Suitability of Minced Cartilage From Osteochondral Lesions of the Talus for Immediate Autograft Reimplantation.

Background: Particulated autograft cartilage implantation is a surgical technique that has been previously described for the repair of osteochondral lesions of the talus (OLT). It uses cartilage fragments harvested from the OLT that are minced into 1-2-mm fragments and then immediately reimplanted back into the chondral defect and sealed with fibrin glue during a single-stage surgery. The purpose of this study was to characterize the suitability of these minced cartilage fragments as immediate autograft for the treatment of OLTs.

First Tarsometatarsal Alignment May Self-Correct After Triple Arthrodesis in Progressive Collapsing Foot Deformity.

Background: Triple arthrodesis is commonly used to correct rigid progressive collapsing foot deformity (PCFD). These patients often have associated first tarsometatarsal (TMT) instability on lateral weightbearing radiographs. It has not been well established if it is necessary to add first TMT arthrodesis to adequately correct the overall deformity.

The Effect of Tibiotalar Joint Line Level Alterations on Tibiotalar Range of Motion Following Total Ankle Arthroplasty.

Background: The effect of tibiotalar joint line level (TTJL) on patient outcomes following total ankle arthroplasty (TAA) remains unclear. It was previously reported that patients with end-stage ankle arthritis have an elevated TTJL compared with nonarthritic ankles, and the TTJL post-TAA remains elevated compared with nonarthritic ankles. The objectives of this study were to (1) propose a reliable radiographic method to measure the TTJL absolute value and (2) determine the effect of TTJL alterations on tibiotalar range of motion (ROM) following TAA.

Weightbearing CT Analysis of the Transverse Tarsal Joint During Eversion and Inversion.

Background: Understanding of the movement and function of the transverse tarsal joint (TTJt) continues to evolve. Most studies have been done in cadavers or under nonphysiologic conditions. Weightbearing computed tomographic (WBCT) scans may provide more accurate information about the position of the TTJt when the hindfoot is in valgus or varus.

The Hallux Metatarsophalangeal Capsule: An Anatomic Study With Respect to Percutaneous Hallux Valgus Correction.

Background: Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux metatarsophalangeal (MTP) proximal capsular origin on the metatarsal neck is essential for surgeons in planning and executing extracapsular corrective osteotomies. A cadaveric study was undertaken to further study this anatomic relationship.

Effect of Achilles Tendon Lengthening and Gastrocnemius Recession on Radiographic Tibiotalar Motion Following Total Ankle Replacement.

Background: Surgeons frequently add an Achilles tendon lengthening or gastrocnemius recession to increase dorsiflexion following total ankle replacement. Previous studies have looked at the effects of these procedures on total tibiopedal motion. However, tibiopedal motion includes motion of the midfoot and hindfoot as well as the ankle replacement.

Painful Accessory Navicular and Spring Ligament Injuries in Athletes.

Painful accessory navicular and spring ligament injuries in athletes are different entities from more common posterior tibialis tendon problems seen in older individuals. These injuries typically affect running and jumping athletes, causing medial arch pain and in severe cases a pes planus deformity. Diagnosis requires a detailed physical examination, standing radiographs, and MRI.

Assessment of Bony Subfibular Impingement in Flatfoot Patients Using Weight-Bearing CT Scans.

Background:: Lateral hindfoot pain in patients with flatfoot deformity is frequently attributed to subfibular impingement. It remains unclear whether this is primarily due to bony or soft-tissue impingement. No studies have used weight-bearing CT scans to evaluate subfibular impingement.

Measuring Visualized Joint Surface in Hallux Metatarsophalangeal Arthroscopy.

Background: Arthroscopy has been increasingly used to evaluate small joints in the foot and ankle. In the hallux metatarsophalangeal (MTP) joint, little data exist evaluating the efficacy of arthroscopy to visualize the articular surface. The goal of this cadaveric study was to determine how much articular surface of the MTP joint could be visualized during joint arthroscopy.

Measuring Visualized Tendon Length in Peroneal Tendoscopy.

Background: Despite multiple studies outlining peroneal tendoscopy, no study exists to evaluate how effective tendoscopy is at visualizing the peroneal tendons without missing a lesion. We sought to measure the length of the peroneal tendons that could be visualized using tendoscopy.

Methods: Ten fresh cadaveric specimens were evaluated using standard peroneal tendoscopy techniques.

Outcome of Lateral Transfer of the FHL or FDL for Concomitant Peroneal Tendon Tears.

Background: Concomitant tears of the peroneus longus and brevis tendons are rare injuries, with literature limited to case reports and small patient series. Only 1 recent study directly compared the results of single-stage lateral deep flexor transfer, and no previous series objectively evaluated power and balance following transfer. The purpose of this study was to evaluate clinical outcomes, patient satisfaction, and objective power and balance data following single-stage flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendon transfers for treatment of concomitant peroneus longus and brevis tears.

Reproducibility of computed tomography to evaluate ankle and hindfoot fusions.

Background: Although plain radiographs have been historically used to evaluate the status of arthrodesis in the foot and ankle, computed tomography (CT) has gained popularity for evaluation of fusion status. The degree of fusion identified on CT scan has been correlated with functional outcome, with an arthrodesis area of 25-50% necessary for clinical success. In the clinical setting, orthopaedic surgeons often evaluate CT scans independently.

Anatomic comparison of lateral transfer of the long flexors for concomitant peroneal tears.

Background: Lateral transfers of the flexor hallucis longus (FHL) or flexor digitorum longus (FDL) tendons have been described for treatment of concomitant, irreparable peroneal tears. This study evaluated the anatomic benefits and constraints of lateral FHL and FDL tendon transfers with regard to available tendon length, diameter, and proximity to the posterior neurovascular bundle.

Methods: In 9 cadaveric specimens, the FHL and FDL tendons were transected through a medial approach distal to the knot of Henry.

Tibiotalocalcaneal arthrodesis with bulk femoral head allograft for salvage of large defects in the ankle.

Background: Tibiotalocalcaneal arthrodesis in patients with large segmental bony defects presents a substantial challenge to successful reconstruction. These defects typically occur following failed total ankle replacement, avascular necrosis of the talus, trauma, osteomyelitis, Charcot, or failed reconstructive surgery. This study examined the outcomes of tibiotalocalcaneal (TTC) arthrodesis using bulk femoral head allograft to fill this defect.

Relative strengths of the calf muscles based on MRI volume measurements.

Background: In 1985, Silver et al. published a cadaver study which determined the relative order of strength of the muscles in the calf. Muscle strength, which is proportional to volume, was obtained by dissecting out the individual muscles, weighing them, and then multiplying by the specific gravity.

Driving brake reaction time following right ankle arthrodesis.

Background: The purpose of this study was to compare the brake reaction time of patients with successful right ankle fusion to normal volunteers without an ankle fusion.

Methods: Ten patients who underwent successful right ankle arthrodesis were evaluated using a driving simulator as well as an in-shoe pedobarographic measuring system. Brake reaction time, braking force, peak pressure, contact area, and the center of force between the foot and the brake pedal were recorded.

Comparison of initial compression of the medial, lateral, and posterior screws in an ankle fusion construct.

Background: One of the requirements for successful ankle arthrodesis is adequate compression by the fixation across the fusion surfaces. A common screw construct for ankle fusion is three crossed screws from proximal-to-distal. Because the screws are inserted nearly orthogonal to each other, it is possible minimal additional compression is obtainable once the first screw is inserted.

Minimally invasive deltoid ligament reconstruction for stage IV flatfoot deformity.

Background: Stage IV is the most advanced form of acquired adult flatfoot deformity (AAFD). It is present when valgus tibiotalar angulation occurs with foot deformities associated with AAFD. Tibiotalocalcaneal or pantalar fusion has been the gold standard for treatment of Stage IV AAFD.

Percutaneous screw configuration versus perimeter plating of calcaneus fractures: a cadaver study.

Background: Percutaneous screw configuration has been used clinically to reduce the high rate of wound complications associated with the extensile approach of standard open reduction and internal plate fixation. The aim of this cadaveric biomechanical study was to compare the strength of the standard perimeter plating with that of the percutaneous screw configuration for a Sanders type-2B calcaneus fracture.

Materials And Methods: Ten pairs of fresh-frozen cadaveric lower limbs were prepared and osteotomized to create a Sanders type-2B fracture.

Allograft total ankle replacement--a dead ringer to the natural joint.

For decades, orthopedic surgeons have been looking for practical alternatives to ankle arthrodesis for the treatment of end-stage ankle arthritis. The most popular alternatives available today are total ankle replacement, supramalleolar osteotomy, and ankle distraction arthroplasty. Fresh bipolar osteochondral allograft of the ankle joint has been sporadically reported in the literature as another alternative to ankle fusion.

Fresh osteochondral total ankle allograft transplantation for the treatment of ankle arthritis.

Background: Fresh osteochondral total ankle allograft transplantation has been reported in the literature with survival rates between 50% and 92% at 1- to 12-years followup. The goal of this study was to present the results of total ankle allografts from another institution.

Materials And Methods: Twenty-nine patients underwent osteochondral total ankle transplant at our institution between July 2003 and July 2005.

Radiographic comparison of sagittal plane stability between cast and boots.

Background: The importance of postoperative stability when considering surgery on the foot and ankle cannot be overestimated. To our knowledge, no literature exists to describe the radiographic sagittal plane motion with varying types of immobilization devices. The purpose of this study was to evaluate the sagittal plane range of motion allowed in different types of boots in comparison to fiberglass cast treatment on normal human subjects.