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Kim KC, Schmidt E, de Carvalho KAM, Lalevee M, Mansur N, Dibbern K, Auch E, Behrens A, Netto CDC. Prevalence of midfoot arthritis and lesser toe deformities. Foot Ankle Surg 2024:S1268-7731(24)00044-4. [PMID: 38490924 DOI: 10.1016/j.fas.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/23/2023] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The aim of this study was to investigate the epidemiology of Midfoot Arthritis (MA) and Lesser toe deformity (LTD) using Weight-Bearing Computed Tomography (WBCT). METHODS 606 cases (247 male, 359 female) among 1316 consecutive cases with WBCT data from September 2014 to April 2022 were retrospectively reviewed at a single referral institution. The Cochran-Armitage test was performed to evaluate the trend of prevalence with respect to age group and obesity classification. RESULTS 139 male (56.3%) and 210 female cases (58.5%) showed MA. 157 male (63.6%) and 222 female cases (61.6%) showed LTD. 115 male (19.0%) and 157 female cases (25.9%) showed both MA and LTD. The prevalence of MA and LTD increased with age in both genders. The incidence of MA in males showed an increasing tendency until obesity class II and then was slightly decreased in obesity class III. This is contrary to females whose prevalence increased with increasing obesity groups. LTD had a similar pattern in both genders to obesity classification. CONCLUSIONS The prevalence of MA and LTD increased with age and increasing obesity groups for both genders. LEVEL OF EVIDENCE Level III, Retrospective Comparative Study.
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Affiliation(s)
- Ki Chun Kim
- Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, South Korea.
| | - Eli Schmidt
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Matthieu Lalevee
- Department of Orthopedic Surgery, Rouen University Hospital, 37 Boulevard Gambetta, 76000 Rouen, France
| | - Nacime Mansur
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Kevin Dibbern
- Orthopaedic and Rehabilitation Engineering Center, Marquette and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elijah Auch
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Andrew Behrens
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Schmidt E, Lalevée M, Kim KC, Carvalho KAMD, Dibbern K, Lintz F, Barbachan Mansur NS, de Cesar Netto C. The Role of the Transverse Arch in Progressive Collapsing Foot Deformity. Foot Ankle Int 2024; 45:44-51. [PMID: 37902231 DOI: 10.1177/10711007231205298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND The transverse arch (TA) has recently been shown to significantly increase the intrinsic stiffness of the midfoot when coupled with the medial longitudinal arch (MLA). Progressive collapsing foot deformity (PCFD) is a complex deformity that ultimately results in a loss of stiffness and collapse of the MLA. The role of the TA has not been investigated in patients diagnosed with this disorder using weightbearing CT (WBCT). Therefore, this study aims to answer the following questions: (1) Is the curvature of the TA decreased in PCFD? (2) Where within the midfoot does TA curvature flattening happen in PCFD? METHODS A retrospective review of weightbearing CT images was conducted for 32 PCFD and 32 control feet. The TA curvature was assessed both indirectly using previously described methods and directly using a novel measurement termed the transverse arch plantar (TAP) angle that assesses the angle formed between the first, second, and fifth metatarsals in the coronal plane. Location of TA collapse was also assessed in the coronal plane. RESULTS The TAP angle was significantly higher in PCFD (mean 115.2 degrees, SD 10.7) than in the control group (mean 100.8 degrees, SD 7.9) (P < .001). No difference was found using the calculated normalized TA curvature between PCFD (mean 17.1, SD 4.8) and controls (mean 18.3, SD 4.0) (P = .266). Location of collapse along the TA in PCFD was most significant at the second metatarsal and medial cuneiform. CONCLUSION The TA is more collapsed in PCFD compared to controls. This collapse was most substantial between the plantar medial cuneiform and the plantar second metatarsal. This may represent a location of uncoupling of the TA and MLA. LEVEL OF EVIDENCE Level III, retrospective case control.
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Affiliation(s)
- Eli Schmidt
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Matthieu Lalevée
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Department of Orthopedic Surgery, Rouen University Hospital, Rouen, France
| | - Ki Chun Kim
- Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, South Korea
| | | | - Kevin Dibbern
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Francois Lintz
- Department of Foot and Ankle Surgery, Ramsay Healthcare, Clinique de L'Union, Saint-Jean, France
| | - Nacime Salomao Barbachan Mansur
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Federal University of Sao Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, Sau Paulo, Brazil
| | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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de Cesar Netto C, Barbachan Mansur NS, Lalevee M, Carvalho KAMD, Godoy-Santos AL, Kim KC, Lintz F, Dibbern K. Effect of Peritalar Subluxation Correction for Progressive Collapsing Foot Deformity on Patient-Reported Outcomes. Foot Ankle Int 2023; 44:1128-1141. [PMID: 37698292 DOI: 10.1177/10711007231192479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
BACKGROUND Peritalar subluxation (PTS) is part of progressive collapsing foot deformity (PCFD). This study aimed to evaluate initial deformity correction and PTS optimization in PCFD patients with flexible hindfoot deformity undergoing hindfoot joint-sparing surgical procedures and its relationship with improvements in patient-reported outcome measures (PROMs) at latest follow-up. We hypothesized that significant deformity/PTS correction would be observed postoperatively, positively correlating with improved PROMs. METHODS A prospective comparative study was performed with 26 flexible PCFD patients undergoing hindfoot joint-sparing reconstructive procedures, mean age 47.1 years (range, 18-77). We assessed weightbearing computed tomography (WBCT) overall deformity (foot and ankle offset [FAO]) and PTS markers (distance and coverage maps) at 3 months, as well as PROMs at final follow-up. A multivariate regression model assessed the influence of initial deformity correction and PTS optimization in patient-reported outcomes. RESULTS Mean follow-up was 19.9 months (6-39), and the average number of procedures performed was 4.8 (2-8). FAO improved from 9.4% (8.4-10.9) to 1.9% (1.1-3.6) postoperatively (P < .0001). Mean coverage improved by 69.6% (P = .012), 12.1% (P = .0343) and 5.2% (P = .0074) in, respectively, the anterior, middle, and posterior facets, whereas the sinus tarsi coverage decreased by an average 57.1% (P < .0001) postoperatively. Improvements in patient-reported outcomes were noted for all scores assessed (P < .03). The multivariate regression analysis demonstrated that improvement in both FAO and PTS measurements significantly influenced the assessed PROMs. CONCLUSION This study demonstrated significant improvements in the overall 3D deformity, PTS markers, and PROMs following hindfoot joint-sparing surgical treatment in patients with flexible PCFD. More importantly, initial 3D deformity correction and improvement in subtalar joint coverage and extraarticular impingement have been shown to influence PROMs significantly and positively. Addressing these variables should be considered as goals when treating PCFD. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), Iowa City, IA, USA
| | - Nacime Salomao Barbachan Mansur
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), Iowa City, IA, USA
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Matthieu Lalevee
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), Iowa City, IA, USA
- Service d'orthopédie Traumatologie, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | | | | | - Ki Chun Kim
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), Iowa City, IA, USA
- Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, Republic of Korea
| | | | - Kevin Dibbern
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), Iowa City, IA, USA
- Marquette University, Milwaukee, WI, USA
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Lalevée M, de Carvalho KAM, Barbachan Mansur NS, Kim KC, McGettigan L, Dibbern K, Easley M, de Cesar Netto C. Distribution, prevalence, and impact on the metatarsosesamoid complex of first metatarsal pronation in hallux valgus. Foot Ankle Surg 2023; 29:488-496. [PMID: 37400328 DOI: 10.1016/j.fas.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 05/25/2023] [Accepted: 06/18/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Previous simulated weight-bearing CT (WBCT) studies classifying first metatarsal (M1) pronation suggested a high prevalence of M1 hyper-pronation in hallux valgus (HV). These findings have prompted a marked increase in M1 supination in HV surgical correction. No subsequent study confirms these M1 pronation values, and two recent WBCT investigations suggest lower normative M1 pronation values. The objectives of our WBCT study were to (1) determine M1 pronation distribution in HV, (2) define the hyperpronation prevalence compared to preexisting normative values, and (3) assess the relationship of M1 pronation to the metatarso-sesamoid complex. We hypothesized that the M1 head pronation distribution would be high in HV. METHODS We retrospectively identified 88 consecutive feet with HV in our WBCT dataset and measured M1 pronation with the Metatarsal Pronation (MPA) and α angles. Similarly, using two previously published methods defining the pathologic pronation threshold, we assessed our cohort's M1 hyper-pronation prevalence, specifically (1) the upper value of the 95% confidence interval (CI95) and (2) adding two standard deviations at the mean normative value (2 SD). Sesamoid station (grading) was assessed on the coronal plane. RESULTS The mean MPA was 11.4+/-7.4 degrees and the α angle was 16.2+/-7.4 degrees. According to the CI95 method, 69/88 HV (78.4%) were hyperpronated using the MPA, and 81/88 HV (92%) using the α angle. According to the 2 SD method, 17/88 HV (19.3%) were hyperpronated using the MPA, and 20/88 HV (22.7%) using the α angle. There was a significant difference in MPA among sesamoid gradings (p = 0.025), with a paradoxical decrease in MPA when metatarsosesamoid subluxation was increased. CONCLUSION M1 head pronation distribution in HV was higher than in normative values, but threshold change demonstrated contradictory hyper-pronation prevalences (85% to 20%), calling into question the previously reported high prevalence of M1 hyper-pronation in HV. An increase in sesamoid subluxation was associated with a paradoxical decrease in M1 head pronation in our study. We suggest that a greater understanding of the impact of HV M1 pronation is warranted before routine M1 surgical supination is recommended for patients with HV. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Matthieu Lalevée
- Department of Orthopedic Surgery, Rouen University Hospital, 37 Boulevard Gambetta, 76000 Rouen, France; University of Iowa, Carver College of Medicine, Department of Orthopedics and Rehabilitation, Iowa City, IA, USA.
| | | | | | - Ki Chun Kim
- University of Iowa, Carver College of Medicine, Department of Orthopedics and Rehabilitation, Iowa City, IA, USA.
| | - Lily McGettigan
- University of Iowa, Carver College of Medicine, Department of Orthopedics and Rehabilitation, Iowa City, IA, USA.
| | - Kevin Dibbern
- University of Iowa, Carver College of Medicine, Department of Orthopedics and Rehabilitation, Iowa City, IA, USA.
| | - Mark Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA.
| | - Cesar de Cesar Netto
- University of Iowa, Carver College of Medicine, Department of Orthopedics and Rehabilitation, Iowa City, IA, USA.
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Dibbern K, Vivtcharenko V, Salomao Barbachan Mansur N, Lalevée M, Alencar Mendes de Carvalho K, Lintz F, Barg A, Goldberg AJ, de Cesar Netto C. Distance mapping and volumetric assessment of the ankle and syndesmotic joints in progressive collapsing foot deformity. Sci Rep 2023; 13:4801. [PMID: 36959355 PMCID: PMC10036322 DOI: 10.1038/s41598-023-31810-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/17/2023] [Indexed: 03/25/2023] Open
Abstract
The early effects of progressive collapsing foot deformity (PCFD) on the ankle and syndesmotic joints have not been three-dimensionally quantified. This case-control study focused on using weight bearing CT (WBCT) distance (DM) and coverage maps (CM) and volumetric measurements as 3D radiological markers to objectively characterize early effects of PCFD on the ankle and syndesmotic joints. Seventeen consecutive patients with symptomatic stage I flexible PCFD and 20 matched controls that underwent foot/ankle WBCT were included. Three-dimensional DM and CM of the ankle and syndesmotic joints, as well volumetric assessment of the distal tibiofibular syndesmosis was performed as possible WBCT markers of early PCFD. Measurements were compared between PCFD and controls. Significant overall reductions in syndesmotic incisura distances were observed in PCFD patients when compared to controls, with no difference in the overall syndesmotic incisura volume at 1, 3, 5 and 10 cm proximally to the ankle joint. CMs showed significantly decreased articular coverage of the anterior regions of the tibiotalar joint as well as medial/lateral ankle joint gutters in PCFD patients. This study showed syndesmotic narrowing and decreased articular coverage of the anterior aspect of the ankle gutters and talar dome in stage I PCFD patients when compared to controls. These findings are consistent with early plantarflexion of the talus within the ankle Mortise, and absence of true syndesmotic overload in early PCFD, and support DM and CM as early 3D PCFD radiological markers.
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Affiliation(s)
- Kevin Dibbern
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Victoria Vivtcharenko
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Nacime Salomao Barbachan Mansur
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Matthieu Lalevée
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
- Service d'orthopédie Traumatologie, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Kepler Alencar Mendes de Carvalho
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | | | - Alexej Barg
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Hamburg, Hamburg, Germany
| | | | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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Dibbern K, Talaski G, Schmidt E, Jasper R, Mallavarapu V, Jones M, Stebral H, Behrens A, Alencar Mendes de Carvalho K, Chun Kim K, Barbachan Mansur NS, De César Netto C. Ankle syndesmotic instability assessment using a three-dimensional distance mapping algorithm: a cadaveric pilot WBCT study. J Foot Ankle 2022. [DOI: 10.30795/jfootankle.2022.v16.1673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective: This cadaveric pilot study was to develop a weight bearing computed tomography (WBCT) three-dimensional (3D) distance mapping algorithm that would allow for detection of syndesmotic instability. Methods: Pilot study, two cadaveric specimens. Syndesmotic instability was induced by release of all syndesmotic ligaments through a conventional lateral ankle approach. WBCT imaging under simulated weight bearing was acquired before and after syndesmotic destabilization. Syndesmotic incisura and ankle gutter distances were assessed using a 3D distance mapping WBCT algorithm. Results: We found increases in the overall mean syndesmotic distances in the injured syndesmosis when compared to pre-injury state, and color coded distance maps allowed easy interpretation of the syndesmotic widening following ligament sectioning and destabilization of the syndesmotic joint. Conclusion: The WBCT 3D distance mapping algorithm has the potential to allow detection of mild syndesmotic instability with a relatively ease of interpretation by using color-coded distance maps. Level of Evidence V; Cadaveric Study.
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Jasper R, Mallavarapu V, Stebral H, Jones M, VandeLune C, Schmidt E, Talaski G, Fayed A, Alencar Mendes de Carvalho K, Chun Kim K, Barbachan Mansur NS, Dibbern K, De César Netto C. Three-dimensional assessment of hallux valgus correction using the Lapicotton technique. J Foot Ankle 2022. [DOI: 10.30795/jfootankle.2022.v16.1674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective: The objective of the study was to assess the efficacy of the LapiCotton procedure on patients with hallux valgus (HV) combined with medial longitudinal arch collapse. Methods: Preoperative and postoperative weight-bearing computed tomography (WBCT) scans were obtained from patients with HV submitted to the LapiCotton procedure. Semi-automatic measurements were applied to 22 WBCT images across 11 patients enrolled in the study using a software package (Bonelogic, Disior™, Helsinki, Finland). Significance level was set at 0.05. Results: The hallux valgus angle (HVA) was significantly larger (p=0.026) in the preoperative group (Mdn = 27.52) than in the postoperative group (Mdn = 20). In addition, the Meary sagittal measurement was found to be significantly increased (p=0.033) in the preoperative group (Mdn = -14.28) when compared to the postoperative group (Mdn = -11.15). It was also observed that the intermetatarsal angle was significantly larger (p=0.003) in the preoperative group (Mdn = 15.68) compared to the postoperative group (Mdn = 11.26). Conclusion: The LapiCotton procedure effectively corrected radiographic parameters in patients with HV combined with the medial longitudinal arch collapse. Level of Evidence III; Therapeutic Studies; Comparative Retrospective Study.
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de Carvalho KAM, Mallavarapu V, Ehret A, Dibbern K, Lee HY, Barbachan Mansur NS, Laleveé M, de Cesar Netto C. The Use of Advanced Semiautomated Bone Segmentation in Hallux Rigidus. Foot & Ankle Orthopaedics 2022; 7:24730114221137597. [PMCID: PMC9716603 DOI: 10.1177/24730114221137597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Weightbearing computed tomography (WBCT) measurements allow evaluation of several anatomical points for a correct clinical-radiographic diagnosis of pathologies, such as hallux rigidus (HR). In addition, a new semiautomatic segmentation software obtains automated 3D measurements from WBCT scan data sets, minimizing errors in reading angular measurements. The study’s objective was (1) to evaluate the reliability of WBCT semiautomatic imaging measures in HR, (2) to evaluate correlation and agreement between manual and semiautomatic measures in the setting of HR, and (3) to compare semiautomatic measurements between pathologic (HR) and standard control groups. Methods: A retrospective study of HR patients was performed including 20 feet with HR. WBCT manual and semiautomatic 3D measurements were performed using the following parameters: (1) first metatarsal-proximal phalanx angle (1stMPP), (2) hallux valgus angle (HVA), (3) first to second intermetatarsal angle (IMA), (4) hallux interphalangeal angle (IPA), (5) first metatarsal length (1stML), (6) second metatarsal length (2ndML), (7) first metatarsal declination angle (1stMD), (8) second metatarsal declination angles (2ndMD), and (9) metatarsus primus elevatus (MPE). The differences between pathologic and control cases were assessed with a Wilcoxon test. Results: Interobserver and intraobserver agreement for manual vs semiautomatic WBCT measurements demonstrated excellent reliability. According to the Pearson coefficient, there was a strong positive linear correlation between both methods for the following parameters evaluated: HVA (ρ = 0.96), IMA (ρ = 0.86), IPA (ρ = 0.89), 1stML (ρ = 0.96), 2ndML (ρ = 0.91), 1stMD (ρ = 0.86), 2ndMD (ρ = 0.95), and MPE (ρ = 0.87). Comparison between the pathologic group with HR and the control (standard) group allowed for the differentiating of the pathologic (HR) from the non-pathologic conditions for MPE (p < 0.05). Conclusion: Semiautomatic measurements are reproducible and comparable to measurements performed manually, showing excellent interobserver and intraobserver agreement. The software used differentiated pathologic from nonpathologic conditions when submitted to semiautomatic MPE measurements. Level of Evidence: Level III, retrospective comparative study.
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Affiliation(s)
| | - Vineel Mallavarapu
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Amanda Ehret
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Kevin Dibbern
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA,Kepler Alencar Mendes de Carvalho, MD, Department of Orthopaedics and Rehabilitation, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA 52242, USA.
| | - Hee Young Lee
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Nacime Salomao Barbachan Mansur
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA,Department of Orthopedics and Traumatology, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Matthieu Laleveé
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA,Department of Orthopedic Surgery, Rouen University Hospital, Rouen, France
| | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Behrens A, Dibbern K, Lalevée M, Alencar Mendes de Carvalho K, Lintz F, Barbachan Mansur NS, de Cesar Netto C. Coverage maps demonstrate 3D Chopart joint subluxation in weightbearing CT of progressive collapsing foot deformity. Sci Rep 2022; 12:19367. [PMID: 36371449 PMCID: PMC9653439 DOI: 10.1038/s41598-022-23638-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022] Open
Abstract
A key element of the peritalar subluxation (PTS) seen in progressive collapsing foot deformity (PCFD) occurs through the transverse tarsal joint complex. However, the normal and pathological relations of these joints are not well understood. The objective of this study to compare Chopart articular coverages between PCFD patients and controls using weight-bearing computed tomography (WBCT). In this retrospective case control study, 20 patients with PCFD and 20 matched controls were evaluated. Distance and coverage mapping techniques were used to evaluate the talonavicular and calcaneocuboid interfaces. Principal axes were used to divide the talar head into 6 regions (medial/central/lateral and plantar/dorsal) and the calcaneocuboid interface into 4 regions. Repeated selections were performed to evaluate reliability of joint interface identification. Surface selections had high reliability with an ICC > 0.99. Talar head coverage decreases in plantarmedial and dorsalmedial (- 79%, p = 0.003 and - 77%, p = 0.00004) regions were seen with corresponding increases in plantarlateral and dorsolateral regions (30%, p = 0.0003 and 21%, p = 0.002) in PCFD. Calcaneocuboid coverage decreased in plantar and medial regions (- 12%, p = 0.006 and - 9%, p = 0.037) and increased in the lateral region (13%, p = 0.002). Significant subluxation occurs across the medial regions of the talar head and the plantar medial regions of the calcaneocuboid joint. Coverage and distance mapping provide a baseline for understanding Chopart joint changes in PCFD under full weightbearing conditions.
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Affiliation(s)
- Andrew Behrens
- grid.214572.70000 0004 1936 8294Department of Orthopedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Kevin Dibbern
- grid.214572.70000 0004 1936 8294Department of Orthopedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Matthieu Lalevée
- grid.214572.70000 0004 1936 8294Department of Orthopedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA ,grid.41724.340000 0001 2296 5231Service d’orthopédie Traumatologie, Centre Hospitalier Universitaire de Rouen, 37 Boulevard Gambetta, 76000 Rouen, France
| | - Kepler Alencar Mendes de Carvalho
- grid.214572.70000 0004 1936 8294Department of Orthopedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Francois Lintz
- Clinique de L’Union, Bd Ratalens, 31240 Saint-Jean, France
| | - Nacime Salomao Barbachan Mansur
- grid.214572.70000 0004 1936 8294Department of Orthopedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA ,grid.411249.b0000 0001 0514 7202Department of Orthopedics and Traumatology, Escola Paulista de Medicina UNIFESP, São Paulo, SP Brazil
| | - Cesar de Cesar Netto
- grid.214572.70000 0004 1936 8294Department of Orthopedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA
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Bates B, Albright J, Methenitis A, Dibbern K, Losee R, Albright J. Low-Profile Modifications of the Losee Pivot Shift Test for Assessment of an ACL-Deficient Knee in the Awake Patient. Video Journal of Sports Medicine 2022. [DOI: 10.1177/26350254221122557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Pivot shift test results have demonstrated widely inconsistent sensitivities when used on awake clinic patients. We believe the painful valgus force applied during traditional pivot shift techniques is the primary culprit and can be circumvented with our novel examination technique. Indications: The reason for publishing this examination technique is to maximize the sensitivity and accuracy of the pivot shift examination in the awake patient. Technique Description: Four major modifications of Ronald Losee’s original valgus-based examination technique are introduced. These are the 4 general modifications: minimizing the sagittal plane arc of motion, avoiding applying valgus force to the knee, application of gentle anteriorly directed force to the lateral tibia, and performing the examination on the patient’s noninjured knee first. We also provide detailed description of the hand placement during the Albright-Losee pivot shift test. (1) Once the patient is relaxed, the examiner’s hands are placed as follows: (1) the ulnar side of the examiner’s thumb is applied to the posterior aspect of the fibular head. The fingers are placed above the patella on the distal femur as shown in the video. (2) With the examiner’s hands in the correct position, the knee is flexed to 20° to 30°. One-to-3 pounds of anterior translatory force is then applied by the side of the thumb to the fibular head while the knee is taken slowly toward extension. Pathological anterior tibial translation can be expected to begin in a 20° to 30° range short of the patient’s complete knee extension. The examiner must be conscious not to provide any valgus or additional internal or external rotation of the leg. Results: This examination is useful for reproducing the subluxation phenomenon in anterior cruciate ligament (ACL)-deficient knees. Our work has shown that these modifications yield an accuracy of 95.51% and a sensitivity of 94.7% in 353 knees examined by 71 clinicians. Discussion/Conclusion: The Albright-Losee pivot shift test is an easy to perform, highly sensitive, and highly specific test. In our recently submitted American Journal of Sports Medicine manuscript, the Albright-Losee pivot shift test suggested to be of greater value than Lachman test. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
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Affiliation(s)
- Brandon Bates
- The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa, USA
| | - Jay Albright
- Children’s Hospital Colorado, Aurora, Colorado, USA
| | | | - Kevin Dibbern
- The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa, USA
| | | | - John Albright
- The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa, USA
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Lalevée M, Barbachan Mansur NS, Dibbern K, Briggs H, Maly CJ, Carvalho KAMD, Lintz F, de Cesar Netto C. Coronal Plane Rotation of the Medial Column in Hallux Valgus: A Retrospective Case-Control Study. Foot Ankle Int 2022; 43:1041-1048. [PMID: 35502523 DOI: 10.1177/10711007221091810] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We previously reported an increase in pronation of the first metatarsal (M1) head relative to the ground in hallux valgus (HV) patients compared to controls. Still, the origin and location of this hyperpronation along the medial column is unknown. Recent studies showed that presence of progressive collapsing foot deformities (PCFDs), which is a condition frequently associated with HV, can strongly influence the medial column coronal plane alignment. The objective of this study was to assess the coronal rotation of the medial column bones in HV feet, HV feet with radiologic markers of PCFD, and controls. We hypothesized that hyperpronation in HV will originate from a combination of M1 intrinsic torsion and first tarsometatarsal joint malposition. METHODS The same cohort of 36 HV and 20 controls matched on age, gender, and body mass index was used. Previously, a validation of the measurements was carried out through a cadaveric study. Using these metrics, we assessed the coronal plane rotation of the navicular, medial cuneiform, and the M1 at its base and head with respect to the ground using weightbearing CT images. We measured the Meary angle and the calcaneal moment arm in our 36 HV subjects. We subdivided our cohort into an HV group and a potential PCFD HV group according to these measurements. Comparisons on medial column bones coronal rotation were performed between HV, PCFD HV, and control groups. RESULTS Twenty-two HV cases were included in the HV group and 14 in the PCFD HV group. Both groups presented an increase in pronation of the first metatarsal head relative to the ground when compared to the control group (P < .001). Comparing HV and controls showed an 8.3 degrees increase in pronation of M1 intrinsic torsion (P < .001) and a 4.7 degrees pronated malposition of the first tarsometatarsal joint (P = .02) in HV. A 9.7 degrees supinated malposition of the first naviculocuneiform joint (P < .001) was also observed in HV. Comparing PCFD HV and controls showed a significant increase in pronation of the navicular (respectively, 17.2 ± 5.4 and 12.3 ± 3.4 degrees, P = .007) and a 5.5 degrees increase in pronation of M1 intrinsic torsion (P = .02) in PCFD HV, without malposition of the first tarsometatarsal and naviculocuneiform joints. CONCLUSION Hyperpronation of the M1 head relative to the ground originated from both increases in pronation of M1 intrinsic torsion and first tarsometatarsal joint malposition in HV, although partially counterbalanced by a supinated malposition of the first naviculocuneiform joint. On the other hand, PCFD HV patients showed a generalized pronated position throughout the medial column from the navicular to the M1 head and may be related to the midfoot and hindfoot deformities frequently present in PCFD. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Matthieu Lalevée
- Department of Orthopedics and Rehabilitation, University of Iowa, Carver College of Medicine, Iowa City, IA, USA.,Department of Orthopedic Surgery, Rouen University Hospital, Rouen, France
| | - Nacime Salomao Barbachan Mansur
- Department of Orthopedics and Rehabilitation, University of Iowa, Carver College of Medicine, Iowa City, IA, USA.,Department of Orthopedics and Traumatology, Federal University of Sao Paulo, Paulista School of Medicine, Sao Paulo, SP, Brazil
| | - Kevin Dibbern
- Department of Orthopedics and Rehabilitation, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - Hunter Briggs
- Department of Orthopedics and Rehabilitation, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - Connor J Maly
- Department of Orthopedics and Rehabilitation, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | | | - François Lintz
- Ramsay Santé Clinique De L'union, Centre de Chirurgie de la Cheville et du Pied. Boulevard Ratalens, Saint-Jean, France
| | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
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12
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de Cesar Netto C, Ehret A, Walt J, Chinelati RMK, Dibbern K, de Carvalho KAM, Tazegul TE, Lalevee M, Mansur NSB. Early results and complication rate of the LapiCotton procedure in the treatment of medial longitudinal arch collapse: a prospective cohort study. Arch Orthop Trauma Surg 2022; 143:2283-2295. [PMID: 35312845 PMCID: PMC10110656 DOI: 10.1007/s00402-022-04399-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Instability/collapse of the medial column has been associated with many conditions, particularly progressive collapsing foot deformity (PCFD), hallux valgus (HV), and midfoot arthritis (MA). Restoration of first ray length and sagittal plane alignment to restore the foot tripod is essential when treating these deformities. This study aimed to assess early results, healing, and complication rate of a distraction dorsal opening plantarflexion wedge allograft first tarsometatarsal joint fusion (LapiCotton Procedure) in patients with collapse/instability of the medial column. METHODS In this prospective cohort study, we included PCFD, HV, and MA patients that underwent a LapiCotton procedure. Fusion site healing was defined by > 50% bone bridging in both interfaces between allograft wedge and host bone using weight-bearing computed tomography (WBCT) after 3 months. First ray collapse radiographic correction and minor and major complications (deep dehiscence, deep infection, and reoperation) were assessed. RESULTS A total of 22 patients (22 feet) were included (11 PCFD, 6 MA, and 5 of HV patients). Mean follow-up was 5.9 months (range 3-12) and median allograft size was 8 mm (range 5-19 mm). Bone healing was observed in 91% of cases. Two minor complications (9%, both superficial dehiscence) and one major complication (4.5%, deep infection) were observed. Statistically significant improvement of the sagittal plane talus-first metatarsal angle was observed, with mean improvement of 9.4° (95% CI 6.7-12.1°; p < 0.0001). CONCLUSION In this prospective cohort study of 22 patients treated with the LapiCotton procedure for medial longitudinal arch collapse/instability, we observed a low complication rate (9% minor, 4.5% major), high healing rate after 3 months (91%), one clinically stable radiographic non-union (4.5%) and one unstable non-union (4.5%) needing reoperation. Our results demonstrate promising initial results for LapiCotton technique in treating collapse of the medial longitudinal arch in patients with PCFD, MA and HV deformities. Long-term results are needed to confirm these promising results. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Amanda Ehret
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Jennifer Walt
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | | | - Kevin Dibbern
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Kepler Alencar Mendes de Carvalho
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Tutku Erim Tazegul
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Matthieu Lalevee
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA.,Department of Orthopedic Surgery, Rouen University Hospital, Rouen, France
| | - Nacime Salomão Barbachan Mansur
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA.,Department of Orthopedics and Traumatology, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
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13
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Barbachan Mansur NS, Lalevee M, Maly C, Dibbern K, Lee HY, Godoy-Santos AL, Lintz F, de Cesar Netto C. Association Between Middle Facet Subluxation and Foot and Ankle Offset in Progressive Collapsing Foot Deformity. Foot Ankle Int 2022; 43:96-100. [PMID: 34581232 DOI: 10.1177/10711007211040820] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Subtalar middle facet (MF) subluxation was recognized as a reliable marker for progressive collapsing foot deformity (PCFD) diagnosis. Foot and Ankle Offset (FAO) is an established measurement, predictive of malalignment severity. The objective of this study was to assess the potential association between MF subluxation and FAO in PCFD patients. METHODS 56 individuals with flexible PCFD (74 feet) were assessed. Two blinded foot and ankle surgeons calculated MF uncoverage, MF incongruence, and FAO. Agreement was quantified using intraclass correlation coefficient (ICC). A multivariate regression analysis and partition prediction models were applied to assess relationship between values. RESULTS All ICCs were >0.80. MF subluxation and FAO were found to be correlated (rs = 0.56; P < .0001). Changes in the MF subluxation were noticeably explained by FAO and BMI (R2 = 0.33). MF incongruence was not correlated with the assessed variables (P = .10). In this cohort, an MF subluxation of 27.5% was a threshold for increased FAO (FAO of 3.4%±2.4% when below; FAO of 8.0% ±3.5% when above). CONCLUSION We found a correlation between MF subluxation and FAO. An MF subluxation of 27.5% was found to be a threshold for higher FAO, which corresponded to a greater malalignment. These data may help surgeons optimize treatment decisions in PCFD patients. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Nacime Salomão Barbachan Mansur
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), Iowa City, IA, USA.,Department of Orthopedics and Traumatology, Escola Paulista de Medicina - UNIFESP, São Paulo, Brazil
| | - Matthieu Lalevee
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), Iowa City, IA, USA.,Department of Orthopedic Surgery, Rouen University Hospital, Rouen, France
| | - Connor Maly
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), Iowa City, IA, USA
| | - Kevin Dibbern
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), Iowa City, IA, USA
| | - Hee Young Lee
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), Iowa City, IA, USA
| | | | | | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), Iowa City, IA, USA
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14
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Braza S, Salomão Barbachan Mansur N, Mallavarapu V, Alencar Mendes de Carvalho K, Dibbern K, Augusto de Souza Nery C, Laleveé M, de César Netto C. Hallux valgus measurements using weight-bearing computed tomography: what changes? J Foot Ankle 2021. [DOI: 10.30795/jfootankle.2021.v15.1600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: To assess whether traditional hallux valgus (HV) measurements obtained with conventional radiography (CR) correspond to those obtained with weight-bearing computed tomography (WBCT). Methods: In this retrospective case-control study, 26 HV feet and 20 control feet were analyzed with CR and WBCT. Hallux valgus angle (HVA), intermetatarsal angle (IMA), interphalangeal angle (IPA), distal metatarsal articular angle (DMAA), sesamoid station (SS), and first metatarsal head shape were measured. Chi-square tests were used to compare hallux valgus and control patients. T-tests were used to compare CR and WBCT. P-values less than 0.05 were considered significant. Results: WBCT was capable of discriminating patients with HV from controls, showing higher mean values for HV patients than controls in HVA (35.29 and 9.02, p < 0.001), IMA (16.01 and 10.01, p < 0.001), and DMAA (18.90 and 4.10, p < 0.001). When comparing the two methods, differences were not significant between CR and WBCT measurements in HVA (-0.84, p = 0.79), IMA (-0.93, p = 0.39), IPA (1.53, p = 0.09), or SS (p = 0.40), but were significant for DMAA (13.43, p < .0001). CR analysis yielded varied metatarsal head shapes, while all WBCT shape classifications were round. Conclusion: Unidimensional HV measurements were similar between WBCT and CR, while more three-dimensional findings were not. CR may be used to assess the axial aspects of HV, but multidimensional aspects of the deformity may not be accurately assessed with plain radiographs. Level of Evidence III; Therapeutic Studies; Retrospective Case-Control Study.
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15
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Rojas EO, Barbachan Mansur NS, Dibbern K, Lalevee M, Auch E, Schmidt E, Vivtcharenko V, Li S, Phisitkul P, Femino J, de Cesar Netto C. Weightbearing Computed Tomography for Assessment of Foot and Ankle Deformities: The Iowa Experience. Iowa Orthop J 2021; 41:111-119. [PMID: 34552412 PMCID: PMC8259196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Weightbearing computed tomography (WBCT) is a reliable and precise modality for the measurement and analysis of bone position in the foot and ankle, as well as associated deformities. WBCT to assess three dimensional relationships among bones allowed the development of new measurements, as the Foot and Ankle Offset (FAO), which has high inter and intra-rater reliability. This study reports the University of Iowa's experience utilizing WBCT for the care of foot and ankle patients by describing its utility across different orthopedic diseases in improving diagnostic assessment, aiding surgical planning, and expanding the use for objective clinical follow-up. METHODS The medical records of consecutive patients with various foot and ankle disorders that underwent WBCT examination as part of the standard of care at a single institution between November 2014 and August 2020 were retrospectively reviewed. Patient factors, including body mass index (BMI), sex, and patient comorbidities were collected. 3D coordinates for calculation of FAO were harvested using the Multiplanar Reconstruction (MPR) views were calculated from the obtained exams. Descriptive statistics were performed with Shapiro-Wilk test and the Anderson-Darling tests. RESULTS 1175 feet and ankles (820 patients) had a WBCT performed over the studied 68 months. 53% of the subjects were male and 47% female. 588 of the acquisitions were from the right side (50.04%) and 587 from the left side (49.96%). Diabetes was present in 15.47% of, Rheumatic diagnoses in 4.52% and smoking habits in 44.10% of patients. Mean BMI of the sample was found to be 32.47 (32.03-32.90, 95% CI). The mean Foot and Ankle Offset (FAO) encountered in the study's population was 2.43 (2.05-2.82, 95% CI; min -30.8, max 37.65; median 2.39). CONCLUSION This study contains the largest cohort of WBCTs with accompanied FAO measurements to date, which can aid with establishing a new baseline FAO measurement for multiple pathological conditions. Acquiring WBCTs resulted in a variety of more specific diagnoses for patient with foot and ankle complaints. The ability to utilize WBCT for presurgical planning, the capability to provide a 3D reconstruction of patient anatomy, and its use for assessment of advanced relational foot and ankle measurements, such as FAO, demonstrate how WBCT may serve as a remarkable utility in clinical practice and has become a standard of care in our practice at the University of Iowa.Level of Evidence: IV.
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Affiliation(s)
- Edward O. Rojas
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | | | - Kevin Dibbern
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Matthieu Lalevee
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Elijah Auch
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Eli Schmidt
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Victoria Vivtcharenko
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Shuyuan Li
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | | | - John Femino
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
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16
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De Cesar Netto C, Ahrenholz S, Iehl C, Vivtcharenko V, Schmidt E, Lee H, Dibbern K, Mansur N. Lapicotton technique in the treatment of progressive collapsing foot deformity. J Foot Ankle 2020. [DOI: 10.30795/jfootankle.2020.v14.1215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We present a technical surgical description of a 36-year-old female diagnosed with Progressive Collapsing Foot Deformity (PCFD) treated with a medial displacement calcaneus osteotomy, a lateral column lengthening, and a modified Lapidus fusion. In order to increase the plantar flexion power of this arthrodesis and minimize the loss in ray length with joint preparation, a bone block structured graft was used. Fixation was performed using a post implant in the medial cuneiform with crossing screws though the surfaces and the graft. Forefoot varus was properly corrected intraoperatively by using the described surgical technique. Satisfactory functional short-term results and an excellent alignment was accomplished. Level of Evidence V; Therapeutic Studies; Expert Opinion.
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de Cesar Netto C, Silva T, Li S, Mansur NS, Auch E, Dibbern K, Femino JE, Baumfeld D. Assessment of Posterior and Middle Facet Subluxation of the Subtalar Joint in Progressive Flatfoot Deformity. Foot Ankle Int 2020; 41:1190-1197. [PMID: 32590925 DOI: 10.1177/1071100720936603] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Adult acquired flatfoot deformity (AAFD) is a complex 3-dimensional pathology characterized by peritalar subluxation (PTS) of the hindfoot. For many years, PTS was measured at the posterior facet of the subtalar joint. More recently, subluxation of the middle facet has been proposed as a more accurate and reliable marker of symptomatic AAFD, enabling earlier detection. The objective of this study was to compare the amount of subluxation between the medial and posterior facets in patients with AAFD. METHODS In this institutional review board-approved retrospective comparative study, a total of 76 patients with AAFD (87 feet) who underwent standing weightbearing computed tomography (WBCT) as a standard baseline assessment of their foot deformity were analyzed. Two blinded fellowship-trained orthopedic foot and ankle surgeons with >10 years of experience measured subtalar joint subluxation (as a percentage of joint uncoverage) at the both posterior and middle facets. One of the readers also measured the foot and ankle offset (FAO). PTS measurements were performed at the sagittal midpoint of the articular facets using coronal plane WBCT images. Intra- and interobserver agreement was measured for PTS measurements using the intraclass correlation coefficient (ICC). The intermethod agreement between the posterior and middle facet subluxation was assessed using Spearman's correlation and bivariate analysis. Paired comparison of the measurements was performed using the Wilcoxon test. A multivariate analysis and a partition prediction model were used to assess influence of PTS measurements on FAO values. P values of <.05 were considered significant. RESULTS ICCs for intra- and interobserver reliabilities were 0.97 and 0.93, respectively, for posterior and 0.99 and 0.97, respectively, for middle facet subluxation. The intermethod Spearman's correlation between subluxation of the posterior and middle facets was measured at 0.61. In a bivariate analysis, both measurements were found to be significantly and linearly correlated (P < .0001; R2 = 0.42). Measurements of middle facet subluxation were found to be significantly higher than those for posterior facet subluxation, with a median difference (using the Hodges-Lehman factor) of 17.7% (P < .001; 95% CI, 10.9%-23.6%). We also found that for every 1% increase in posterior facet subluxation there was a corresponding 1.6-fold increase in middle facet subluxation. Only middle facet subluxation measurements were found to significantly influence FAO calculations (P = .003). The partition prediction model demonstrated that a middle facet subluxation value of 43.8% represented an important threshold for increased FAO. CONCLUSION This study is the first to compare WBCT measurements of subtalar joint subluxation at the posterior and middle facets as markers of PTS in patients with AAFD. We found a positive linear correlation between the measurements, with subluxation of the middle facet being significantly more pronounced than that of the posterior facet by an average of almost 18%. This suggests that middle facet subluxation may provide an earlier and more pronounced marker of progressive PTS in patients with AAFD. LEVEL OF EVIDENCE Level III, retrospective comparative cohort study.
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Affiliation(s)
- Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Thiago Silva
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.,Hospital Madre Teresa, Orthopedics, Belo Horizonte, MG, Brazil
| | - Shuyuan Li
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Nacime Salomao Mansur
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.,Foot and Ankle Service, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Elijah Auch
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Kevin Dibbern
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - John E Femino
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
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Day MA, Ho M, Dibbern K, Rao K, An Q, Anderson DD, Marsh JL. Correlation of 3D Joint Space Width From Weightbearing CT With Outcomes After Intra-articular Calcaneal Fracture. Foot Ankle Int 2020; 41:1106-1116. [PMID: 32648780 PMCID: PMC8162170 DOI: 10.1177/1071100720933891] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Posttraumatic osteoarthritis (PTOA) of the subtalar joint is a serious, disabling, and frequent complication following intra-articular calcaneal fractures (IACFs). Using plain radiographs to assess the subtalar joint for PTOA is imprecise and insensitive, hindering progress toward improving treatment and assessing outcomes. This study explored how low-dose weightbearing computed tomography (WBCT) can be used to provide reliable, quantitative 3D measures of subtalar joint space width (JSW) following IACF and correlated the 3D JSW with clinical outcomes. METHODS After institutional review board approval, 21 patients (15 male; age, 28-70 years) who sustained IACFs and were treated with percutaneous surgical reduction underwent WBCT scans at follow-up visits 2 to 15 years (average, 7.8 years) after surgical treatment. Subtalar joint 3D JSW was computed after a semiautomated protocol was used to segment the talus and calcaneus from the WBCT data. Mean and minimum 3D JSW measurements were calculated and compared with Kellgren-Lawrence (KL) radiographic osteoarthritis grade, RAND-36 Physical (PCS) and Mental (MCS) Component Scores, and visual analog scale (VAS) pain scores. Spearman's rank correlation was used to detect the strength of association between variables, with significance set at P < .05. RESULTS Mean 3D JSW values measured from WBCT for patients with IACFs ranged from 0.9 to 2.5 mm (1.7 ± 0.4 mm) over the entire subtalar joint. Intra- and interrater reliabilities for the WBCT-based JSW measurement technique were 0.95 (95% CI, 0.91-0.97) and 0.97 (95% CI, 0.95-0.98), respectively. Mean and minimum 3D JSW values correlated inversely with VAS pain scores and KL grade (P < .05), particularly in central and posterior subtalar regions. CONCLUSION WBCT-based methods were used to quantify the preservation/loss of JSW in patients with IACFs, enabling more accurate, definitive measurement of subtalar PTOA. The results of this study demonstrate that WBCT can be utilized to objectively assess subtalar PTOA and help us to better understand how arthritic changes affect actual patient experience. LEVEL OF EVIDENCE Level III, prognostic comparative study.
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Affiliation(s)
- Molly A. Day
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Michael Ho
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Kevin Dibbern
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA,Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Karan Rao
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Qiang An
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Donald D. Anderson
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA,Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - J. Lawrence Marsh
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
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Rao K, Dibbern K, Day M, Glass N, Marsh JL, Anderson DD. Correlation of Fracture Energy With Sanders Classification and Post-traumatic Osteoarthritis After Displaced Intra-articular Calcaneus Fractures. J Orthop Trauma 2019; 33:261-266. [PMID: 30640298 PMCID: PMC6476631 DOI: 10.1097/bot.0000000000001432] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To quantify fracture severity for a series of displaced intra-articular calcaneal fractures (DIACFs) and to correlate it with Sanders classification, post-traumatic osteoarthritis (PTOA), and patient outcomes. DESIGN Retrospective review and fracture severity analysis. SETTING Level 1 trauma center affiliated with the University of Iowa in Iowa City, IA. PATIENTS/PARTICIPANTS Thirty-six patients with 48 DIACFs were selected from 153 patients previously treated. All patients 18 years of age and older who had available electronic preop and postop computed tomography (CT) scans, good-quality postop and follow-up radiographs, and a follow-up ≥18 months were selected for study. INTERVENTION Fractures were treated with percutaneous reduction, using multiple small stab incisions and fluoroscopy to guide manipulation of articular fragments using cork screws or Steinmann pins, with subsequent fixation using 3.5- and 4.0-mm screws. MAIN OUTCOME MEASUREMENTS Preop CT scans were used to grade fractures according to the Sanders classification and to quantify fracture severity. Fracture severity was objectively quantified using a CT-based measure of fracture energy. PTOA was assessed on follow-up radiographs using the Kellgren-Lawrence scale. Patient outcomes were assessed using the Short Form 36 (SF-36) questionnaire and a visual analog scale pain score. RESULTS Fracture energies for the 48 DIACFs ranged from 14.1 to 26.2 J (19.3 ± 3.1 J) and correlated with Sanders classification (rho = 0.53, P = 0.0001); type I (16.3 ± 0.9 J); type II (18.0 ± 2.7 J); type III (20.8 ± 2.8 J); and type IV (22.0 ± 0.7 J). Fracture energy was higher for fractures in which the subtalar joint developed PTOA (19.5 ± 2.7 J) than for those that did not (18.9 ± 3.3 J), but the difference did not reach statistical significance. The Sanders classification predicted PTOA risk [odds ratio (OR) = 4.04, 95% confidence interval = 1.43-11.39, P = 0.0084]. No relationship was observed between fracture energy and visual analog scale pain scores. Higher fracture energy correlated with lower SF-36 scores. CONCLUSIONS Fracture energy positively correlates with Sanders classification for DIACFs, which can be used to identify more severe fractures at greater risk of progressing to PTOA. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Karan Rao
- Department of Orthopaedics and Rehabilitation, the University of Iowa, Iowa City, Iowa
| | - Kevin Dibbern
- Department of Orthopaedics and Rehabilitation, the University of Iowa, Iowa City, Iowa
- Department of Biomedical Engineering, the University of Iowa, Iowa City, Iowa
| | - Molly Day
- Department of Orthopaedics and Rehabilitation, the University of Iowa, Iowa City, Iowa
| | - Natalie Glass
- Department of Orthopaedics and Rehabilitation, the University of Iowa, Iowa City, Iowa
| | - J. Lawrence Marsh
- Department of Orthopaedics and Rehabilitation, the University of Iowa, Iowa City, Iowa
| | - Donald D. Anderson
- Department of Orthopaedics and Rehabilitation, the University of Iowa, Iowa City, Iowa
- Department of Biomedical Engineering, the University of Iowa, Iowa City, Iowa
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Phisitkul P, Akoh CC, Rungprai C, Barg A, Amendola A, Dibbern K, Anderson D. Optimizing Arthroscopy for Osteochondral Lesions of the Talus: The Effect of Ankle Positions and Distraction During Anterior and Posterior Arthroscopy in a Cadaveric Model. Arthroscopy 2017; 33:2238-2245. [PMID: 28807507 DOI: 10.1016/j.arthro.2017.06.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 05/25/2017] [Accepted: 06/19/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify arthroscopic accessibility of the talar dome with predefined ankle positions through anterior and posterior approaches. METHODS Fourteen below-knee cadaver specimens underwent preoperative range of motion assessments. A 30° 2.7-mm arthroscopic camera was used to mark accessible areas at varying ankle positions. Accessible regions were quantified using a surface laser scanner and digital 3 × 3 grid. Statistical analyses were performed to detect differences in arthroscopic accessibility between different flexion angles and noninvasive distraction. RESULTS The mean arthroscopic accessibility of the talus was 58.5% and 49.8% for the anterior and posterior approaches, respectively (P < .001). During anterior arthroscopy, accessibility increased with up to 30° of plantarflexion (P < .001). There were no significant differences in accessibility between flexion groups for the posterior approach. There was significantly greater central zone accessibility for anterior arthroscopy (87.7%) when compared with posterior arthroscopy (74.3%; P = .002). Arthroscopic accessibility increased with increasing ankle distraction for both the anterior and posterior approaches (parameter estimates ± standard error): anterior = 6.5% ± 1.3%/mm of distraction, P < .001; and posterior = 7.0% ± 2.8%/mm, P = .026. Frequency analysis showed that the posterior third of the talus was completely inaccessible in 7 out of 14 of ankles during anterior arthroscopy. The anterior third of the talus during posterior arthroscopy was inaccessible in 11 out of 14 ankles during posterior arthroscopy. CONCLUSIONS Ankle plantarflexion up to 30° may be adequate for anterior arthroscopy for osteochondral lesions of the talus (OLTs). Noninvasive distraction also increases accessibility during both anterior and posterior arthroscopy. Anterior arthroscopy should be used for central third OLTs due to greater accessibility. CLINICAL RELEVANCE Ankle positioning is an important consideration for anterior arthroscopy. Surgical approach used should match with the location of the OLTs.
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Affiliation(s)
- Phinit Phisitkul
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, U.S.A
| | - Craig C Akoh
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, U.S.A..
| | | | - Alexej Barg
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
| | | | - Kevin Dibbern
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, U.S.A
| | - Donald Anderson
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, U.S.A
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Akoh CC, Dibbern K, Amendola A, Sittapairoj T, Anderson DD, Phisitkul P. Effect of Ankle Position and Noninvasive Distraction on Arthroscopic Accessibility of the Distal Tibial Plafond. Foot Ankle Int 2017; 38:1152-1159. [PMID: 28741435 DOI: 10.1177/1071100717717264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteochondral lesions of the tibial plafond (OLTPs) can lead to chronic ankle pain and disability. It is not known how limited ankle motion or joint distraction affects arthroscopic accessibility of these lesions. The purpose of this study was to determine the effects of different fixed flexion angles and distraction on accessibility of the distal tibial articular surface during anterior and posterior arthroscopy. METHODS Fourteen below-knee cadaver specimens underwent anterior and posterior ankle arthroscopy using a 30-degree 2.7-mm arthroscopic camera. Intra-articular working space was measured with a precision of 1 mm using sizing rods. The accessible areas at the plafond were marked under direct visualization at varying fixed ankle flexion positions. Arthroscopic accessibilities were normalized as percent area using a surface laser scan. Statistical analyses were performed to assess the relationship between preoperative ankle range of motion, amount of distraction, arthroscopic approach, and arthroscopic plafond visualization. RESULTS There was significantly greater accessibility during posterior arthroscopy (73.5%) compared with anterior arthroscopy (51.2%) in the neutral ankle position ( P = .007). There was no difference in accessibility for anterior arthroscopy with increasing level of plantarflexion ( P > .05). Increasing dorsiflexion during posterior arthroscopy significantly reduced ankle accessibility ( P = .028). There was a significant increase in accessibility through the anterior and posterior approach with increasing amount of intra-articular working space (parameter estimates ± SE): anterior = 14.2 ± 3.34 ( P < .01) and posterior = 10.6 ± 3.7 ( P < .05). Frequency data showed that the posterior third of the plafond was completely inaccessible in 33% of ankles during anterior arthroscopy. The frequency of inaccessible anterior plafond during posterior arthroscopy was 12%. CONCLUSION Intra-articular working space and arthroscopic accessibility were greater during posterior arthroscopy compared with anterior arthroscopy. Improved accessibility of OLTPs may be achieved from posterior arthroscopy. Arthroscopic accessibility was heavily dependent on the amount of intraoperative joint working space achieved and not on ankle position. CLINICAL RELEVANCE OLTPs are often encountered in tandem with talar lesions, and safely achieving intra-articular working space through noninvasive distraction greatly improved arthroscopic accessibility.
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Affiliation(s)
- Craig C Akoh
- 1 Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Kevin Dibbern
- 1 Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Annuziato Amendola
- 1 Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Tinnart Sittapairoj
- 1 Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Donald D Anderson
- 1 Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Phinit Phisitkul
- 1 Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Dibbern K, Kempton LB, Higgins TF, Morshed S, McKinley TO, Marsh JL, Anderson DD. Fractures of the tibial plateau involve similar energies as the tibial pilon but greater articular surface involvement. J Orthop Res 2017; 35:618-624. [PMID: 27381653 PMCID: PMC5218984 DOI: 10.1002/jor.23359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/30/2016] [Indexed: 02/04/2023]
Abstract
Patients with tibial pilon fractures have a higher incidence of post-traumatic osteoarthritis than those with fractures of the tibial plateau. This may indicate that pilon fractures present a greater mechanical insult to the joint than do plateau fractures. We tested the hypothesis that fracture energy and articular fracture edge length, two independent indicators of severity, are higher in pilon than plateau fractures. We also evaluated whether clinical fracture classification systems accurately reflect severity. Seventy-five tibial plateau fractures and 52 tibial pilon fractures from a multi-institutional study were selected to span the spectrum of severity. Fracture severity measures were calculated using objective CT-based image analysis methods. The ranges of fracture energies measured for tibial plateau and pilon fractures were 3.2-33.2 Joules (J) and 3.6-32.2 J, respectively, and articular fracture edge lengths were 68.0-493.0 mm and 56.1-288.6 mm, respectively. There were no differences in the fracture energies between the two fracture types, but plateau fractures had greater articular fracture edge lengths (p < 0.001). The clinical fracture classifications generally reflected severity, but there was substantial overlap of fracture severity measures between different classes. Similar fracture energies with different degrees of articular surface involvement suggest a possible explanation for dissimilar rates of post-traumatic osteoarthritis for fractures of the tibial plateau compared to the tibial pilon. The substantial overlap of severity measures between different fracture classes may well have confounded prior clinical studies relying on fracture classification as a surrogate for severity. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:618-624, 2017.
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Affiliation(s)
- Kevin Dibbern
- Department of Orthopaedics and Rehabilitation, The University of Iowa
| | | | | | - Saam Morshed
- Department of Orthopaedic Surgery, University of California San Francisco
| | - Todd O. McKinley
- Department of Orthopaedic Surgery, Indiana University School of Medicine
| | - J. Lawrence Marsh
- Department of Orthopaedics and Rehabilitation, The University of Iowa
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Graham JM, Tackels D, Dibbern K, Superneau D, Rogers C, Corning K, Schwartz CE. FG syndrome: report of three new families with linkage to Xq12-q22.1. Am J Med Genet 1998; 80:145-56. [PMID: 9805132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
FG syndrome is a rare X-linked recessive form of mental retardation, first described by Opitz and Kaveggia in 1974 in five related males with mental retardation, disproportionately large heads, imperforate anus, and congenital hypotonia. Partial agenesis of the corpus callosum was noted in at least one of the initial cases and has been seen in a number of subsequently-reported cases. The associated congenital hypotonia with joint hyperlaxity tends to progress to contractures with spasticity and unsteady gait in later life. The presence of subtle facial abnormalities and the characteristic behavior in midchildhood facilitate diagnosis at this age, particularly when there are other affected male relatives in the maternal family. Recently, Briault et al. [1997] mapped a gene for FG syndrome to the Xq12-q21.31 region. We describe three additional families (six additional patients) with FG syndrome on whom we have conducted linkage analysis. Our findings support the localization of a gene for the FG syndrome in Xq12-q21. In addition, we have noted skewed X-inactivation in carrier females, as well as new associated findings in affected males of sagittal craniosynostosis and split hand malformation.
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Affiliation(s)
- J M Graham
- Ahmanson Department of Pediatrics, Steven Spielberg Pediatric Research Center, Los Angeles, California, USA
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Abstract
With an incidence of 1 in 3,000, neurofibromatosis type 1 (NF1), or von Recklinghausen disease, is one of the most common genetic disorders encountered by primary care physicians. NF1 is a multisystem disease that affects more than one million people worldwide (more than 80,000 in the United States). Although most pediatricians have patients with NF1 in their practices, many affected individuals go undiagnosed as children. This article is intended to facilitate the diagnosis and management of young patients with NF1.
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Affiliation(s)
- Y Goldberg
- Medical Genetics Birth Defects Center, Steven Spielberg Pediatric Research Center, Los Angeles, CA, USA
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