerning a series of 12 cases of plantar reconstruction using ultra-thin free flaps was gathered retrospectively by the authors. Data from preoperative functional scores in Lower Extremity Functional Scale and American Orthopaedic Foot and Ankle Society scale were obtained from clinical records; these were compared to postoperative scores assigned prospectively during follow-up. Differences were determined using Student's t-test for paired samples. Objective measurements concerning evolution (ulceration, footwear usage, sensation), as well as patient satisfaction, were also explored. RESULTS The mean follow-up duration was 16.5 (range 12 to 24) months. The Lower Extremity Functional Scale scores mean modified from 39.1 to 60.2, p = 0.004; the American Orthopaedic Foot and Ankle Society scale mean modified from 42.2 to 53.4, p = 0.012. No patient showed plantar ulceration. Protective sensation was achieved in 75% of the patients, and 10 out of 12 could use regular footwear. All patients reported satisfaction with the surgical procedure. CONCLUSIONS Ultra-thin flaps for foot reconstruction are related to improvement in functional scales, high rates of patient satisfaction, and use of regular footwear as well as a limited range of complications.
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Affiliation(s)
| | - Miguel Angel Gaxiola-García
- Plastic and Reconstructive Surgery Department, Mexico's Children's Hospital (Hospital Infantil de México "Federico Gómez"), Mexico City, Mexico
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Medial Cuneiform Opening Wedge Osteotomy for Correction of Flexible Flatfoot Deformity: Trabecular Titanium vs. Bone Allograft Wedges. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1472471. [PMID: 31049351 PMCID: PMC6462320 DOI: 10.1155/2019/1472471] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 03/12/2019] [Indexed: 11/18/2022]
Abstract
Adult flatfoot is a common pathology characterized by multiplanar deformity involving hindfoot, midfoot, and forefoot. Various surgical techniques have been described for the treatment but may not adequately correct the fixed forefoot varus component. Residual forefoot supination can be addressed by a plantar flexing opening wedge osteotomy of the medial cuneiform, also known as a Cotton osteotomy. Thus, the aims of this study were to compare clinical, radiological, and functional outcome after Cotton osteotomy, in patients treated with bone allograft or metallic implant. Consequently, 36 patients treated with opening wedge osteotomy of the medial cuneiform for forefoot varus were studied retrospectively. Patients were divided into two groups: the bone allograft group (HBG) (n=18) and the metallic implant group with BIOFOAM® Cotton Wedges (TTW) (n=18). Radiographic assessment and clinical scores including American Orthopaedic Foot and Ankle Society score, Foot Function Index, and visual analogue scale for pain were collected before operation and the last follow-up. The difference between baseline and follow-up for both groups was statistically significant for all the clinical scores and radiographic angles (p < 0.05). Most participants (92%) were very satisfied after surgery. Our results showed that Cotton osteotomy with a metallic implant provided both good clinical and radiographic outcomes comparable with bone allograft.
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Ortega-Avila AB, Cervera-Garvi P, Ramos-Petersen L, Chicharro-Luna E, Gijon-Nogueron G. Patient-Reported Outcome Measures for Patients with Diabetes Mellitus Associated with Foot and Ankle Pathologies: A Systematic Review. J Clin Med 2019; 8:jcm8020146. [PMID: 30691204 PMCID: PMC6407033 DOI: 10.3390/jcm8020146] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/21/2019] [Accepted: 01/24/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Diabetes mellitus (DM) is a chronic and complex disease, which is a major cause of morbidity and mortality and affects all age groups. It commonly produces secondary effects on the foot, often making daily activities impossible. Patient-reported outcome measures (PROMs) provide a standardised method of obtaining patients’ outlooks on their functional status and wellbeing. Although many instruments have been proposed for obtaining data on persons with DM whose feet are affected by the disease, in many cases the psychometric properties of the instrument have yet to be established. The principal objective of our review was to identify PROMs specific for patients with DM affecting the foot and ankle and to evaluate the psychometric properties and methodological quality of these instruments. Methods: In this systematic review, we investigate studies (published in English or Spanish) based on the use of one or more PROMs specific to foot and ankle pathologies for patients with DM (type I or II). To do so, the databases PubMed, Scopus, CINAHL, PEDro and Google Scholar were searched for studies that analysed psychometric or clinimetric properties in this respect. These were assessed according to Terwee or COSMIN criteria. Results: Of the 1016 studies identified in the initial search, only 11 were finally included in the qualitative review. Analysis according to Terwee and COSMIN criteria showed that the Foot Health Status Questionnaire (FHSQ) presented the greatest number of positive values. Conclusions: The FHSQ is the highest-quality PROM currently available for the foot and ankle, for patients with DM.
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Affiliation(s)
- Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Penalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain.
| | - Pablo Cervera-Garvi
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Penalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain.
| | - Laura Ramos-Petersen
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Penalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain.
| | - Esther Chicharro-Luna
- Department of Behavioral Sciences and Health, Miguel Hernández University, San Juan de Alicante, 03550 Alicante, Spain.
| | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Penalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain.
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain.
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Chiu YC, Chung TC, Wu CH, Tsai KL, Jou IM, Tu YK, Ma CH. Chopart amputation with tibiotalocalcaneal arthrodesis and free flap reconstruction for severe foot crush injury. Bone Joint J 2018; 100-B:1359-1363. [DOI: 10.1302/0301-620x.100b10.bjj-2018-0118.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims This study reports the outcomes of a technique of soft-tissue coverage and Chopart amputation for severe crush injuries of the forefoot. Patients and Methods Between January 2012 to December 2016, 12 patients (nine male; three female, mean age 38.58 years; 26 to 55) with severe foot crush injury underwent treatment in our institute. All patients were followed-up for at least one year. Their medical records, imaging, visual analogue scale score, walking ability, complications, and functional outcomes one year postoperatively based on the American Orthopedic Foot and Ankle Society (AOFAS) and 36-Item Short-Form Health Survey (SF-36) scores were reviewed. Results The mean length of follow-up was 18.6 months (13 to 28). Two patients had a local infection, flap necrosis was seen in one patient, and one patient experienced a skin graft wound healing delay. Of the 12 patients, one had persistent infection and eventually required below-knee amputation, but pain-free walking was achieved in all the other patients. The mean one-year postoperative AOFAS and SF-36 scores were 75.6 (68 to 80) and 82 (74 to 88), respectively. Conclusion Although our sample size was small, we believe that this treatment method may be a valuable alternative for treating severe foot crush injuries. Cite this article: Bone Joint J 2018;100-B:1359–63.
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Affiliation(s)
- Y-C. Chiu
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - T-C. Chung
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - C-H. Wu
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - K-L. Tsai
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-M Jou
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Y-K. Tu
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - C-H. Ma
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
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De Boer AS, Meuffels DE, Van der Vlies CH, Den Hoed PT, Tuinebreijer WE, Verhofstad MHJ, Van Lieshout EMM. Validation of the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale Dutch language version in patients with hindfoot fractures. BMJ Open 2017; 7:e018314. [PMID: 29138208 PMCID: PMC5695419 DOI: 10.1136/bmjopen-2017-018314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale is among the most used questionnaires for measuring functional recovery after a hindfoot injury. Recently, this instrument was translated and culturally adapted into a Dutch version. In this study, the measurement properties of the Dutch language version (DLV) were investigated in patients with a unilateral hindfoot fracture. DESIGN Multicentre, prospective observational study. SETTING This multicentre study was conducted in three Dutch hospitals. PARTICIPANTS In total, 118 patients with a unilateral hindfoot fracture were included. Three patients were lost to follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES Patients were asked to complete the AOFAS-DLV, the Foot Function Index and the Short Form-36 on three occasions. Descriptive statistics (including floor and ceiling effects), reliability (ie, internal consistency), construct validity, reproducibility (ie, test-retest reliability, agreement and smallest detectable change (SDC)) and responsiveness were determined. RESULTS Internal consistency was inadequate for the AOFAS-DLV total scale (α=0.585), but adequate for the function subscale (α=0.863). The questionnaire had adequate construct validity (82.4% of predefined hypotheses were confirmed), but inadequate longitudinal validity (70.6%). No floor effects were found, but ceiling effects were present in all AOFAS-DLV (sub)scales, most pronounced from 6 to 24 months after trauma onwards. Responsiveness was only adequate for the pain and alignment subscales, with a SDC of 1.7 points. CONCLUSIONS The AOFAS Ankle-Hindfoot Scale DLV has adequate construct validity and is reliable, making it a suitable instrument for cross-sectional studies investigating functional outcome in patients with a hindfoot fracture. The inadequate longitudinal validity and responsiveness, however, hamper the use of the questionnaire in longitudinal studies and for assessing long-term functional outcome. TRIAL REGISTRATION NUMBER NTR5613; Post-results.
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Affiliation(s)
- A Siebe De Boer
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Duncan E Meuffels
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - P Ted Den Hoed
- Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands
| | - Wim E Tuinebreijer
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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50
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de Boer AS, Tjioe RJC, Van der Sijde F, Meuffels DE, den Hoed PT, Van der Vlies CH, Tuinebreijer WE, Verhofstad MHJ, Van Lieshout EMM. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale; translation and validation of the Dutch language version for ankle fractures. BMJ Open 2017; 7:e017040. [PMID: 28775193 PMCID: PMC5588950 DOI: 10.1136/bmjopen-2017-017040] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale is among the most commonly used instruments for measuring outcome of treatment in patients who sustained a complex ankle or hindfoot injury. It consists of a patient-reported and a physician-reported part. A validated, Dutch version of this instrument is currently not available. The aim of this study was to translate the instrument into Dutch and to determine the measurement properties of the AOFAS Ankle-Hindfoot Scale Dutch language version (DLV) in patients with a unilateral ankle fracture. SETTING Multicentre (two Dutch hospitals), prospective observational study. PARTICIPANTS In total, 142 patients with a unilateral ankle fracture were included. Ten patients were lost to follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES Patients completed the subjective (patient-reported) part of the AOFAS Ankle-Hindfoot Scale-DLV. A physician or trained physician-assistant completed the physician-reported part. For comparison and evaluation of the measuring characteristics, the Foot Function Index and the Short Form-36 were completed by the patient. Descriptive statistics (including floor and ceiling effects), reliability (ie, internal consistency), construct validity, reproducibility (ie, test-retest reliability, agreement and smallest detectable change) and responsiveness were determined. RESULTS The AOFAS-DLV and its subscales showed good internal consistency (Cronbach's α >0.90). Construct validity and longitudinal validity were proven to be adequate (76.5% of predefined hypotheses were confirmed). Floor effects were not present. Ceiling effects were present from 6 months onwards, as expected. Responsiveness was adequate, with a smallest detectable change of 12.0 points. CONCLUSIONS The AOFAS-DLV is a reliable, valid and responsive measurement instrument for evaluating functional outcome in patients with a unilateral ankle fracture. This implies that the questionnaire is suitable to compare different treatment modalities within this population or to compare outcome across hospitals. TRIAL REGISTRATION The Netherlands Trial Register (NTR5613; 05-jan-2016).
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Affiliation(s)
- A Siebe de Boer
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roderik J C Tjioe
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Fleur Van der Sijde
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Duncan E Meuffels
- Department of Orthopedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | | - Wim E Tuinebreijer
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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