Abstract Arthroscopic and open ankle arthrodesis have been compared in very few studies, and no consensus has been reached regarding the incidence of postoperative revision surgery associated with ...each technique. The purpose of the present study was to compare these 2 approaches for the incidence of postsurgical operations. Patients who had undergone either arthroscopic or open ankle arthrodesis were identified between January 2005 to December 2011 in the PearlDiver™ database using a predetermined algorithm and searched for the following postsurgical operations: revision ankle arthrodesis, midfoot arthrodesis, and hindfoot arthrodesis. In the current database, 7322 cases were performed with an open technique and 1152 arthroscopically. The incidence of revision arthrodesis was not significantly different statistically between the 2 techniques. However, the incidence of subsequent adjacent joint arthrodesis was greater for the open cohort (5.6% versus 2.6%; odds ratio 2.17, 95% confidence interval 1.49 to 3.16). In the open cohort, the incidence of hindfoot arthrodesis was greater than the incidence of midfoot arthrodesis (3.9% versus 1.6%, odds ratio 2.43, 95% confidence interval 1.95 to 3.01). The results showed that although open ankle arthrodesis is more commonly performed, it is associated with a greater incidence of subsequent adjacent joint arthrodesis specifically in the hindfoot.
Highlights • Anterior ankle impingement is a common cause of chronic ankle pain, particularly in athletic populations. • Advancements in ankle arthroscopy have decreased the risk of complications. • ...A comprehensive understanding of diagnosis and surgical technique can influence patient outcomes. • The purpose of this review is to review the evidence-based outcomes of arthroscopic management for anterior ankle impingement.
Category:
Sports.
Introduction/Purpose:
The purpose of this study was to assess the rate of surgical site infection (SSI) and surgical irrigation and debridement (I&D) after primary Achilles tendon ...repair. Secondary objectives were to assess the potential effect(s) of medical comorbidities on cost and duration of treatment of SSI after Achilles tendon repair.
Methods:
De-identified patient insurance records within the government and private national insurance orthopaedic datasets were searched between 2005-2012. The Current Procedural Terminology (CPT) code was used to identify primary Achilles tendon repair and I&D. Subsequently, post-operative SSIs and comorbidities were examined by searching corresponding International Classification of Disease Ninth Revision, Clinical Modification (ICD-9-CM) codes.
Results:
24,269 primary Achilles tendon repairs were identified. Overall, there was a significantly increased rate of SSI if a medical comorbidity was present at the time of surgery compared to those without a comorbidity (17.96% vs. 5.96%, p < 0.0001). Patients with diabetes and vascular complications had the highest SSI rate (OR 7.85, CI 6.25-9.86, p < 0.001), followed by peripheral vascular disease, diabetes with peripheral neuropathy, history of drug abuse, fluid and electrolyte abnormalities, obesity, and uncomplicated diabetes. There was higher rate of surgical I&D in patients with cardiac arrhythmias and uncomplicated hypertension. There was a significant increase in cost of SSI treatment ($6,004.09 vs. $4,184.62, p=0.006) and duration of treatment (8.41 days vs. 5.54 days, p < 0.001) if a medical comorbidity was present in Achilles tendon patients with SSI.
Conclusion:
An analysis of a large cohort of patients undergoing Achilles tendon reconstruction revealed that having certain medical comorbidities conferred a significantly greater risk for developing SSI, which increased both the cost of subsequent care and duration of treatment. Furthermore, with the advent of “value”/outcomes based care being linked to reimbursement, SSI is a one measure being used by the Centers for Medicare & Medicaid Services and private insures to determine appropriate orthopaedic care. Thus, patients with modifiable risk factors should be referred for medical management prior to surgery or deferred to a non-operative treatment program to reduce the risk of SSI after Achilles tendon repair.
Background: Internal fixation is a popular first-line treatment method for proximal fifth metatarsal Jones fractures in athletes; however, nonunions and screw breakage can occur, in part because of ...nonspecific fixation hardware and poor blood supply.
Purpose: To report the results from 26 patients who underwent percutaneous internal fixation with a specialized screw system of a proximal fifth metatarsal Jones fracture (zones II and III) and bone marrow aspirate concentrate.
Study Design: Case series; Level of evidence, 4.
Methods: Percutaneous internal fixation for a proximal fifth metatarsal Jones fracture (zones II and III) was performed on 26 athletic patients (mean age, 27.47 years; range, 18-47). All patients were competing at some level of sport and were assessed preoperatively and postoperatively using the Foot and Ankle Outcome Score and SF-12 outcome scores. The mean follow-up time was 20.62 months (range, 12-28). Of the 26 fractures, 17 were traditional zone II Jones fractures, and the remaining 9 were zone III proximal diaphyseal fractures.
Results: The mean Foot and Ankle Outcome Score significantly increased, from 51.15 points preoperatively (range, 14-69) to 90.91 at final follow-up (range, 71-100; P < .01). The mean physical component of the SF-12 score significantly improved, from 25.69 points preoperatively (range, 6-39) to 54.62 at final follow-up (range, 32-62; P < .01). The mean mental component of the SF-12 score also significantly improved, from 28.20 points preoperatively (range, 14-45) to 58.41 at final follow-up (range, 36-67; P < .01). The mean time to fracture healing on standard radiographs was 5 weeks after surgery (range, 4-24). Two patients did not return to their previous levels of sporting activity. One patient experienced a delayed union, and 1 healed but later refractured.
Conclusion: Percutaneous internal fixation of proximal fifth metatarsal Jones fractures, with a Charlotte Carolina screw and bone marrow aspirate concentrate, provides more predictable results while permitting athletes a return to sport at their previous levels of competition, with few complications.
Purpose
The objective of the present study was to correlate macroscopic and microscopic anatomy of the lateral capsule of the knee joint with high-quality magnetic resonance imaging (MRI), with a ...hypothesis that a distinct lateral capsular ligament would be inconsistently observed via surgical dissection and that high-quality MRI imaging would correlate to findings from dissection.
Methods
Ten fresh-frozen human cadaveric knee specimens were utilized for this study. MRI of each knee was obtained pre- and post-dissection. The lateral knee was dissected and analysed for the presence or absence of a discrete capsular thickening or an independent ligamentous structure. A musculoskeletal radiologist analysed the pre- and post-dissection MRI. Subsequently, two specimens with positive lateral capsular thickening were prepared for histology.
Results
On macroscopic dissection, none of the ten specimens were found to have a discrete lateral capsular ligament. A palpable macroscopic thickening of the lateral capsule was identified in 4/10 specimens. MRI analysis revealed a 2–4 mm thickening of the central third of the lateral capsule in 3/10 specimens. On histological analysis, the lateral capsular thickening demonstrated properties similar to both capsule and ligament.
Conclusions
In fresh-frozen cadaveric specimens, macroscopic and MRI evaluation of the lateral capsule of the knee revealed variations in morphology without consistent capsuloligamentous anatomy and specifically no discrete lateral capsular ligament. Further investigation in the form of clinical and mechanical relevance of the lateral capsular structures is of paramount importance before limited anatomical data can be utilized to drive clinical decision-making and patient care.
To help determine whether planktonic eggs of fishes on the West Florida Shelf (WFS) are retained locally or exported elsewhere, we collected fish eggs by plankton net from 17 locations (stations) and ...identified them using DNA barcoding. We then entered the station coordinates into the West Florida Coastal Ocean Model (WFCOM) and simulated the trajectories of the passively drifting eggs over 2 weeks at three depths (surface, midwater, and near bottom). The results indicated there were two groups of trajectories: a nearshore group that tended to be retained and an offshore group that tended toward export and potential long‐distance dispersal. We also found evidence of a relationship between retention and higher fish‐egg abundance; nearshore stations were associated with higher fish‐egg abundances and higher retention. We suggest this is the result of (1) increased spawning in high‐retention areas, (2) increased drift convergence in high‐retention areas, or both processes acting together. Community analysis using SIMPROF indicated the presence of a depth‐related (retention‐related) difference in species assemblages. Fish‐egg species were also categorized as pelagics or non‐pelagics; there was no evidence of pelagic species being more likely to be exported.
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