Publications by authors named "Christopher Kreulen"

Article Synopsis
  • Chronic nonspinal osteomyelitis is difficult to diagnose and manage, prompting experts to create consensus statements on the use of percutaneous image-guided biopsies to improve standard care practices across different healthcare institutions.* -
  • MRI is an essential tool for ruling out osteomyelitis and should be performed early in patient evaluation; other microbiological culture methods can be used when conditions allow.* -
  • Expert recommendations include avoiding antibiotics for at least 2 weeks before a biopsy and advising against biopsies in cases of severe ulcers, emphasizing the need for a multidisciplinary approach in treatment.*
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Introduction: The treatment of Lisfranc injuries continues to evolve with time. The purpose of this study was to report early outcomes of patients with Lisfranc ligamentous injuries treated with the Arthrex InternalBrace, which has benefits to other previously described techniques.

Materials And Methods: We retrospectively identified 15 adult patients with Lisfranc injuries that were treated via open reduction internal fixation with the Arthrex InternalBrace (Naples, Fl).

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Background: Deltoid ligament injuries occur in isolation as well as with ankle fractures and other ligament injuries. Both operative treatment and nonoperative treatment are used, but debate on optimal treatment continues. Likewise, the best method of surgical repair of the deltoid ligament remains unclear.

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Purpose: Neoplasms originating from the "small bones of the lower limb and the overlapping joints" are rare but portend a serious prognosis. Current study utilizes a population-based registry in the United States to characterize the malignancies of the foot.

Methods: National Cancer Institute's Surveillance, Epidemiology and End Result database from 1975 to 2017 was queried to report incidence and survival data in 514 patients in the Uited States.

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Article Synopsis
  • - Osteochondral lesions of the talus are difficult conditions for orthopedic foot and ankle surgeons to treat, with various options available but little evidence to support one over another.
  • - The main aim of surgery is to fill the lesion with tissue that closely resembles natural hyaline cartilage, which is crucial for joint function.
  • - Combining traditional bone marrow stimulation techniques with cartilage allografts might enhance the healing process and improve long-term outcomes for patients.
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Patients with pes planovalgus deformity often have coexisting spring ligament pathology. A primary repair of the ligament may fail during weightbearing due to chronic degeneration of the ligamentous tissue. Augmentation with a suture tape has been suggested to strengthen the repair.

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Syndesmotic instability is a source of significant pain and disability. Both subtle instability and gross diastasis, whether acute or chronic, require stabilization and may benefit from reconstruction with ligamentous augmentation. The use of nonabsorbable suture-tape has emerged as a promising operative strategy, allowing surgeons to anatomically reconstruct the syndesmosis, in particular the anterior inferior tibiofibular ligament.

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Background: There is controversy regarding the effectiveness of postoperative antibiotics to prevent wound infection. Some surgeons still use a routine postoperative oral antibiotic regimen. The purpose of this study was to review a series of cases and document statistically any difference in infection rates and whether routine postoperative antibiotics in foot and ankle surgery are justified.

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Purpose: The aim of this study was to investigate the biomechanical properties of the InternalBrace for lisfranc injuries.

Methods: A Sawbone model was developed comparing screw, suture button and InternalBrace.

Results: When loaded in axial tension at 0.

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Injuries to the Lisfranc complex range from purely ligamentous disruptions to fracture-dislocations of the tarsometatarsal joint. Treatment options include closed/open reduction with percutaneous pinning, open reduction and internal fixation (ORIF), and primary arthrodesis. We present a ligament reinforcement technique utilizing a flexible fixation device for the treatment of ligamentous Lisfranc injuries.

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Tarsal tunnel syndrome (TTS) is a relatively uncommon compression neuropathy caused by impingement of the tibial nerve or one of the terminal branches. The presence of accessory musculature at the posteromedial aspect of the ankle has been identified as a rare cause of this condition. Despite the rarity of this condition, it must be considered in patients with refractory symptoms consistent with tibial nerve dysfunction.

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To describe the imaging findings of patients treated with subchondroplasty (SCP) of the ankle and hindfoot. Eighteen patients (10 men, 8 women; age mean 43.1 years [range 20.

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Article Synopsis
  • Chronic ankle instability (CAI) affects 10-30% of patients with recurrent lateral ankle sprains, leading to the ankle "giving way" during activities.
  • Diagnosis involves patient history, risk factor assessment, clinical tests, and imaging to confirm the condition.
  • Treatment options include nonoperative methods (rehabilitation, taping, bracing) and, if those fail, surgical options that focus on restoring ankle biomechanics, with increasing interest in minimally invasive arthroscopic techniques.
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Article Synopsis
  • The study aimed to evaluate the accuracy of ankle arthroscopy in diagnosing syndesmotic reduction or malreduction and identify key anatomical landmarks for this diagnosis using six matched-pair cadavers.
  • Out of 36 arthroscopic evaluations conducted by three experienced orthopedic surgeons, 34 (94%) correctly diagnosed the condition, with specific measurements strongly indicating malreduction.
  • Key anatomical landmarks, such as the Anterior inferior tibiofibular ligament and interosseous membrane, were found to be reliable indicators for assessing syndesmotic reduction, showing high interrater reliability among surgeons.
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The ankle is one of the most commonly injured joints in soccer and represents a significant cost to the healthcare system. The ligaments that stabilize the ankle joint determine its biomechanics-alterations of which result from various soccer-related injuries. Acute sprains are among the most common injury in soccer players and are generally treated conservatively, with emphasis placed on secondary prevention to reduce the risk for future sprains and progression to chronic ankle instability.

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Clinical decisions are often made on weight-bearing radiographs. However, it is unknown whether various weight-bearing conditions alter specific radiographic measurements. The purpose of this study was to determine whether percentage weight-bearing influences radiographic measurements of the normal foot.

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Background: The repair of osteochondral lesions remains a challenge due to its poor vascularity and limited healing potential. Micronized cartilage matrix (MCM) is dehydrated, decellularized, micronized allogeneic cartilage matrix that contains the components of native articular tissue and is hypothesized to serve as a scaffold for the formation of hyaline-like tissue. Our objective was to demonstrate that the use of MCM combined with mesenchymal stem cells (MSCs) can lead to the formation of hyaline-like cartilage tissue in a single-stage treatment model.

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Unlabelled: Forty years of clinical experience and peer-reviewed research studies support the use of nonweight-bearing removable rigid dressings (RRDs) as an effective means of postoperative management of transtibial amputations. We reviewed the published medical evidence regarding the use of RRDs as a postoperative management strategy, culminating in an evidence-based practice recommendation. Published peer-reviewed literature on the topic was searched and classified by level of evidence based on the research design using the scale recommended by the PM&R (level I through V).

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Background: Osteochondral lesions of the talus (OLT) are difficult to treat because of the poor intrinsic healing capability of articular cartilage. Matrix-induced autologous chondrocyte implantation (MACI) has been shown to be a reliable method for treating cartilage lesions that fail to respond to traditional microfracture and debridement. The purpose of this study was to assess 7-year clinical follow-up data of this technique and demonstrate midterm success of this implant.

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There are many causes of large bone defects in the tibiotalar joint that need to be definitively treated with a tibiotalocalcaneal (TTC) arthrodesis. Some of the challenges of a large defect are its effect on leg length and the complications associated with trying to fill the defect with structural bone graft. We present an operative strategy involving the use of a trabecular metal implant, a TTC nail that utilized 2 forms of compression, and Reamer/Irrigator/Aspirator (RIA) autograft, to address limitations of previous operative approaches and reliably treat this operative challenge.

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Arthrodesis of the subtalar joint can be performed via both open and arthroscopic techniques. Both groups of procedures have their own relative indications and contraindications, as well as complications. Good results have been reported for both general procedures, although some studies suggest superiority with arthroscopic subtalar arthrodesis.

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Article Synopsis
  • The study aimed to assess how accurately MRI and MRA diagnose SLAP lesions in patients who underwent shoulder arthroscopy, with an expectation that their accuracy would be lower than reported in past studies.
  • An examination of 444 patients revealed MRI had an overall accuracy of 76%, while MRA was slightly lower at 69%, indicating limitations in both methods, especially when it came to providing accurate positive diagnoses.
  • The findings suggest that while MRI effectively rules out SLAP lesions (NPV of 95%), it is not a reliable diagnostic tool for confirming them, especially considering the high rate of false positives in MRA.
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Background: Large talar cartilage defects can be treated with either autologous chondrocyte implantation or matrix autologous chondrocyte implantation. Both techniques depend on successful harvesting of the chondrocytes. In the past, they have come from the ipsilateral knee, which has been associated with donor site morbidity.

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Use of amphotericin B-impregnated bone cement in combination with systemic antifungals for the treatment of coccidioidal osteomyelitis offers the potential for sustained local concentrations of drug at the site of the infection. Amphotericin B levels in bone of up to 5.1 μg/g have been demonstrated 4 months after placement of bone cement.

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