Warekessler2074
Mean modified AOFAS score improved from 28 at 6 months to 37 at 2 years postoperatively.
Custom-made 3D-printed titanium trusses provide promising outcomes for treating severe AVN of the talus. The "keystone" design is advantageous as it allows for bone stock preservation and conforms to the shape of the native calcaneum. All patients showed progressive improvements in outcomes at sequential time intervals postoperatively. The implant provides a strong mechanical structure resisting collapse and subsidence during the arthrodesis process.
Level IV, retrospective case series.
Level IV, retrospective case series.
The Internet is often the first resource used by applicants to evaluate fellowship programs. However, information on these websites can be often incomplete, inaccessible, and/or inaccurate. The primary objective of this study was to examine key factors that orthopedic foot and ankle fellowship applicants use to rank programs. The secondary objective was to assess both the accessibility and availability of the information on orthopedic foot and ankle fellowship program websites.
A Qualtrics survey was distributed via e-mail to those who matched into an orthopedic foot and ankle fellowship position from years 2008-2020. A comprehensive list of orthopedic foot and ankle fellowship programs was created. Program websites were evaluated for accessibility as well as the quality of recruitment and educational content.
There were a total of 114 survey responses out of 644 invites (17.7%). The most important factors for establishing a rank list were operative experience, current faculty, and program reputation. Eighty-five percent (41/48) of orthopedic foot and ankle fellowship websites were directly accessible using Google. On average, accessible orthopedic foot and ankle fellowship websites contained only 57% (11.5/20) of the content deemed desirable.
Orthopedic foot and ankle websites are widely accessible and have higher recruitment and educational quality content scores compared with previously published data. The most important factors for establishing a rank list are consistent with previous literature. Those who ranked operative experience as one of the most important factors when establishing a rank list did not complete more operative cases than those who did not.
Level IV.
Level IV.
The impact of varus ankle osteoarthritis (OA) on the distal tibial fibular syndesmosis is poorly described. This study aimed to investigate the possible relationship between the condition of the distal tibial fibular syndesmosis and the degree of the varus deformity using weightbearing simulated computed tomography (CT), in patients with varus ankle OA.
This retrospective comparative study included 155 varus ankles, divided into 4 Takakura-Tanaka groups (stage 2, 3a, 3b, and 4). A control group comprised 35 ankles without prior ankle disorders. The angles between the tibial shaft and the articular surface of the tibial plafond on the anteroposterior view (TAS), and articular surfaces of the tibial plafond and talar dome (TTW) were measured from weightbearing ankle radiographs. The varus angle of the ankle (VA) was defined as 90- TAS + TTW. On the CT axial view, 1 cm proximal to the tibial plafond, the area of the syndesmosis ("CT-area") and the distance between the fibula and the tibia (CT-FCS) were measured.
The CT area in stages 2, 3a, 3b, 4, and control group were 99, 79, 77, 103, and 97 mm
, respectively. The CT-FCS were 3.5, 3.1, 2.9, 4.3, and 3.9 mm, respectively. In all 155 OA ankles, CT area and CT-FCS were negatively correlated with the VA (correlation coefficient
=-0.38,
< .01; and
= 0.38,
< .01, respectively). Both CT area and CT-FCS were significantly smaller in stages 3a and 3b than in the control group (
< .01).
There may be a relationship between the narrowing of the syndesmosis and the varus deformity in patients with varus ankle OA, especially in stages 3a and 3b.
Clinicians should be aware of the impact of varus ankle arthritis on the distal tibial fibular syndesmosis when operatively treating varus ankle OA. For some patients, the isolated treatment for the tibiotalar joint may be insufficient, and treatment for the syndesmosis as well as tibiotalar joint may be needed.
Level III, retrospective case control study.
Level III, retrospective case control study.
Hindfoot and ankle fusions are mechanically limiting procedures for patients. However, patient-reported outcomes of these procedures have not been well studied. This study assessed outcomes of hindfoot and ankle fusions by using Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) Computer Adaptive Tests (CATs).
Between 2014 and 2018, 102 patients were prospectively enrolled after presenting to a tertiary care facility for ankle and hindfoot fusions, including tibiotalar, tibiotalocalcaneal, subtalar, and triple arthrodeses. Study participants completed preoperative and 12-month postoperative PF and PI CATs. The differences between mean 12-month postoperative and preoperative PROMIS PF and PI
scores were analyzed with paired
tests. NSC 15193 The relationship between the 12-month PF and PI differences for the overall sample and patient factors was examined using multiple regression modeling.
The sample had mean age of 57.69 years; 48% were male, aith favorable patient outcomes leading to increased physical function and decreased pain at 12 months postoperation relative to preoperation.
Level II, prospective comparative study.
Level II, prospective comparative study.
Flexor hallucis longus tendon transfer (FHL) with a cortical button tension slide is an innovative addition that has not been measured against traditional methods.
12 pairs (n=24) of fresh-frozen cadaveric tibia-to-toe samples were used and randomized to receive one of the operative FHL techniques. Specimens underwent bone density analysis. Biomechanical loading was applied between 20 and 60 N at 1 Hz for 100 cycles. Post-cyclic load to failure occurred at 1.25 mm/s. Cyclic displacement, structural stiffness, and ultimate load were derived from load-displacement curves. Student
tests evaluated significant effects between both FHL techniques. Linear regression analysis assessed interactions between bone density and strength of FHL technique.
Average tendon diameter was 5.44±0.46 mm. Average bone density was 1.06±0.08 g/cm
. Addition of a cortical button to FHL transfer did not significantly affect cyclic displacement (0.78±0.52 mm vs 0.87±0.80 mm) or structural stiffness (162.11±43.34 N/mm vs 167.57±ed Laboratory Study.
Resection of talocalcaneal coalitions has generally involved osseous coalitions. We attempted to evaluate the morphology of nonosseous talocalcaneal coalitions. This study aimed to investigate if the calcaneal articular surface area of feet with talocalcaneal coalitions is different than that of normal feet.
Twenty nonosseous talocalcaneal coalition cases with analyzable computed tomography (CT) scans were compared to 20 control cases. Three-dimensional models of the talus and calcaneus were constructed, and the surface areas of the posterior facet (SPF), whole talocalcaneal joint of the calcaneus (SWJ), and coalition site (SCS) of each 3D-CT model were measured. "Calibrated" values of the 2 groups were created to adjust for relative size of the tali and then compared. The preoperative and postoperative AOFAS Ankle-Hindfoot scale was calculated for 9 cases that had undergone single coalition resection.
The calibrated SPF and SWJ were significantly greater in the coalition group than in the control group (40% and 12%, respectively). No significant difference was detected between the calibrated (SWJ- SCS) value of the coalition group and the calibrated SWJ value of the control group. The AOFAS scale was improved postoperatively in all 9 cases analyzed.
The calcaneal articular surface of nonosseous talocalcaneal coalition feet in our series was larger than that of the normal feet. This study indicates that the total calcaneal articular surface after coalition resection may be comparable to the calcaneal articular surface of normal feet. We suggest that the indication for coalition resection be reconsidered for nonosseous coalition.
Level III, retrospective comparative study.
Level III, retrospective comparative study.
There remains a paucity of data regarding long-term patient-reported outcomes following Lisfranc injuries. We sought to collect long-term clinical outcome data following Lisfranc injuries using PROMIS Physical Function (PROMIS-PF) and visual analog scale-foot and ankle (VAS-FA).
A chart review was performed to identify all patients who had surgical treatment of an acute Lisfranc injury at our institution from 2005 to 2014. Of the 45 patients identified, we were able to recruit 19 for a follow-up clinic visit consisting of physical examination, administration of questionnaires addressing pain and medication usage, radiographs, and completion of outcome surveys including PROMIS-Physical Function and visual analog scale-foot and ankle.
There were 14 female and 5 male patients enrolled in the study with a mean time of 6.25 years from the time of injury. Within this cohort, the mean PROMIS-PF score was 52.4±8.2 and the mean VAS-foot and ankle score was 76.6±22.3.
We report satisfactory long-term patient-reported outcomes using PROMIS-PF and VAS-FA.
Level III, retrospective cohort study.
Level III, retrospective cohort study.
The Centers for Medicare & Medicaid Services (CMS) Open Payments public database provides a means for increased transparency of physicians' financial relationships with industry. Total ankle arthroplasty is a procedure with long-term clinical implications and variable outcomes. We compared physician-reported conflict-of-interest (COI) disclosures in the journal
(
) to CMS database information to evaluate for discrepancies.
Articles published in
reporting clinical outcomes of total ankle arthroplasty from 2015 and 2019 were reviewed. Payment information in the CMS database was cross-referenced with disclosure statements and International Committee of Medical Journal Editors (ICMJE) forms associated with the manuscript. Statistical analysis was performed to determine if industry payments were appropriately disclosed or influenced outcomes.
We reviewed 173 articles pertaining to ankle arthroplasty, with 27 meeting inclusion criteria. Of 120 total authors with 98 unique authors, 114 (95%) disclosed appropriately in disclosure statements. Twenty-two studies (82%) had appropriate declarations for the entire manuscript. For the 27 senior authors, only 2 discrepancies between manuscript disclosure and the Open Payments public database were noted, showing 13 total disclosures in the Open Payments public database vs 11 disclosed in the manuscript. There was no relationship between industry payments and the outcome of the manuscript (
= .725).
The majority of author disclosure statements accurately reflected the Open Payments public data. Additionally, payments were not significantly associated with positive outcomes reported for the specific implant. Overall, authors publishing on ankle arthroplasty in
are disclosing appropriately.
Level IV, systematic review; survey study; literature review.
Level IV, systematic review; survey study; literature review.
