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Eric K Bonness, Justin C Siebler, Lori K Reed, Elizabeth R Lyden, Matthew A Mormino
OBJECTIVE: To evaluate an alternative protocol of allowing immediate weight-bearing as tolerated in a functional walking boot in patients with a medial clear space (MCS) of less than 4 millimeters (mm) on non-stressed initial radiographs with subsequent weight-bearing radiographs at 1-week follow-up to determine if this can differentiate stable from unstable distal fibular fractures. DESIGN: Retrospective case series. SETTING: Level 1 trauma center...
July 16, 2018: Journal of Orthopaedic Trauma
S Ashraf, P I Mapp, S M Shahtaheri, D A Walsh
OBJECTIVE: Knee osteoarthritis (OA) is associated with ongoing pain and joint damage that can be punctuated by acute flares of pain and inflammation. Synovitis in normal knees might resolve without long-term detriment to joint function. We hypothesised that osteoarthritis is associated with impaired resilience to inflammatory flares. DESIGN: We induced synovitis by injecting carrageenan into rat knees with or without meniscal transection (MNX)-induced OA, and measured synovitis, weightbearing asymmetry (pain behaviour), and joint damage up to 35 days after OA induction (23 days after carrageenan-injection)...
July 19, 2018: Osteoarthritis and Cartilage
Robert F LaPrade, Nicholas N DePhillipo, Tyler R Cram, Mark E Cinque, Mitchell I Kennedy, Grant J Dornan, Luke T O'Brien
BACKGROUND: While early weightbearing protocols have been advocated after anterior cruciate ligament (ACL) reconstruction, early weightbearing after fibular (lateral) collateral ligament reconstruction has not been well defined. PURPOSE: (1) To determine if early partial controlled weightbearing after fibular collateral ligament (FCL) reconstruction resulted in an objective difference in laxity on varus stress radiographs at postoperative 6 months as compared with nonweightbearing, and (2) to determine if there was a difference in pain, edema, range of motion, and subjective patient-reported outcomes between these groups at 3 time points...
August 2018: American Journal of Sports Medicine
Dhong Won Lee, Ji Hwan Lee, Du Han Kim, Jin Goo Kim
BACKGROUND: Meniscal extrusion prevention would be important for restoring normal knee kinematics, even though the effect of graft extrusion after meniscal allograft transplantation (MAT) has not been clearly identified. HYPOTHESIS: When compared with standard rehabilitation protocols, delayed rehabilitation after lateral MAT could reduce graft extrusion. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 53 patients who underwent lateral MAT with the keyhole technique from June 2011 to March 2015 were included...
August 2018: American Journal of Sports Medicine
Henryk Liszka, Artur Gądek
BACKGROUND: The main goal of the study was to evaluate the costs, clinical and radiologic results, and complications of hallux valgus surgery using scarf osteotomy, depending on the type of fixation (with or without screws). METHODS: We evaluated 169 patients who underwent scarf osteotomy between January 2013 and August 2016. The patients were separated into 3 groups depending on the type of stabilization: A, 2 screws (50 patients); B, modified with 1 screw (55 patients); C, modified without implant (64 patients)...
July 1, 2018: Foot & Ankle International
Pierre-Yves Rohan, Antoine Perrier, Mira Ramanoudjame, Jérôme Hausselle, Henri Lelièvre, Raphael Seringe, Wafa Skalli, Philippe Wicart
The initial assessment and postoperative monitoring of patients with various abnormalities of the foot in clinical routine practice is primarily based on the analysis of radiographs taken in the weightbearing position. Conventional x-ray imaging, however, only provides a 2-dimensional projection of 3-dimensional (3D) bony structures, and the clinical parameters assessed from these images can be affected by projection biases. In the present work, we addressed this issue by proposing an accurate 3D reconstruction method of the foot in the weightbearing position from low-dose biplanar radiographs with clinical index measurement assessment for clinical routine practice...
July 9, 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Pernilla Eliasson, Anne-Sofie Agergaard, Christian Couppé, René Svensson, Rikke Hoeffner, Susan Warming, Nichlas Warming, Christina Holm, Mikkel Holm Jensen, Michael Krogsgaard, Michael Kjaer, S Peter Magnusson
BACKGROUND: Treatment strategies for Achilles tendon rupture vary considerably, and clinical outcome may depend on the magnitude of tendon elongation after surgical repair. The aim of this project was to examine whether tendon elongation, mechanical properties, and functional outcomes during rehabilitation of surgically repaired acute Achilles tendon ruptures were influenced by different rehabilitation regimens during the early postsurgical period. HYPOTHESIS: Restricted early weightbearing that permits only limited motion about the ankle in the early phase of tendon healing limits tendon elongation and improves functional outcome...
August 2018: American Journal of Sports Medicine
Michaela O'Connor, Anas A Minkara, Robert W Westermann, James Rosneck, T Sean Lynch
Background: The detection and management of chondral injuries of the hip, especially in a younger patient population, may preempt joint degeneration. Although the outcomes of preservation techniques have been well described for other weightbearing joints, such as the knee, evidence for hip joint preservation after procedures such as microfracture and autologous chondrocyte implantation remains in its infancy. Purpose: To evaluate outcomes of joint preservation procedures in the hip, including the success rate and patient-reported outcomes (PROs)...
June 2018: Orthopaedic Journal of Sports Medicine
Munim Moiz, Nick Smith, Toby O Smith, Amit Chawla, Peter Thompson, Andrew Metcalfe
Background: The first-line treatment for patellar dislocations is often nonoperative and consists of physical therapy and immobilization techniques, with various adjuncts employed. However, the outcomes of nonoperative therapy are poorly described, and there is a lack of quality evidence to define the optimal intervention. Purpose: To perform a comprehensive review of the literature and assess the quality of studies presenting patient outcomes from nonoperative interventions for patellar dislocations...
June 2018: Orthopaedic Journal of Sports Medicine
Amandine Bonte, Nicolas Bertheuil, Tiphaine Menez, Jean-Louis Grolleau, Christian Herlin, Benoit Chaput
The proximally based medial plantar flap is considered to be the reference standard for heel reconstruction. Although less well-studied, a distally based medial plantar flap is a suitable alternative when used to cover a distal foot defect, especially of the hallux, first metatarsal, or metatarsophalangeal joint. Our objective was to provide a complete description and propose a classification of the different surgical procedures used to harvest this flap. A review of the data reported in the MEDLINE database until May 2017 concerning the distally based medial plantar flap was performed...
June 21, 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
David W Shofler, Bryon McKenna, Johnny Huang, Robert A Christman
BACKGROUND: Tailor's bunion, or bunionette, deformity is a common condition of the lateral forefoot. To aid in assessing the deformity, radiographic angular measurements are frequently used. The objective of this study was to determine the reliability and reproducibility of these angular measurements. METHODS: Thirty unique weightbearing dorsoplantar digital radiographs of pathologic feet were compiled. For these 30 radiographs and for ten repeated radiographs, six practicing clinicians measured the following angles: the fourth to fifth intermetatarsal angle, the lateral deviation angle, and the fifth metatarsophalangeal angle...
May 2018: Journal of the American Podiatric Medical Association
Patrick J Sanchez, John F Grady, Robin C Lenz, Sarah J Park, Jake G Ruff
BACKGROUND: Hallux limitus (HL) is the second-most common pathology associated with the first metatarsophalangeal joint. A common etiology believed to be associated with HL is metatarsus primus elevatus (MPE), although causation has been unsubstantiated by evidence. Historically, correction of MPE is surgically addressed with an osteotomy. However, some believe MPE is a secondary manifestation of HL due to retrograde pressure and lack of dorsiflexion at the first metatarsophalangeal joint...
May 2018: Journal of the American Podiatric Medical Association
Agnetha de Sá, David A Hart, Karim Khan, Alexander Scott
INTRODUCTION: Statins are widely used to inhibit cholesterol production in the liver among people with hypercholesterolemia. A recent epidemiological study in the UK has shown that statin use (unlike elevated BMI) is not associated with an increased risk of Achilles tendon rupture. However, because of laboratory reports suggesting a negative influence of statins on tenocyte metabolism, we decided to directly compare the Achilles tendon structure (cross-sectional area and longitudinal collagen organization) in regular statin users compared to non-users...
2018: PloS One
Paul Hoogervorst, Zachary M Working, Ashraf N El Naga, Meir Marmor
BACKGROUND: It is clear that motion at the syndesmosis occurs due to ranging of the ankle joint, but the influence of weightbearing with the foot in the plantigrade position is unclear. In vivo computed tomographic (CT) evaluation of the syndesmosis has not been previously described. The purpose of this study is to quantify physiological fibular motion at the level of the ankle syndesmosis in both weightbearing and nonweightbearing conditions with the foot in the plantigrade position...
June 1, 2018: Foot & Ankle Specialist
Gabriele Falzarano, Giuseppe Pica, Antonio Medici, Giuseppe Rollo, Michele Bisaccia, Raffaele Cioffi, Mario Pavone, Luigi Meccariello
The aim of our study was to investigate which technique among hybrid external fixation, plate and screws, and intramedullary nailing produces better outcomes in foot loading when treating type 43.A1, 43.A2, and 43.A3 fractures, according to the AO classification. From November 2011 to December 2014, 34 patients, including 25 (73.5%) males and 9 (26.5%) females with an average age of 32.3 (range 16 to 67) years, with a type A tibia fracture were treated with intramedullary nailing, plate and screws, or hybrid external fixation...
June 15, 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Michael Matthews, Emily A Cook, Jeremy Cook, Lindsay Johnson, Timothy Karthas, Byron Collier, Daniel Hansen, Elena Manning, Bryon McKenna, Philip Basile
Common corrective osteotomies used in flexible flatfoot deformity reconstruction include Cotton and Evans osteotomies, which require structural graft to maintain correction. Auto-, allo-, and xenografts are associated with a number of limitations, including disease transmission, rejection, donor site morbidity, technical challenges related to graft fashioning, and graft resorption. Porous titanium is a synthetic substance designed to address these flaws; however, few studies have been reported on the efficacy, safety, and long-term outcomes...
June 8, 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Harry M Lightsey, Margaret L Wright, David P Trofa, Charles A Popkin, Christopher S Ahmad, Lauren H Redler
BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction is an increasingly utilized surgical option for recurrent patellar instability. Recent studies have highlighted the potential benefits of accelerated functional rehabilitation; however, no validated MPFL rehabilitation guidelines currently exist. OBJECTIVE: To assess the variability of MPFL reconstruction rehabilitation protocols published online by academic orthopaedic programs. METHODS: Online MPFL rehabilitation protocols from U...
July 2, 2018: Physician and Sportsmedicine
Nick J Besselink, Koen L Vincken, L Wilbert Bartels, Ronald J van Heerwaarden, Arno N Concepcion, Anne C A Marijnissen, Sander Spruijt, Roel J H Custers, Jan-Ton A D van der Woude, Karen Wiegant, Paco M J Welsing, Simon C Mastbergen, Floris P J G Lafeber
Objective High tibial osteotomy (HTO) and knee joint distraction (KJD) are treatments to unload the osteoarthritic (OA) joint with proven success in postponing a total knee arthroplasty (TKA). While both treatments demonstrate joint repair, there is limited information about the quality of the regenerated tissue. Therefore, the change in quality of the repaired cartilaginous tissue after KJD and HTO was studied using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC). Design Forty patients (20 KJD and 20 HTO), treated for medial tibiofemoral OA, were included in this study...
June 1, 2018: Cartilage
Michael R Karns, Temitope F Adeyemi, Andrew R Stephens, Stephen K Aoki, Mark E Beese, Michael J Salata, Travis G Maak
BACKGROUND: Subspine impingement is a recognized source of extraarticular hip impingement. Although CT-based classification systems have been described, to our knowledge, no study has evaluated the morphology of the anteroinferior iliac spine (AIIS) with plain radiographs nor to our knowledge has any study compared its appearance between plain radiographs and CT scan and correlated AIIS morphology with physical findings. Previous work has suggested a correlation of AIIS morphology and hip ROM but this has not been clinically validated...
July 2018: Clinical Orthopaedics and related Research
S F Baumbach, W C Prall, M Braunstein, W Böcker, S Polzer, H Polzer
Fractures of the base of the fifth metatarsal bone are one of the most frequent fractures to the foot and ankle. Despite the high frequency and although a number of studies are now available, treatment frequently does not follow the available evidence. Among the reasons is the inconsistent terminology used and that the studies available are neglected. The aim of this review is to present the current classifications, the available treatment studies and to derive evidence-based treatment recommendations. The term "Jones fracture" has been used inconsistently for different fracture entities and should, therefore, not be used anymore...
May 17, 2018: Der Unfallchirurg
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