Pub Date : 2024-04-25eCollection Date: 2024-04-01DOI: 10.1177/24730114241247818
Bernard Burgesson, Alireza Ebrahimi, Omer Subasi, Soheil Ashkani-Esfahani, John Y Kwon
{"title":"Getting the Hindfoot Alignment and Starting Point Correct: A Technique Tip for Accurate Placement of Hindfoot Fusion Nails.","authors":"Bernard Burgesson, Alireza Ebrahimi, Omer Subasi, Soheil Ashkani-Esfahani, John Y Kwon","doi":"10.1177/24730114241247818","DOIUrl":"https://doi.org/10.1177/24730114241247818","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 2","pages":"24730114241247818"},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11047236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-05eCollection Date: 2024-04-01DOI: 10.1177/24730114241241318
Peter Klug, Jacob Adams, Gordon Lents, Rachel Long, Ashley Herda, Bryan Vopat, Lisa Vopat
Background: Female representation within athletics has increased as a result of Title IX, rising popularity, demand for equal compensation, and greater participation in multiple sports. Despite this, gender disparities in sports medicine research are apparent. This project serves to review the literature available on fifth-metatarsal fractures and assess the representation of female athletes in current literature.
Methods: We used a standardized protocol to audit the representation of female athletes in sports science and sports medicine research for fifth-metatarsal fractures. Primary factors included population, athletic caliber, menstrual status, research theme, sample of males and females, journal impact factor, and Altmetric score.
Results: Thirty articles met the inclusion criteria. A total of 472 fifth-metatarsal fractures were identified, with 373 of 472 fractures (79%) occurring in males and 99 of 472 (21%) in females. The majority of studies (18/30, 60%) were mixed cohort, followed by 10 male only (33.33%), 1 female only (3.33%), and 1 male vs female (3.33%). Out of 831 total patients in the 18 mixed-cohort studies, 605 of 831 patients (72.8%) were male and 226 of 831 patients (27%) were female. All 18 mixed-sex cohorts investigated health outcomes. Male-only studies evaluated health outcomes and performance metrics. No studies investigated female performance. The one female-only study investigated health outcomes and was the only study to account for menstrual status. There was a single metatarsal fracture in this study population.
Conclusion: Females are underrepresented in research regarding sports science and sports medicine research for fifth-metatarsal fractures. Research focused on female-only fifth-metatarsal fracture studies exploring the potential impact of female sex-specific factors such as menstrual status in study design are needed.
{"title":"Auditing the Representation of Female Athletes in Sports Medicine Research: Fifth-Metatarsal Fractures.","authors":"Peter Klug, Jacob Adams, Gordon Lents, Rachel Long, Ashley Herda, Bryan Vopat, Lisa Vopat","doi":"10.1177/24730114241241318","DOIUrl":"https://doi.org/10.1177/24730114241241318","url":null,"abstract":"<p><strong>Background: </strong>Female representation within athletics has increased as a result of Title IX, rising popularity, demand for equal compensation, and greater participation in multiple sports. Despite this, gender disparities in sports medicine research are apparent. This project serves to review the literature available on fifth-metatarsal fractures and assess the representation of female athletes in current literature.</p><p><strong>Methods: </strong>We used a standardized protocol to audit the representation of female athletes in sports science and sports medicine research for fifth-metatarsal fractures. Primary factors included population, athletic caliber, menstrual status, research theme, sample of males and females, journal impact factor, and Altmetric score.</p><p><strong>Results: </strong>Thirty articles met the inclusion criteria. A total of 472 fifth-metatarsal fractures were identified, with 373 of 472 fractures (79%) occurring in males and 99 of 472 (21%) in females. The majority of studies (18/30, 60%) were mixed cohort, followed by 10 male only (33.33%), 1 female only (3.33%), and 1 male vs female (3.33%). Out of 831 total patients in the 18 mixed-cohort studies, 605 of 831 patients (72.8%) were male and 226 of 831 patients (27%) were female. All 18 mixed-sex cohorts investigated health outcomes. Male-only studies evaluated health outcomes and performance metrics. No studies investigated female performance. The one female-only study investigated health outcomes and was the only study to account for menstrual status. There was a single metatarsal fracture in this study population.</p><p><strong>Conclusion: </strong>Females are underrepresented in research regarding sports science and sports medicine research for fifth-metatarsal fractures. Research focused on female-only fifth-metatarsal fracture studies exploring the potential impact of female sex-specific factors such as menstrual status in study design are needed.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 2","pages":"24730114241241318"},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10996359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140850788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1177/2473011424S00060
Stone R. Streeter, Sophie Kush, Agnes D Cororaton, Jensen K. Henry, Scott Ellis, Matthew S. Conti
Introduction/Purpose: Although reconstruction of the flexible progressive collapsing foot deformity (PCFD) has been shown to improve patient-reported outcomes (PROs), there is limited data describing postoperative success as defined by patient satisfaction following surgery. Distinct from the minimal clinically important difference (MCID), the patient acceptable symptom state (PASS) is a novel PRO measurement that represents the symptom threshold beyond which patients are satisfied with their postoperative outcome. The primary aim of this study was to use Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) scores in combination with anchor questions to define PASS thresholds following reconstruction of the flexible PCFD. A secondary aim was to analyze how patient-specific variables and certain PCFD reconstruction procedures may impact the probability of reaching PASS thresholds. Methods: Using data collected from a foot and ankle orthopedic registry at a large academic institution, 109 patients who underwent reconstruction of a flexible PCFD between February 2019 and March 2021, had preoperative and 2-year postoperative PROMIS PF and PI scores, and 2-year postoperative responses to two PASS anchor questions (the delighted-terrible scale and the satisfied scale) were included in the study. Patients who underwent either a double or triple arthrodesis were excluded. Patient responses to the anchor questions were dichotomized and receiver operating characteristic (ROC) curve analyses were performed. Using the Youden Index to balance sensitivity and specificity and maximize the area under the curve (AUC), PASS thresholds with 95% confidence intervals were quantified using 2000 bootstrapped iterations. Lastly, multivariable logistic regressions were performed to analyze the influence of patient demographics, preoperative PROMIS scores, and certain PCFD reconstruction procedures on the probability of reaching the PASS thresholds. Results: The PASS threshold for PROMIS PF was found to be 42.6 using both the delighted-terrible and the satisfied scale and 73.4% of patients (80/109) reached the threshold (both AUCs: 0.91) (Table 1). The PASS thresholds for PROMIS PI defined using the delighted-terrible scale and the satisfied scale were 54.5 (AUC: 0.90) and 57.5 (AUC: 0.91), respectively, with 72.5% of patients (79/109) and 81.7% of patients (89/109) meeting the respective thresholds. Neither patient demographics nor specific PCFD reconstruction procedures affected the probability of meeting the PASS thresholds. However, a lower preoperative PROMIS PF score or a higher preoperative PROMIS PI score significantly decreased the probability of achieving the PASS thresholds. Conclusion: Following reconstruction of the flexible PCFD, PASS thresholds for the PROMIS PF and PI domains were found to be lower and higher, respectively, than population norms. This suggests that patients may be satisfied wit
{"title":"Defining the Patient Acceptable Symptom State Using PROMIS Following Reconstruction of the Progressive Collapsing Foot Deformity","authors":"Stone R. Streeter, Sophie Kush, Agnes D Cororaton, Jensen K. Henry, Scott Ellis, Matthew S. Conti","doi":"10.1177/2473011424S00060","DOIUrl":"https://doi.org/10.1177/2473011424S00060","url":null,"abstract":"Introduction/Purpose: Although reconstruction of the flexible progressive collapsing foot deformity (PCFD) has been shown to improve patient-reported outcomes (PROs), there is limited data describing postoperative success as defined by patient satisfaction following surgery. Distinct from the minimal clinically important difference (MCID), the patient acceptable symptom state (PASS) is a novel PRO measurement that represents the symptom threshold beyond which patients are satisfied with their postoperative outcome. The primary aim of this study was to use Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) scores in combination with anchor questions to define PASS thresholds following reconstruction of the flexible PCFD. A secondary aim was to analyze how patient-specific variables and certain PCFD reconstruction procedures may impact the probability of reaching PASS thresholds. Methods: Using data collected from a foot and ankle orthopedic registry at a large academic institution, 109 patients who underwent reconstruction of a flexible PCFD between February 2019 and March 2021, had preoperative and 2-year postoperative PROMIS PF and PI scores, and 2-year postoperative responses to two PASS anchor questions (the delighted-terrible scale and the satisfied scale) were included in the study. Patients who underwent either a double or triple arthrodesis were excluded. Patient responses to the anchor questions were dichotomized and receiver operating characteristic (ROC) curve analyses were performed. Using the Youden Index to balance sensitivity and specificity and maximize the area under the curve (AUC), PASS thresholds with 95% confidence intervals were quantified using 2000 bootstrapped iterations. Lastly, multivariable logistic regressions were performed to analyze the influence of patient demographics, preoperative PROMIS scores, and certain PCFD reconstruction procedures on the probability of reaching the PASS thresholds. Results: The PASS threshold for PROMIS PF was found to be 42.6 using both the delighted-terrible and the satisfied scale and 73.4% of patients (80/109) reached the threshold (both AUCs: 0.91) (Table 1). The PASS thresholds for PROMIS PI defined using the delighted-terrible scale and the satisfied scale were 54.5 (AUC: 0.90) and 57.5 (AUC: 0.91), respectively, with 72.5% of patients (79/109) and 81.7% of patients (89/109) meeting the respective thresholds. Neither patient demographics nor specific PCFD reconstruction procedures affected the probability of meeting the PASS thresholds. However, a lower preoperative PROMIS PF score or a higher preoperative PROMIS PI score significantly decreased the probability of achieving the PASS thresholds. Conclusion: Following reconstruction of the flexible PCFD, PASS thresholds for the PROMIS PF and PI domains were found to be lower and higher, respectively, than population norms. This suggests that patients may be satisfied wit","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"41 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140769613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1177/2473011424s00067
C. Jeng, Morgan Motsay, Kenneth Rowe, Maggie K. Manchester, Michael Cotton, John T. Campbell
Introduction/Purpose: Triple arthrodesis is commonly used to correct severe or rigid progressive collapsing foot deformity (PCFD). In many cases of PCFD, patients have associated first tarsometatarsal instability demonstrated by plantar gapping or dorsal subluxation on the lateral weight-bearing radiographs. During flatfoot reconstruction this is usually addressed with a first tarsometatarsal fusion to realign the joint and to restore the medial column height. However in the setting of triple arthrodesis it has not been well established if it is necessary to add a first tarsometatarsal fusion to the procedure in order to adequately correct the overall deformity. This study retrospectively examined pre- and post-operative radiographs of patients that had first tarsometatarsal instability as a component of their PCFD and who were managed by triple arthrodesis alone. Methods: All triple arthrodesis cases were searched for a single surgeon between 2013 and 2021. Inclusion criteria were patients who had a diagnosis of PCFD and had an isolated triple arthrodesis without first tarsometatarsal joint fusion. Pre-operative radiographs were then examined for the presence of first tarsometatarsal joint instability on the lateral weight-bearing view only. This was demonstrated by either plantar gapping or first metatarsal dorsal subluxation at the tarsometatarsal joint. Those patients who were a minimum of 21 months post-op were called to obtain current radiographs. Measurement of the sagittal first metatarsal-medial cuneiform angle as well as a the first metatarsal lift as described by King and Toolan (FAI 2004) was performed. Results: Twenty patients satisfied the inclusion criteria and were included in the study. Of these patients, five had no correction of their first tarsometatarsal joint instability postoperatively and were considered failures. The remaining fifteen patients demonstrated early correction of their first tarsometatarsal joint instability and were called back for longer term follow-up radiographs. Average follow-up was 4.8 years (range 1.8 - 9.4 years). The sagittal first metatarsal-medial cuneiform angle (plantar gapping) improved significantly from 3.8 degrees to 1.0 degrees (p=0.00002). The first metatarsal lift (dorsal subluxation) corrected from 4.0 mm to 1.5 mm (p=0.000001). Only one patient showed radiographic evidence of arthritis in the first tarsometatarsal joint at final follow-up. Conclusion: First tarsometatarsal joint fusion to correct medial column instability is well established in flatfoot reconstruction cases. However less is known about whether this is required when performing a triple arthrodesis for PCFD. In this study, 75% of patients had their first tarsometatarsal joint instability correct itself after isolated triple arthrodesis and maintained this correction at 4.8 year follow-up. In many cases of PCFD with medial column instability, triple arthrodesis alone may be adequate to restore overall alignment thereby avo
{"title":"First Tarsometatarsal Instability Corrects Itself After Triple Arthrodesis in Progressive Collapsing Foot Deformity","authors":"C. Jeng, Morgan Motsay, Kenneth Rowe, Maggie K. Manchester, Michael Cotton, John T. Campbell","doi":"10.1177/2473011424s00067","DOIUrl":"https://doi.org/10.1177/2473011424s00067","url":null,"abstract":"Introduction/Purpose: Triple arthrodesis is commonly used to correct severe or rigid progressive collapsing foot deformity (PCFD). In many cases of PCFD, patients have associated first tarsometatarsal instability demonstrated by plantar gapping or dorsal subluxation on the lateral weight-bearing radiographs. During flatfoot reconstruction this is usually addressed with a first tarsometatarsal fusion to realign the joint and to restore the medial column height. However in the setting of triple arthrodesis it has not been well established if it is necessary to add a first tarsometatarsal fusion to the procedure in order to adequately correct the overall deformity. This study retrospectively examined pre- and post-operative radiographs of patients that had first tarsometatarsal instability as a component of their PCFD and who were managed by triple arthrodesis alone. Methods: All triple arthrodesis cases were searched for a single surgeon between 2013 and 2021. Inclusion criteria were patients who had a diagnosis of PCFD and had an isolated triple arthrodesis without first tarsometatarsal joint fusion. Pre-operative radiographs were then examined for the presence of first tarsometatarsal joint instability on the lateral weight-bearing view only. This was demonstrated by either plantar gapping or first metatarsal dorsal subluxation at the tarsometatarsal joint. Those patients who were a minimum of 21 months post-op were called to obtain current radiographs. Measurement of the sagittal first metatarsal-medial cuneiform angle as well as a the first metatarsal lift as described by King and Toolan (FAI 2004) was performed. Results: Twenty patients satisfied the inclusion criteria and were included in the study. Of these patients, five had no correction of their first tarsometatarsal joint instability postoperatively and were considered failures. The remaining fifteen patients demonstrated early correction of their first tarsometatarsal joint instability and were called back for longer term follow-up radiographs. Average follow-up was 4.8 years (range 1.8 - 9.4 years). The sagittal first metatarsal-medial cuneiform angle (plantar gapping) improved significantly from 3.8 degrees to 1.0 degrees (p=0.00002). The first metatarsal lift (dorsal subluxation) corrected from 4.0 mm to 1.5 mm (p=0.000001). Only one patient showed radiographic evidence of arthritis in the first tarsometatarsal joint at final follow-up. Conclusion: First tarsometatarsal joint fusion to correct medial column instability is well established in flatfoot reconstruction cases. However less is known about whether this is required when performing a triple arthrodesis for PCFD. In this study, 75% of patients had their first tarsometatarsal joint instability correct itself after isolated triple arthrodesis and maintained this correction at 4.8 year follow-up. In many cases of PCFD with medial column instability, triple arthrodesis alone may be adequate to restore overall alignment thereby avo","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"39 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140756229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1177/2473011424S00095
Emily Teehan, Isabel Shaffrey, Joseph T. Nguyen, Mark D Wishman, Joaquin Palma Munita, Jensen Henry, Constantine Demetracopoulos
Introduction/Purpose: Polyethylene wear is a concern for failure of any joint replacement, including total ankle arthroplasty (TAA). Heterogeneity in bearing surface design among current TAA systems show no clear solution to the competing objectives of function (constraint and kinematics) and wear (contact stresses). Literature has begun to investigate polyethylene wear and damage; however, a comprehensive understanding of polyethylene wear patterns in vivo and location remains unknown. This study aims to quantify the type and severity of differing damage modes on the polyethylene insert from retrieved TAA prostheses following reoperation or revision. We hypothesized that polyethylene wear amount will be greater in TAAs that underwent revisions rather than reoperation, and that wear would vary between implants based on extent of constraint. Methods: This is a retrospective study of TAA patients (2007-2021) who underwent revision (removal of polyethylene and tibial and/or talar components) or reoperation (removal of polyethylene only) following primary TAA with a symmetric bicondylar (SB) implant with more constraint or an asymmetric bicondylar (AB) implant with less constraint. Demographics and surgical data were recorded. Retrieved polyethylene inserts were examined microscopically to characterize wear patterns according to a standardized protocol. Polyethylenes were divided into four regions on both the articular and backside surfaces: 1) lateral anterior, 2) lateral posterior, 3) medial anterior, and 4) medial posterior. Each region was graded by two independent raters on a scale of 0-3 based on severity for each of the following damage modes: 1) burnishing, 2) pitting, 3) scratching, 4) third body debris, 5) abrasion, 6) surface deformation, and 7) delamination. We assessed associations between polyethylene wear pattern and severity with implant type, revision, and reoperation. Results: 55 TAAs underwent revision (n=28) or reoperation (n=27). 30 (55%) ankles had primary TAA with AB implants (Salto Talaris) and 25 (45%) with SB implants (Inbone/Infinity) (Table 1). SB cohort had a shorter mean in-body duration (time from polyethylene implant to polyethylene explant) versus AB cohort (P=0.011). SB cohort had significantly greater overall polyethylene damage severity (P=0.007) and greater damage severity in all articular regions versus AB (P≤0.035 for all). Burnishing was significantly greater in SB versus AB (P < 0.001). TAAs that underwent revision had significantly greater overall damage severity versus reoperation (P=0.005), with significantly greater damage severity on articular medial posterior (P=0.003), lateral anterior (P=0.001), and lateral posterior (P=0.004) regions. Scratching (P=0.005), pitting (P < 0.001), and third body debris (P=0.036) were significantly greater in revision TAAs. Conclusion: While damage modes between SB and AB total ankle implants were similar, ankles with primary SB implants exhibited greater overall polyethyl
{"title":"Total Ankle Arthroplasty Polyethylene Wear Varies with Implant Type and Mode of Failure","authors":"Emily Teehan, Isabel Shaffrey, Joseph T. Nguyen, Mark D Wishman, Joaquin Palma Munita, Jensen Henry, Constantine Demetracopoulos","doi":"10.1177/2473011424S00095","DOIUrl":"https://doi.org/10.1177/2473011424S00095","url":null,"abstract":"Introduction/Purpose: Polyethylene wear is a concern for failure of any joint replacement, including total ankle arthroplasty (TAA). Heterogeneity in bearing surface design among current TAA systems show no clear solution to the competing objectives of function (constraint and kinematics) and wear (contact stresses). Literature has begun to investigate polyethylene wear and damage; however, a comprehensive understanding of polyethylene wear patterns in vivo and location remains unknown. This study aims to quantify the type and severity of differing damage modes on the polyethylene insert from retrieved TAA prostheses following reoperation or revision. We hypothesized that polyethylene wear amount will be greater in TAAs that underwent revisions rather than reoperation, and that wear would vary between implants based on extent of constraint. Methods: This is a retrospective study of TAA patients (2007-2021) who underwent revision (removal of polyethylene and tibial and/or talar components) or reoperation (removal of polyethylene only) following primary TAA with a symmetric bicondylar (SB) implant with more constraint or an asymmetric bicondylar (AB) implant with less constraint. Demographics and surgical data were recorded. Retrieved polyethylene inserts were examined microscopically to characterize wear patterns according to a standardized protocol. Polyethylenes were divided into four regions on both the articular and backside surfaces: 1) lateral anterior, 2) lateral posterior, 3) medial anterior, and 4) medial posterior. Each region was graded by two independent raters on a scale of 0-3 based on severity for each of the following damage modes: 1) burnishing, 2) pitting, 3) scratching, 4) third body debris, 5) abrasion, 6) surface deformation, and 7) delamination. We assessed associations between polyethylene wear pattern and severity with implant type, revision, and reoperation. Results: 55 TAAs underwent revision (n=28) or reoperation (n=27). 30 (55%) ankles had primary TAA with AB implants (Salto Talaris) and 25 (45%) with SB implants (Inbone/Infinity) (Table 1). SB cohort had a shorter mean in-body duration (time from polyethylene implant to polyethylene explant) versus AB cohort (P=0.011). SB cohort had significantly greater overall polyethylene damage severity (P=0.007) and greater damage severity in all articular regions versus AB (P≤0.035 for all). Burnishing was significantly greater in SB versus AB (P < 0.001). TAAs that underwent revision had significantly greater overall damage severity versus reoperation (P=0.005), with significantly greater damage severity on articular medial posterior (P=0.003), lateral anterior (P=0.001), and lateral posterior (P=0.004) regions. Scratching (P=0.005), pitting (P < 0.001), and third body debris (P=0.036) were significantly greater in revision TAAs. Conclusion: While damage modes between SB and AB total ankle implants were similar, ankles with primary SB implants exhibited greater overall polyethyl","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"281 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1177/24730114241245396
George J. Borrelli, Maxwell Albiero, James Jastifer
Background: The purpose of this study was to quantify the articular surfaces of the naviculocuneiform (NC) joint to help clinicians better understand common pathologies observed such as navicular stress fractures and arthrodesis nonunions. Methods: Twenty cadaver NC joints were dissected and the articular cartilage of the navicular, medial, middle, and lateral cuneiforms were quantified by calibrated digital imaging software. Statistical analysis included calculating the mean cartilage surface area dimensions of the distal navicular and proximal cuneiform bones. Length measurements on the navicular were obtained to estimate the geographic location of the interfacet ridges. Lastly, all facets of the articular surfaces were described in regard to the shape and location of cartilaginous or fibrous components. Results were compared using Student t tests. Results: Navicular cartilage was present over 75.4% of the surface area of the proximal NC joint, compared with 72.6% of combined cuneiform cartilage distally. The mean height of the deepest (dorsal-plantar) measurement of navicular articular cartilage was 18 ± 3 mm. The mean heights of the distal medial, middle, and lateral cuneiform articular facets were 15 ± 1 mm, 17 ± 2 mm, and 15 ± 2 mm, respectively. Conclusion: There is significant variation among the articular surfaces of the NC joint. Additionally, the central third of the navicular was calculated to lie in the inter-facet ridge between the medial and middle articular facets of the navicular. Clinical Relevance: Surgeons may consider this study data when performing joint preparation for NC arthrodesis as cartilage was present to a mean depth of 18 mm at the NC joint. Additionally, this study demonstrates that the central third of the navicular, where most navicular stress fractures occur, lies in the interfacet ridge between the medial and middle articular facets of the navicular.
{"title":"Anatomy of the Naviculocuneiform Joint Complex","authors":"George J. Borrelli, Maxwell Albiero, James Jastifer","doi":"10.1177/24730114241245396","DOIUrl":"https://doi.org/10.1177/24730114241245396","url":null,"abstract":"Background: The purpose of this study was to quantify the articular surfaces of the naviculocuneiform (NC) joint to help clinicians better understand common pathologies observed such as navicular stress fractures and arthrodesis nonunions. Methods: Twenty cadaver NC joints were dissected and the articular cartilage of the navicular, medial, middle, and lateral cuneiforms were quantified by calibrated digital imaging software. Statistical analysis included calculating the mean cartilage surface area dimensions of the distal navicular and proximal cuneiform bones. Length measurements on the navicular were obtained to estimate the geographic location of the interfacet ridges. Lastly, all facets of the articular surfaces were described in regard to the shape and location of cartilaginous or fibrous components. Results were compared using Student t tests. Results: Navicular cartilage was present over 75.4% of the surface area of the proximal NC joint, compared with 72.6% of combined cuneiform cartilage distally. The mean height of the deepest (dorsal-plantar) measurement of navicular articular cartilage was 18 ± 3 mm. The mean heights of the distal medial, middle, and lateral cuneiform articular facets were 15 ± 1 mm, 17 ± 2 mm, and 15 ± 2 mm, respectively. Conclusion: There is significant variation among the articular surfaces of the NC joint. Additionally, the central third of the navicular was calculated to lie in the inter-facet ridge between the medial and middle articular facets of the navicular. Clinical Relevance: Surgeons may consider this study data when performing joint preparation for NC arthrodesis as cartilage was present to a mean depth of 18 mm at the NC joint. Additionally, this study demonstrates that the central third of the navicular, where most navicular stress fractures occur, lies in the interfacet ridge between the medial and middle articular facets of the navicular.","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"42 34","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140771339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1177/24730114241241300
Isabel Wolfe, Matthew W. Conti, Jensen K. Henry, Isabel Shaffrey, Agnes D Cororaton, Grace DiGiovanni, Constantine Demetracopoulos, Scott Ellis
Background: Joint replacement procedures have traditionally been performed in an inpatient setting to minimize complication rates. There is growing evidence that total ankle arthroplasty (TAA) can safely be performed as an outpatient procedure, with the potential benefits of decreased health care expenses and improved patient satisfaction. Prior studies have not reliably made a distinction between outpatient TAA defined as length of stay <1 day and same-day discharge. The purpose of our study was to compare a large volume of same-day discharge and inpatient TAA for safety and efficacy. Methods: Patients undergoing TAA at our US-based institution are part of an institutional review board–approved registry. We queried the registry for TAA performed by the single highest-volume surgeon at our institution between May 2020 and March 2022. Same-day discharge TAA was defined as discharge on the day of the procedure. Patient demographics, baseline clinical variables, concomitant procedures, postoperative complications, and patient-reported outcomes were collected. Postoperative outcomes were compared after 1:1 nearest-neighbor matching by age, sex, Charlson Comorbidity Index (CCI), and American Society of Anesthesiologists (ASA) score. Multivariable models were created for comparison with the matched cohort outcome comparison analysis. Results: Our same-day discharge group was younger (median 58 vs 67 years; P < .001), with proportionally fewer females (36.4% vs 51.4%; P = .044) and lower Charlson Comorbidity Indices (median 1 vs 3; P < .001) than the inpatient group. At a median follow-up of 1 year, after matching by age, sex, CCI, and ASA score, there was no difference in complications (P = .788), reoperations (P = .999), revisions (P = .118), or Patient-Reported Outcomes Measurement Information System (PROMIS) scores between the 2 groups. Multivariable analyses performed demonstrated no evidence of association between undergoing same-day discharge TAA vs inpatient TAA and reoperation, revision, complication, or 1-year PROMIS scores (P > .05). Conclusion: In our system of health care, with appropriate patient selection, same-day discharge following TAA can be a safe alternative to inpatient TAA. Level of Evidence: Level III, retrospective cohort study.
{"title":"Safety of Same-Day Discharge Following Total Ankle Arthroplasty: A Retrospective Cohort Analysis","authors":"Isabel Wolfe, Matthew W. Conti, Jensen K. Henry, Isabel Shaffrey, Agnes D Cororaton, Grace DiGiovanni, Constantine Demetracopoulos, Scott Ellis","doi":"10.1177/24730114241241300","DOIUrl":"https://doi.org/10.1177/24730114241241300","url":null,"abstract":"Background: Joint replacement procedures have traditionally been performed in an inpatient setting to minimize complication rates. There is growing evidence that total ankle arthroplasty (TAA) can safely be performed as an outpatient procedure, with the potential benefits of decreased health care expenses and improved patient satisfaction. Prior studies have not reliably made a distinction between outpatient TAA defined as length of stay <1 day and same-day discharge. The purpose of our study was to compare a large volume of same-day discharge and inpatient TAA for safety and efficacy. Methods: Patients undergoing TAA at our US-based institution are part of an institutional review board–approved registry. We queried the registry for TAA performed by the single highest-volume surgeon at our institution between May 2020 and March 2022. Same-day discharge TAA was defined as discharge on the day of the procedure. Patient demographics, baseline clinical variables, concomitant procedures, postoperative complications, and patient-reported outcomes were collected. Postoperative outcomes were compared after 1:1 nearest-neighbor matching by age, sex, Charlson Comorbidity Index (CCI), and American Society of Anesthesiologists (ASA) score. Multivariable models were created for comparison with the matched cohort outcome comparison analysis. Results: Our same-day discharge group was younger (median 58 vs 67 years; P < .001), with proportionally fewer females (36.4% vs 51.4%; P = .044) and lower Charlson Comorbidity Indices (median 1 vs 3; P < .001) than the inpatient group. At a median follow-up of 1 year, after matching by age, sex, CCI, and ASA score, there was no difference in complications (P = .788), reoperations (P = .999), revisions (P = .118), or Patient-Reported Outcomes Measurement Information System (PROMIS) scores between the 2 groups. Multivariable analyses performed demonstrated no evidence of association between undergoing same-day discharge TAA vs inpatient TAA and reoperation, revision, complication, or 1-year PROMIS scores (P > .05). Conclusion: In our system of health care, with appropriate patient selection, same-day discharge following TAA can be a safe alternative to inpatient TAA. Level of Evidence: Level III, retrospective cohort study.","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"60 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140795762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1177/24730114241241058
Chingiz Alizade, Huseyn Aliyev, Farhad Alizada
Background: Chronic osteomyelitis of the calcaneus (OC) and open infected calcaneal fractures, especially when complicated by infected soft tissue defects, present significant surgical challenges. Accepted recommendations for the surgical treatment of this pathology are yet to be established. Methods: Drawing from our experience and the consensus among experts, we have developed a concept for selecting optimal, well-known surgical approaches based on the specific pathologic presentation. This concept distinguishes 4 main forms of hindfoot infection: infected wounds, open infected fractures, OC, and their mixed forms. Patients with conditions that could confound the treatment outcomes, such as diabetes mellitus and neurotrophic diseases, were excluded from this analysis. We present a retrospective analysis of the treatment outcomes for 44 patients (4 women and 40 men) treated between 2009 and 2022 using some refined surgical techniques. Treatment success was evaluated based on the absence of disease recurrence within a 2-year follow-up, the avoidance of below-knee amputations, and the restoration of weightbearing function. Results: The treatment results were considered through the prism of our proposed concept and according to the Cierny-Mader classification. There were 4 instances of disease recurrence, necessitating 6 additional surgeries, 2 of which (4.5% of the patient cohort) resulted in amputations. In the remaining cases, we were able to restore weightbearing function and eliminate the infection through reconstructive surgeries, employing skin grafts when necessary. Conclusion: Surgical infections of the hindfoot area remain a significant challenge. The strategic concept we propose for surgical decision making, tailored to the specific pathology, represents a potential advancement in addressing this challenge. This framework could provide valuable guidance for orthopaedic surgeons in their clinical decision-making process. Level of Evidence: Level IV, case series.
{"title":"The Concept of Treatment for Surgical Infection in the Hindfoot","authors":"Chingiz Alizade, Huseyn Aliyev, Farhad Alizada","doi":"10.1177/24730114241241058","DOIUrl":"https://doi.org/10.1177/24730114241241058","url":null,"abstract":"Background: Chronic osteomyelitis of the calcaneus (OC) and open infected calcaneal fractures, especially when complicated by infected soft tissue defects, present significant surgical challenges. Accepted recommendations for the surgical treatment of this pathology are yet to be established. Methods: Drawing from our experience and the consensus among experts, we have developed a concept for selecting optimal, well-known surgical approaches based on the specific pathologic presentation. This concept distinguishes 4 main forms of hindfoot infection: infected wounds, open infected fractures, OC, and their mixed forms. Patients with conditions that could confound the treatment outcomes, such as diabetes mellitus and neurotrophic diseases, were excluded from this analysis. We present a retrospective analysis of the treatment outcomes for 44 patients (4 women and 40 men) treated between 2009 and 2022 using some refined surgical techniques. Treatment success was evaluated based on the absence of disease recurrence within a 2-year follow-up, the avoidance of below-knee amputations, and the restoration of weightbearing function. Results: The treatment results were considered through the prism of our proposed concept and according to the Cierny-Mader classification. There were 4 instances of disease recurrence, necessitating 6 additional surgeries, 2 of which (4.5% of the patient cohort) resulted in amputations. In the remaining cases, we were able to restore weightbearing function and eliminate the infection through reconstructive surgeries, employing skin grafts when necessary. Conclusion: Surgical infections of the hindfoot area remain a significant challenge. The strategic concept we propose for surgical decision making, tailored to the specific pathology, represents a potential advancement in addressing this challenge. This framework could provide valuable guidance for orthopaedic surgeons in their clinical decision-making process. Level of Evidence: Level IV, case series.","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"33 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140786799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1177/2473011424s00059
Allison L. Boden, Stone R. Streeter, Seif El Masry, Grace DiGiovanni, Agnes D Cororaton, Matthew S. Conti, Scott Ellis
Introduction/Purpose: Surgical interventions to correct hallux valgus have been shown to improve patient reported outcomes (PROs); however, many of these instruments do not measure a patient’s subjective outcome experience. The patient acceptable symptom state (PASS) is defined as the symptom threshold that a patient must reach to be satisfied with the outcome of their surgery. PASS thresholds have been defined for hallux valgus correction using American Orthopaedic Foot & Ankle Society (AOFAS) scores; however, no studies have used a validated PRO metric. This is the first study that aims to establish PASS thresholds for Patient-Reported Outcome Measurement Information System (PROMIS) scores in patients following operative intervention for hallux valgus. Methods: A retrospective review of prospectively collected data within an institutional registry was performed. We identified 291 patients treated for hallux valgus with or without second hammertoe correction between February 2019 and March 2021 with at least 2-year post-operative PROMIS scores. Chart review was performed to obtain demographic information and to confirm the surgical procedures completed. Two-years post-operatively, patients answered two PASS anchor questions (Satisfaction, Delighted-Terrible scale) with Likert-scale responses, which was collected along with pre-operative and 2-year post-operative PROMIS scores via the registry. After patient’s answers to the Satisfaction and Delighted-Terrible scales were recategorized into binary responses; PASS thresholds were determined using the maximum Youden Index and a 95% confidence interval was quantified using 2000 bootstrapped iterations. Differences in patient and surgical characteristics between patients who met or did not meet the PASS threshold were compared using independent samples t-test and Pearson chi square. Results: There was excellent association between PASS thresholds and the PROMIS domains of Physical Function (50.3, AUC=0.86) and Pain Interference (51.5, AUC=0.86). Overall, 204/291 and 205/291 patients met the threshold for Physical Function (PF) and Pain Interference (PI), respectively. For both PROMIS domains, a lower BMI was associated with a higher likelihood of meeting the PASS threshold (p=0.002 for PF, p=0.032 for PI). For the PF domain, Lapidus patients were more likely to meet the PASS threshold (p=0.05), and patients with first MTP fusion were less likely to meet the PASS threshold (p=0.004). Meeting the PASS threshold wasn’t impacted by the concomitant correction of a second hammertoe. Lastly, patients with a higher pre-operative PF score had a greater chance of meeting the PASS threshold (p < 0.001). Conclusion: This is the first study to define a PASS threshold for hallux valgus correction using PROMIS scores, a validated outcomes measure. Pre-operative PROMIS scores, patient BMI, and the type of procedure performed impacted a patient’s likelihood of meeting the PASS threshold. These results may be helpful
{"title":"Defining the Patient Acceptable Symptom State (PASS) for PROMIS After Hallux Valgus Correction Surgery","authors":"Allison L. Boden, Stone R. Streeter, Seif El Masry, Grace DiGiovanni, Agnes D Cororaton, Matthew S. Conti, Scott Ellis","doi":"10.1177/2473011424s00059","DOIUrl":"https://doi.org/10.1177/2473011424s00059","url":null,"abstract":"Introduction/Purpose: Surgical interventions to correct hallux valgus have been shown to improve patient reported outcomes (PROs); however, many of these instruments do not measure a patient’s subjective outcome experience. The patient acceptable symptom state (PASS) is defined as the symptom threshold that a patient must reach to be satisfied with the outcome of their surgery. PASS thresholds have been defined for hallux valgus correction using American Orthopaedic Foot & Ankle Society (AOFAS) scores; however, no studies have used a validated PRO metric. This is the first study that aims to establish PASS thresholds for Patient-Reported Outcome Measurement Information System (PROMIS) scores in patients following operative intervention for hallux valgus. Methods: A retrospective review of prospectively collected data within an institutional registry was performed. We identified 291 patients treated for hallux valgus with or without second hammertoe correction between February 2019 and March 2021 with at least 2-year post-operative PROMIS scores. Chart review was performed to obtain demographic information and to confirm the surgical procedures completed. Two-years post-operatively, patients answered two PASS anchor questions (Satisfaction, Delighted-Terrible scale) with Likert-scale responses, which was collected along with pre-operative and 2-year post-operative PROMIS scores via the registry. After patient’s answers to the Satisfaction and Delighted-Terrible scales were recategorized into binary responses; PASS thresholds were determined using the maximum Youden Index and a 95% confidence interval was quantified using 2000 bootstrapped iterations. Differences in patient and surgical characteristics between patients who met or did not meet the PASS threshold were compared using independent samples t-test and Pearson chi square. Results: There was excellent association between PASS thresholds and the PROMIS domains of Physical Function (50.3, AUC=0.86) and Pain Interference (51.5, AUC=0.86). Overall, 204/291 and 205/291 patients met the threshold for Physical Function (PF) and Pain Interference (PI), respectively. For both PROMIS domains, a lower BMI was associated with a higher likelihood of meeting the PASS threshold (p=0.002 for PF, p=0.032 for PI). For the PF domain, Lapidus patients were more likely to meet the PASS threshold (p=0.05), and patients with first MTP fusion were less likely to meet the PASS threshold (p=0.004). Meeting the PASS threshold wasn’t impacted by the concomitant correction of a second hammertoe. Lastly, patients with a higher pre-operative PF score had a greater chance of meeting the PASS threshold (p < 0.001). Conclusion: This is the first study to define a PASS threshold for hallux valgus correction using PROMIS scores, a validated outcomes measure. Pre-operative PROMIS scores, patient BMI, and the type of procedure performed impacted a patient’s likelihood of meeting the PASS threshold. These results may be helpful ","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"129 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140793356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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