Foot & Ankle Orthopaedics最新文献

{"title":"Preliminary Radiographic Classification of First Metatarsal Osteotomy Healing Following Minimally Invasive Hallux Valgus Surgery.","authors":"Thomas L Lewis, Sanjana Mehrotra, Jonathan Kaplan, Tyler Gonzalez, Sergio Morales, Thomas J Goff, Vikramman Vignaraja, Ayla Claire Newton, Robbie Ray, Peter Lam","doi":"10.1177/24730114251345818","DOIUrl":"10.1177/24730114251345818","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive or percutaneous surgery (MIS) for hallux valgus correction has seen increased adoption because of a growing evidence base of positive clinical and radiographic outcomes following surgery. However, no standardized or validated radiographic classification exists to evaluate the first metatarsal osteotomy healing following MIS hallux valgus surgery. The aim was to develop a new radiographic classification system for assessing bone healing following MIS distal transverse osteotomy for hallux valgus.</p><p><strong>Methods: </strong>A 4-domain radiographic classification system based on callus formation, anteroposterior (AP) osteotomy line, lateral osteotomy line, and remodeling for MIS osteotomy healing was developed and tested on a cohort of 27 feet that underwent percutaneous transverse osteotomy for hallux valgus correction. Patients had simultaneous postoperative weightbearing computed tomography (WBCT) and standard radiographs following surgery. Five surgeons reviewed anonymized radiographs to evaluate interobserver reliability. WBCT was used to confirm union status and classification interpretation.</p><p><strong>Results: </strong>The classification system demonstrated substantial interobserver reliability for lateral osteotomy line (Fleiss kappa = 0.671, 95% CI 0.505-0.814) and AP osteotomy line assessment (Fleiss kappa = 0.664, 95% CI 0.459-0.811), with moderate agreement for callus formation (κ = 0.465) and remodeling (κ = 0.439). The classification showed strong correlation with WBCT findings, with an optimal threshold of 8 points identified to differentiate union from nonunion, achieving an overall classification accuracy of 85.2%. This finding was supported by the area under the receiver operating characteristic (ROC) curve of 0.832. At the optimal threshold, the classification demonstrated 90.0% sensitivity and 71.4% specificity for detecting union.</p><p><strong>Conclusion: </strong>This preliminary classification provides a reliable tool for assessing first metatarsal bone healing following MIS hallux valgus osteotomies, with substantial interobserver reliability. It offers a standardized approach for radiographic evaluation, which may enhance comparability across studies and serve as a radiographic research tool pending further validation. Its clinical applicability remains to be determined.</p><p><strong>Level of evidence: </strong>Level III, diagnostic study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251345818"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12214334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MicroCT Advanced Imaging of the Foot and Ankle: Technique Guide.","authors":"Jonathan Day","doi":"10.1177/24730114251351633","DOIUrl":"10.1177/24730114251351633","url":null,"abstract":"<p><strong>Background: </strong>Recent advances in micro-computed tomography (MicroCT) imaging have enabled detailed investigations of human microvascular anatomy, providing new insights that may influence treatment options and optimize local reparative potential. This article describes a reproducible cadaveric perfusion technique for visualizing foot and ankle microvasculature using MicroCT, designed to support anatomical research and surgical planning studies.</p><p><strong>Methods: </strong>Ten matched pairs of fresh-frozen cadaveric lower limbs were used to develop this protocol. An 18-gauge angiocatheter was used to cannulate the anterior and posterior tibial arteries for perfusion of the foot and ankle, or the popliteal artery for perfusion of the entire lower leg. Clearing was performed sequentially with 0.9% saline, 3% hydrogen peroxide, and water. Perfusion was performed with a 50% barium sulfate/2.5% gelatin solution. Confirmatory images were obtained using mini c-arm fluoroscopy. Final images were obtained for microvascular assessment using a commercial MicroCT scanner. Integrity of the perfusate was visually evaluated on MicroCT over the course of 4 freeze-thaw cycles spanning 2 months.</p><p><strong>Results: </strong>All intraosseous and extraosseous microvascular structures were successfully visualized using MicroCT of the cadaveric lower extremities. Microvasculature was perfused in continuity without incidence of contrast extravasation. When present, intraosseous nutrient arteries of the first and fifth metatarsal, and branches of the tarsal sinus artery were appreciated. Contrast material remained visually consistent even after preforming surgical resections and undergoing multiple freeze-thaw cycles.</p><p><strong>Conclusion: </strong>This standardized perfusion technique was effective in the visualization of microvasculature in the foot and ankle. In addition to 3-dimensional mapping using MicroCT, this reproducible protocol can be used in numerous advanced imaging applications, including microvascular assessment following surgical reconstructions and instrumentation.</p><p><strong>Clinical relevance: </strong>A refined understanding of the microvascular anatomy of the foot and ankle using MicroCT perfusion imaging can potentially guide surgical techniques to minimize iatrogenic injury and optimize healing.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251351633"},"PeriodicalIF":0.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Epidemiology of Sports and Recreation Related Toe Fractures in the United States.","authors":"Dogerno Norceide, Gabriel I Onor, Oluwatomi Akingbola, William Justice, Nana F Amponsah, Abimbola Okulaja, Ifeanyichukwu Onor, Michael Okoronkwo, Chibuikem Nwizu, David Pedowitz","doi":"10.1177/24730114251342797","DOIUrl":"10.1177/24730114251342797","url":null,"abstract":"<p><strong>Background: </strong>Fractures of the toes are among the most frequently diagnosed lower extremity fractures. In sports, toe fractures may present after diverse mechanisms of injury, varying severity, and varying implications for management. This study aimed to discern trends in toe fractures presenting to US emergency departments (EDs) particularly in association with sports and recreational activities. An additional aim of the study was to identify if rates of toe fracture presentation significantly decreased during the year 2020 at the height of the COVID-19 pandemic.</p><p><strong>Methods: </strong>We queried the National Electronic Injury Surveillance System (NEISS) database to identify toe fractures presented to US EDs from 2013 to 2022. The data outputs were analyzed by age group, sex, sport/recreational activity, and year. US Census data were used for calculation of incidence rates (IR) in 100,000 person-years. χ² tests and regression analyses were performed to determine significance. Grubbs's test was performed to determine significant yearly outliers with particular attention to the year 2020.</p><p><strong>Results: </strong>A total of 921,033 toe fractures were identified across US EDs, with 175,864 cases associated with sports and recreation. Exercise (IR = 140.3) had the leading IR among sports/recreation followed by cycling (IR = 136.8), basketball (IR = 136.8), and football (IR = 94.9). Males accounted for 40.8% of fractures (IR = 23.0), whereas females contributed 59.2% (IR = 32.8). Toe fractures peaked in the 10- to 14-year-old age group in both males and females. Sports- and recreation-related toe fractures did not significantly decrease from 2013 to 2022, although all-cause toe fractures did significantly decrease as shown by a <i>P</i> value of .0037 from linear regression analysis of yearly trend in all toe fractures. The year 2020 was a significant outlier with a decrease in sports-related toe fractures though there was no significant decrease in all-cause toe fractures in 2020.</p><p><strong>Conclusion: </strong>Sports- and recreation-related toe fractures did not significantly decrease from 2013 to 2022, although a significant decrease in all-cause toe fractures was observed. Toe fractures continue to peak in the pediatric age groups, particularly 10-14 year-olds. Youth sports and recreation officials should be aware of the risks of toe fractures to aid in prevention.<b>Level of Evidence:</b> Level III, epidemiologic database, retrospective cohort studies.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251342797"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achilles Tendon Scraping With Plantaris Tendon Removal for Achilles Tendinopathy: A Systematic Review and Meta-analysis.","authors":"Jimmy Wen, Meraj Alam, Romteen Sedighi, Burhaan Syed, Ramy Khalil, Mouhamad Shehabat, Bethany Joy, Daniel Razick, Adam Razick, Eldo Frezza","doi":"10.1177/24730114251346791","DOIUrl":"10.1177/24730114251346791","url":null,"abstract":"<p><strong>Background: </strong>Achilles tendinopathy (AT) patients who are refractory or have a suboptimal response to traditional tendon loading rehabilitation may have an additional component of pain with the plantaris tendon. This systematic review aims to evaluate the efficacy and safety of the combination of Achilles tendon scraping (ATS) and plantaris tendon removal (PTR) for AT.</p><p><strong>Methods: </strong>A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in PubMed, Embase, and Cochrane Library for studies reporting on concurrent ATS with PTR for AT. Study variables included the number of patients, mean age, mean follow-up time, return to activity (RTA) or sport (RTS), pre- and postintervention patient-reported outcomes (PROs), and complications. A meta-analysis was performed for pre- and postintervention Victorian Institute of Sports Assessment-Achilles (VISA-A) scores.</p><p><strong>Results: </strong>Seven studies including 235 patients (291 tendons) with a mean age of 40.8 years (27.2-52) and a mean follow-up time of 23.2 months (6-69.6) were analyzed. Mean preoperative score VISA-A (5 studies), and visual analog scale (VAS) scores (2 studies) were 43.4 (0-74.1) and 6.6 (5.8-7.4), respectively. RTA (1 study) and RTS (4 studies) were 100% and 95.5%. Mean postoperative VISA-A and VAS scores were 92.7 (61-100) and 0.8 (0.8-0.8). Pooled VISA-A mean differences were statistically significant at 43.6 (95% CI: 41.0-46.3, <i>P</i> < .00001). The complication and revision rates were 11 (3.8%) and 5 (1.7%), respectively.</p><p><strong>Conclusion: </strong>ATS with PTR demonstrated promising preliminary results, with improved postoperative PROs, high reported rates of RTA/RTS, and low complication and revision rates. These findings should be interpreted cautiously given the limited available evidence and high study heterogeneity.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251346791"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Combined Proximal Medial Gastrocnemius Release and Achilles Tendon Debridement and Reinsertion for Calcified Insertional Achilles Tendinopathy.","authors":"Daniel Saraiva, Markus Knupp, Daniel Freitas, André Sá Rodrigues, Tiago Pato, José Tulha, Tiago Mota Gomes, Xavier Martín Oliva","doi":"10.1177/24730114251348194","DOIUrl":"10.1177/24730114251348194","url":null,"abstract":"<p><strong>Background: </strong>Gastrocnemius tightness has been implicated in the pathogenesis of calcified insertional Achilles tendinopathy (IAT), Haglund deformity, and Achilles intratendinous calcifications (IC). The aims of this study were to determine long-term clinical and radiographic results of combined proximal medial gastrocnemius release (PMGR) and Achilles tendon debridement and reattachment (ATDR) for patients presenting with symptomatic calcified IAT.</p><p><strong>Methods: </strong>A retrospective cohort study was performed in order to determine clinical and radiographic outcomes of PMGR and ATDR for patients presenting with symptomatic calcified IAT, at a minimum follow-up of 30 months. Patient satisfaction was assessed at last available follow-up as very satisfied, satisfied, and unsatisfied. Clinical assessment was performed evaluating preoperative and last available follow-up visual analog scale for pain (VAS-P) and the Foot and Ankle Outcome Score (FAOS). Radiographic evaluation included Fowler-Phillip angle, calcification length, calcification width, and presence of Achilles IC, measured on standard weightbearing lateral calibrated radiograph of the foot preoperatively and last available follow-up evaluation for each patient.</p><p><strong>Results: </strong>The mean follow-up was 46 (range, 30-72) months. We registered 45 \"very satisfied\" patients (84.91%), 6 \"satisfied\" patients (11.32%), and 2 \"unsatisfied\" patients (3.77%), as well as statistically significant improvement on both clinical scores tested. We found statistically significant differences between the initial evaluation and last available follow-up on all radiographic measurements. There was no significant radiographic recurrence of calcified IAT, whereas minor Achilles intratendinous calcifications were found in 10 patients (18.87%).</p><p><strong>Conclusion: </strong>Combined PMGR and ATDR provides significant clinical and radiographic improvement for patients presenting with symptomatic calcified IAT and, although not preventing radiographic recurrence of minor Achilles IC, may reduce the rate of radiographic recurrence of calcified IAT, though the lack of a control group limits causal inference.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251348194"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topical <i>Bixa orellana</i> for Postoperative Wound Healing: A Prospective Randomized Controlled Trial.","authors":"Joshua T Chew, Joshua J Xu, Thomas A J Goff, Karen A Fogarty, Michael J Symes, Brahman S Sivakumar, Andrew P Wines","doi":"10.1177/24730114251345821","DOIUrl":"10.1177/24730114251345821","url":null,"abstract":"<p><strong>Background: </strong>Numerous ointments may be applied to surgical incisions in the postoperative period to minimize scar formation. There is little evidence assessing their efficacy on wound healing following foot and ankle procedures. This trial was conducted to assess the efficacy of <i>Bixa orellana</i> (Urucu) ointment in the treatment of postoperative elective foot and ankle incisions, compared with conventional postoperative wound care using a control ointment.</p><p><strong>Methods: </strong>A prospective, single-center, randomized controlled trial of adults who had undergone elective foot and ankle surgery was performed. Participants were randomized into receiving either a protocol of <i>B orellana</i> ointment application or conventional postoperative wound care with a control ointment. These ointments were applied 2 weeks postoperatively for a 4-week duration. The primary outcome assessed was the Patient and Observer Scar Assessment Scale (POSAS) 6 weeks postoperatively.</p><p><strong>Results: </strong>Significant improvements were noted in observer-reported wound vascularity, pigmentation, thickness, relief, pliability, and surface area with the use of Urucu, when compared to the control ointment. Overall, observers reported that scars treated with Urucu cream were found to more closely resemble normal skin with an overall POSAS score of 2.56 compared with 3.33 for the control ointment (<i>P</i> < .01). Lower scores in this instance indicate a more favorable result. Similarly, patients also reported a similar finding with an overall POSAS score of 3.70 for Urucu compared with a control ointment, 4.80 (<i>P</i> = .012). No difference was noted in terms of antibiotic use, delayed wound healing, or return to theatre. Two patients had adverse effects on the application of Urucu ointment in the form of a localized reaction and pruritis that improved with treatment cessation (<i>P</i> = .08). Neither patient required any further intervention.</p><p><strong>Conclusion: </strong>Topical Urucu ointment demonstrated promising early improvements in POSAS scores from both patients and observers, particularly in pigmentation and pliability domains, but findings should be interpreted cautiously because of the small sample size and short follow-up.</p><p><strong>Level of evidence: </strong>Level I, randomized controlled trial.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251345821"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial Gastrocnemius Recession.","authors":"Irvin Oh, Jeremy Ansah-Twum, Arianna Gianakos, Kinjal Vasavada","doi":"10.1177/24730114251347265","DOIUrl":"10.1177/24730114251347265","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251347265"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical Comparison of Two Plantar Lapidus Plating Systems.","authors":"Felix Werneburg, Maria Felsberg, Juliane Beschauner, Christin Arnold, Darius Arbab, Heike Kielstein, Alexander Zeh, Karl-Stefan Delank, Natalia Gutteck","doi":"10.1177/24730114251342799","DOIUrl":"10.1177/24730114251342799","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Hallux valgus (HV) is a common forefoot deformity that often leads to foot pain and functional limitations, requiring surgical intervention when conservative treatments fail. Tarsometatarsal arthrodesis is a widely used procedure for severe HV deformities, with plantar plate fixation demonstrating superior biomechanical outcomes. However, the biomechanical equivalence of different plantar plate designs remains unclear. Specifically, there is a lack of biomechanical studies comparing how design variations affect load distribution, durability, and the risk of material failure postoperatively. This study aims to address this gap by evaluating the biomechanical performance of 2 commonly used plantar plate designs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study involved a biomechanical analysis of 2 widely used plantar Lapidus plating designs: U-shaped plates and straight-shaped plates. A total of 20 fresh frozen cadaveric feet from 10 donors were included. The plates were assigned randomly to each specimen, and tarsometatarsal arthrodesis was performed according to the manufacturers' guidelines. Mechanical testing was conducted using a universal testing machine, focusing on cyclic loading and maximum load capacity to assess the mechanical stability of each system. Cyclic loads were systematically applied in 4 increments, culminating in a ramp test to ascertain the maximum load to material failure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Both the U-shaped and the straight-shaped plantar Lapidus plates demonstrated commendable mechanical stability under cyclic loading, with nearly no significant differences in stiffness across the 4 cyclic loading force cycles. In the maximum load capacity test, the straight-shaped plate showed a higher mean load capacity (540.6 N, SD = 36.09) compared with the U-shaped plate (446.6 N, SD = 91.32), with a statistically significant difference (&lt;i&gt;P&lt;/i&gt; = .03) and a large effect size (Cohen &lt;i&gt;d&lt;/i&gt; = 1.56).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This biomechanical study demonstrated that both U-shaped and straight-shaped plantar Lapidus plating systems provided comparable mechanical performance under stepwise cyclic loading conditions. The straight-shaped plates showed a higher failure rate during cyclic loading but achieved a significantly greater maximum load capacity in the final load-to-failure test. In contrast, the U-shaped plates were more consistent under repeated loading, suggesting potential advantages in fatigue resistance. These findings may reflect a trade-off between repetitive load endurance and maximum load-bearing capacity. Although these results offer biomechanical insight into the design-specific behavior of 2 commonly used plantar plating systems, their clinical relevance should be interpreted with caution, given the limitations of cadaveric testing, the absence of biological bone healing, and small sample sizes. Further clinical and long-term outcome studies are needed to confirm whe","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251342799"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal Tightrope Positioning for Adequate Syndesmotic Stabilization in Simulated Syndesmotic Injuries.","authors":"Mark A Goss, Alex T Burton, Jonathan C Kraus, Linda M McGrady, Mei Wang","doi":"10.1177/24730114251342243","DOIUrl":"10.1177/24730114251342243","url":null,"abstract":"<p><strong>Background: </strong>Use of syndesmotic suture button fixation has gained in popularity for treating an injury to the tibiofibular syndesmosis. This biomechanical study used a cadaveric model to simulate in vivo loading conditions to assess the impact of the placement of a syndesmotic stabilization construct using a suture button device.</p><p><strong>Methods: </strong>Biomechanical fixation stability with suture button device (TightRope; Arthrex, Naples, FL) placed at 4 distances from the tibiotalar joint line (0.5, 1.5, 2.5, and 3.5 cm) and 3 trajectories (anterior, medial, and posterior) were studied using cadaveric lower extremities with created syndesmotic injuries. Nondestructive testing was conducted on a biaxial servo-hydraulic load frame. The load application consisted of 2 portions: (1) axial compression simulating weightbearing and (2) external rotation of the ankle (up to 12 degrees and under 7.5 Nm) around the long axis of the tibia combined with weightbearing. Fibular motion and syndesmotic widening were tracked using motion analysis to quantify stability.</p><p><strong>Results: </strong>Fixation placed at 0.5 or 1.5 cm from the joint line in medial or posterior trajectories resulted in the lowest increases in fibular rotation under loading. More proximal or anterior placements led to increased fibular motion and decreased rotational stability. Ankle width changes were minimal in most groups, although slightly increased widening occurred at proximal and anterior placements.</p><p><strong>Conclusion: </strong>Placement of the syndesmotic suture button fixation 0.5-1.5 cm of the joint line in medial or posterior orientations provides the most rotationally stable fixation in a cadaveric model. These findings support flexibility in syndesmotic suture button fixation positioning when hardware constraints limit ideal placement.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251342243"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12179484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disclosed Industry Funding Does Not Increase Positive Outcomes in Studies on Suture Button Fixation for Ankle Syndesmotic Injuries: A Systematic Review.","authors":"Cailan L Feingold, Eric H Lin, Ajith K Subhash, Samuel C Tercyak, Aidan A Jagasia, Eric W Tan, Alexander B Peterson, Joseph N Liu","doi":"10.1177/24730114251341305","DOIUrl":"10.1177/24730114251341305","url":null,"abstract":"<p><strong>Background: </strong>Industry funding can increase the likelihood of positive outcomes. This study sought to investigate whether industry funding or conflicts of interest (COI) for studies investigating suture button fixation devices for ankle syndesmosis injuries influenced outcomes.</p><p><strong>Methods: </strong>PubMed, Scopus, and Embase were queried for studies investigating suture button fixation devices for the ankle. Included studies investigated suture button fixation devices for the ankle and reported funding or COI. Excluded studies were systematic reviews, meta-analyses, and case reports. Outcomes were categorized into \"positive\" if the null hypothesis was rejected or outcomes favored the implant, \"neutral\" if the null hypothesis was confirmed, or \"negative\" if the result was unfavorable toward the implant. Studies were grouped into industry-funded, nonfunded, and \"other\" funding, including specialty societies, National Institutes of Health (NIH), and grants. Studies were also grouped by the presence or absence of COI. Chi-squared test was used to test for significance defined as <i>P</i> <.05.</p><p><strong>Results: </strong>A total of 112 studies were included for analysis. Of these, 19 (17%) were industry-funded, 21 (19%) had other funding sources, and 72 (64%) were nonfunded. The proportion of studies with positive outcomes was 48% in industry-funded studies, 63% in studies with other funding sources, and 65% in nonfunded studies. There was no significant association between funding source and outcome (<i>P</i> = .063). A COI was present in 42 studies (37.5%), and no COI was present in 70 studies (62.5%). The proportion of positive studies in those with a COI was 52%, whereas in studies without a COI, it was 67%. Positive studies were significantly associated with studies without COI (<i>P</i> = .003).</p><p><strong>Conclusion: </strong>Industry funding and COI was not found to be associated with an increased likelihood of positive outcome reporting in studies on suture-button fixation for ankle syndesmostic injuries; we found in this review that positive outcomes are more likely in studies without COI.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"10 2","pages":"24730114251341305"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}