Daniel Latt - Academia.edu (original) (raw)

Papers by Daniel Latt

Foot & Ankle Orthopaedics, Jul 1, 2023

Anatomic lateral ankle ligament reconstruction using free tendon graft with osseous tunnels has b... more Anatomic lateral ankle ligament reconstruction using free tendon graft with osseous tunnels has become a popular technique for revision reconstruction of the lateral ankle ligaments. With the procedure’s burgeoning popularity, an accompanying increase in postoperative complications is likely to occur. We report on one such complication: traumatic distal fibula fracture through the transosseous tunnels.

Foot & Ankle Orthopaedics, Jul 1, 2023

Ankle fractures are common musculoskeletal injuries that may result in tibiotalar joint dislocati... more Ankle fractures are common musculoskeletal injuries that may result in tibiotalar joint dislocations. Ankle fracture-dislocations occur via similar mechanisms as ankle fractures, although the persistence or magnitude of the deforming force is sufficient to disrupt any remaining bony or soft-tissue stability. Ankle fracture-dislocations likely represent distinct clinical entities, as the pathology, management, and patient outcomes following these injuries differ from those seen in more common ankle fractures without dislocation. Ankle fracture-dislocations have higher rates of concomitant injury including open fractures, chondral lesions, and intra-articular loose bodies. Long-term outcomes in ankle fracture-dislocations are worse than ankle fractures without dislocation. Higher rates of posttraumatic osteoarthritis and chronic pain have also been reported. In this review, we discuss the current literature regarding the history, management, and outcomes of ankle-fracture dislocations and highlight the need for future study.

Foot & Ankle Orthopaedics, Jul 1, 2023

Foot and Ankle Specialist, Dec 13, 2022

Background Symptomatic progressive collapsing foot deformity (PCFD) is frequently treated with re... more Background Symptomatic progressive collapsing foot deformity (PCFD) is frequently treated with reconstructive surgery. Multiple studies have documented successful treatment based on improvements in symptoms and physical examination findings. However, it is not well-established whether there are corresponding improvements in gait function following surgical treatment for PCFD. Methods A systematic review of biomechanical outcomes of treatments for flexible PCFD was conducted on PubMed. The 4 articles chosen involved patients with symptomatic flexible PCFD who underwent a reconstructive surgery. Surgical interventions included osteotomy, tendon transfer, and/or ligament repair or reconstruction. Primary outcomes involved objective quantifiable measurements of kinematic, kinetic, or temporospatial parameters. Results The initial search yielded 605 articles, from which 26 were retained after screening the title and abstract. Twenty-two were eliminated yielding 4 articles. Temporospatial, kinematic, and kinetic parameters were all altered after the patients underwent surgical intervention. Specifically, stride length, cadence, and walking speed all improved postoperatively. Walking kinetics also improved with restoration of normal motion in the frontal and sagittal planes and improvements in the dorsiflexion angle. There were also improvements in sagittal power. Discussion Surgical intervention to treat flexible PCFD improves objective biomechanical outcomes; however, more follow-up studies are needed to establish the reliability and durability of these improvements. Level of Evidence: Level III: Systematic review

Current Radiology Reports, Apr 21, 2015

Foot & Ankle Orthopaedics, Jul 1, 2023

Foot & Ankle Orthopaedics, Oct 1, 2022

Category: Ankle Introduction/Purpose: Suspected peroneal tendinopathy, tears, and subluxation are... more Category: Ankle Introduction/Purpose: Suspected peroneal tendinopathy, tears, and subluxation are often confirmed using magnetic resonance imaging (MRI) or diagnostic ultrasound (US). The choice between these two imaging modalities is commonly based on surgeon preference as the accuracy of these tests for the diagnosis of peroneal tendinopathy, tears, and subluxation is not known. The purpose of this study was to compare MRI and US to the intraoperative findings in patients who underwent surgery for the treatment of suspected peroneal tendinopathy, tears, and subluxations to determine the diagnostic accuracy of each imaging modality. Methods: The operative records and diagnostic images for 21 patients who underwent surgery for suspected peroneal tendinopathy, tears, or subluxation were retrospectively reviewed. Two fellowship trained musculoskeletal radiologists conducted a systematic blinded review of the stored MRI and US images. The results of this review were compared with the intraoperative findings to yield the sensitivity and specificity for each imaging modality. Results: For the diagnosis of peroneus brevis tears, both MRI and ultrasound were equally good at detecting tears. In the diagnosis of peroneus brevis tears, MRI was marginally better with a sensitivity and specificity of 100% versus ultrasound, which had a sensitivity of 90% and specificity of 100%. In the diagnosis of peroneal subluxation, ultrasound had a sensitivity of 100% and a specificity of 100% compared to MRI, which had a sensitivity of 33% and specificity of 100%. Conclusion: In comparing MRI and US to intraoperative findings for the diagnosis of peroneal tendinosis, tears and subluxation, we found ultrasound to be more effective at diagnosing peroneal tendinopathy and subluxation, while MRI was found to be slightly more accurate in the diagnosis of peroneus brevis tendon tears. Both MRI and ultrasound were effective for the diagnosis of peroneus longus tears.

Foot and Ankle Specialist, Oct 8, 2022

Background In minimally displaced Weber B ankle fractures, the distal fibular fracture fragment c... more Background In minimally displaced Weber B ankle fractures, the distal fibular fracture fragment can be externally rotated. This malrotation is difficult to detect on radiographs and, when left malreduced through nonoperative treatment, may contribute to altered joint mechanics, predisposing to posttraumatic osteoarthritis. This study evaluates the effects of fibular malrotation on tibiotalar joint contact mechanics. Methods Six cadaveric ankles were tested using a materials testing system (MTS) machine. A tibiotalar joint sensor recorded contact area and pressure. Samples were tested in the intact, neutrally rotated, and malrotated state. Each trial applied a 686N axial load and a 147N Achilles tendon load in neutral position, 15° dorsiflexion, and 15° plantarflexion. Results In the comparison of malrotated to intact ankles, peak contact pressure was found to be significantly greater at neutral flexion (intact 5.56 MPa ± 1.39, malrotated 7.21 MPa ± 1.07, P = .03), not significantly different in dorsiflexion, and significantly decreased in plantarflexion (intact 11.2 MPa ± 3.04, malrotated 9.01 MPa ± 1.84, P = .01). Significant differences in contact area were not found between conditions. Conclusion The findings suggest that fibular malrotation contributes to significant alterations in tibiotalar joint contact pressures, which may contribute to the development of posttraumatic osteoarthritis. When malrotation of the fibula is suspected on plain radiographs, a computer tomography (CT) scan should be obtained to evaluate its extent and further consideration should be given to surgical treatment. Levels of Evidence: Level V: Bench testing

Orthopaedic Journal of Sports Medicine, 2021

Background: Anterior cruciate ligament (ACL) ruptures are potentially career-threatening injuries... more Background: Anterior cruciate ligament (ACL) ruptures are potentially career-threatening injuries to National Football League (NFL) skill position players. A 2006 study showed a return-to-play (RTP) rate of 79% for NFL running backs (RBs) and wide receivers (WRs). Since then, a number of factors affecting RTP, including style of play as well as rules regarding hits to the head, have changed how defensive players tackle offensive ball carriers. Purpose/Hypothesis: To determine whether the RTP rate for RBs and WRs in the NFL has changed since data were collected in the 2000s. Additionally, we evaluated player performance before and after ACL reconstruction (ACLR). We hypothesized that there will be a lower RTP rate than previously reported as well as a decrease in performance statistics after ACLR. Study Design: Descriptive epidemiology study. Methods: Publicly available NFL injury reports between the 2009-2010 and 2015-2016 seasons were utilized for RBs and WRs who underwent ACLR. Successful RTP was indicated by playing in at least 1 NFL game after reconstruction. Position-specific performance statistics from before and after reconstruction were gathered for these players, and the RTP players were compared against the players who did not RTP (dnRTP group). Pre- and postinjury performance measures were also compared against a matched control group of NFL RBs and WRs who had not sustained an ACL injury. Results: Overall, 61.8% of players (64.5% of RBs, 60% of WRs) returned to play at a mean of 13.6 months. Prior to injury, the RTP group had played in significantly more career games and had significantly more rushes and receptions per game than the dnRTP group; however, there was no significant difference in performance after ACLR. The WR RTP group had significantly decreased performance in all measured categories when compared with the control group. Conclusion: Our study found a lower RTP rate in RBs and WRs than previous studies conducted in the early 2000s. WRs who achieved RTP had decreased performance when compared with noninjured controls.

American Journal of Sports Medicine, Sep 21, 2011

Background: Osteochondral allograft transplantation is technically demanding. It is not always po... more Background: Osteochondral allograft transplantation is technically demanding. It is not always possible to place the surface of the graft perfectly flush with the surrounding cartilage. One must often choose between placing at least some portion of the surface of the graft slightly elevated or recessed. The effect of this choice on joint contact pressure is unknown. Purpose: This study was undertaken to determine the effect of graft height mismatch on joint contact pressure in the ankle. Study Design: Controlled laboratory study. Methods: Ten human cadaveric ankles underwent osteochondral grafting by removal then replacement of an osteochondral plug. Six conditions were tested: intact, graft flush, graft elevated 1.0 mm, graft elevated 0.5 mm, graft recessed 0.5 mm, and graft recessed 1.0 mm. Joint contact pressures were measured with a Tekscan sensor while loads of 200 N, 400 N, 600 N, and 800 N were sequentially applied. Results: The peak contact pressure at the graft site for the flush condition was not significantly different from the intact condition for either medial or lateral lesions. In contrast, peak pressure on the opposite facet of the talar dome was significantly increased during the flush condition for the medial but not the lateral grafts. Elevated grafts experienced significantly increased contact pressures, whereas recessed grafts experienced significantly decreased pressures. These changes were greater for lateral than for medial lesions. Reciprocal changes in joint contact pressures were found on the opposite facet of the talus with elevated grafts on the lateral side and recessed grafts on the medial side. Conclusion: Flush graft placement can restore near-normal joint contact pressure. Elevated graft placement leads to significant increases in joint contact pressure at the graft site. Recessed graft placement leads to a transfer of pressure from the graft site to the opposite facet of the talus. Clinical Relevance: Osteochondral grafts in the talus should be placed flush if possible or else slightly recessed.

Foot & Ankle Orthopaedics, Jul 1, 2023

Foot & Ankle Orthopaedics, Jul 1, 2019

Foot and Ankle Specialist, Jul 9, 2016

Hindfoot (tibiotalocalcaneal or TTC) arthrodesis is commonly used to treat concomitant arthritis ... more Hindfoot (tibiotalocalcaneal or TTC) arthrodesis is commonly used to treat concomitant arthritis of the ankle and subtalar joints. Simultaneous fusion of both joints can be difficult to achieve especially in patients with impaired healing due to smoking, diabetes mellitus, or Charcot neuroarthropathy. Conventional intramedullary fixation devices allow for compression to be applied at the time of surgery, but this compression can be lost due to bone resorption or settling, leading to impaired healing. In contrast, the novel pseudoelastic intramedullary nail is designed to maintain compression at the arthrodesis sites throughout the healing process by the use of an internal pseudoelastic element. We present 2 cases of revision TTC arthrodesis using the pseudoelastic intramedullary nail. In the first case, an 80-year-old diabetic man with previous ankle and failed subtalar fusion with screws underwent revision TTC arthrodesis. In the second case, a 66-year-old man with Charcot neuroarthropathy and a failed TTC arthrodesis with a static intramedullary nail underwent revision tibiotalar arthrodesis. In both cases, computed tomography scan demonstrated successful union and patients were allowed full weight bearing by 3 months after surgery. These cases provide early evidence that sustained compression via an intramedullary nail can lead to rapid successful hindfoot fusion when standard approaches have failed. Therapeutic, Level IV: Case study.

Foot & Ankle Orthopaedics, Jul 1, 2020

Springer eBooks, 2020

Imaging of patients with suspected peroneal tendon disorders should include weight-bearing radiog... more Imaging of patients with suspected peroneal tendon disorders should include weight-bearing radiographs of the ankle and foot as they are useful for the detection of avulsion fractures and for the evaluation of cavovarus alignment. Advance imaging in the form of MRI or ultrasound imaging is often needed to differentiate between peroneal tendonitis (tendinosis and/or tenosysnovitis), tears, and subluxation. MRI has the advantages of supplying information about a wide array of related and concomitant conditions and being useful for pre-operative planning. In contrast, US is a less time consuming and less costly exam which provides equivalent diagnostic accuracy for tears and is superior in the detection of tendon subluxation. Both modalities are capable of providing information about the presence of the anatomic variants including low-lying peroneus brevis muscle belly, os peroneum, peroneus quartus, and hypertrophied peroneal tubercle.

Journal of Knee Surgery, Nov 13, 2013

Patellofemoral instability can be a disabling problem. Numerous techniques are employed for its t... more Patellofemoral instability can be a disabling problem. Numerous techniques are employed for its treatment. Medial patellofemoral ligament (MPFL) reconstruction in combination with other procedures has been explored by many orthopedic surgeons. The purpose of the study was to determine the effectiveness of isolated MPFL reconstruction in treating the symptoms associated with patellofemoral instability, preventing recurrence of patella dislocation, and returning patients to preinjury level of activity. This is a case series study. We conducted a clinical follow-up study on 56 knees (49 patients) after MPFL reconstruction for recurrent patellar instability with a mean follow-up of 4.3 years (range, 1.1-6.8). A single MPFL reconstruction technique was performed in all cases. Patient outcomes were evaluated using: International Knee Documentation Committee (IKDC) subjective knee form, Tegner activity score, functional hop test, and radiographs. Mean age at time of surgery was 24 years old (range, 13-49). Females comprised 75% of the sample. Mean interval from injury to surgery was 7.2 ± 8.6 years (range, 51 days-37 years). At follow-up, there were no recurrent dislocations reported, patella subluxation in 6 (11%) cases, and radiographic degenerative changes were none to mild in all patients. The series mean IKDC scores at follow-up was 76.3 ± 19.2 (range, 30-99), and Tegner activity scores were 5.6 ± 2.5. MPFL reconstruction is an option for treating the symptoms of patellar instability, preventing recurrent dislocation, and returning patients near to their preinjury level of activity. The level of evidence is IV.

Journal of the American Academy of Orthopaedic Surgeons, Oct 1, 2010

Stroke, Feb 1, 2013

Background: Physical activity reduces recurrent stroke risk, yet suitable community-based program... more Background: Physical activity reduces recurrent stroke risk, yet suitable community-based programs are lacking. Tai Chi (TC) and SilverSneakers® (SS) can be easily adapted for persons with disabilities. TC integrates physical movements with mindfulness, while SS focuses on strength and range of movement. Purpose: To examine the effects of TC and SS interventions on physical functioning compared to Usual Care (UC). Methods: A randomized trial was conducted among stroke survivors (n=145), aged ≥ 50 years, and at ≥ 3 months post-stroke (TC, n=53; SS, n=44; or UC, n=48). TC and SS groups attended a 1-hour class 3X/week for 12 weeks. The UC group received a weekly phone call along with written materials for participating in community-based physical activity. The Short Physical Performance Battery (SPPB) assessed balance, gait speed, and lower body strength; a two-minute step-in-place test (StepTest) assessed aerobic endurance. The Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) assessed amount of self-reported physical activity. Clinically meaningful changes in SPPB (small=0.5 points, substantial=1.0 points), and gait speed (small=0.05 m/sec, substantial=0.10 m/sec) were examined. Data were analyzed using 2 (time) X 3 (group) ANOVAs. Results: Subjects (47% women) were on average 70±10 years old, and 37±48 months post-stroke. The majority were married (58%), White (79%), college educated (79%), retired (80%), reporting an ischemic stroke (66%) with hemiparesis (73%). All groups reported a similar amount of physical activity (PASIPD=14.8±11.0 MET hrs/day, F 2,142 =1.04, p=0.36); and had substantial improvements in SPPB score (F 1,142 =85.29, p<0.01), with small improvements in gait speed (F 1,142 =25.97, p<0.01). There was a significant group by time interaction for the StepTest (F 2,142 =4.69, p<0.01); TC (t 53 =2.45, p=0.02) and SS (t 44 =4.63, p<0.01) had significantly better aerobic endurance over time, while this was not observed in the UC group (t 48 =1.58, p=0.12). Conclusions: A goal of stroke rehabilitation is to prevent disability and declines in physical functioning. TC and SS improved aerobic endurance, and both are suitable community-based programs that may aid in stroke recovery and community reintegration.

Foot & Ankle Orthopaedics, Oct 1, 2018

Foot & Ankle Orthopaedics, Oct 1, 2019

Foot & Ankle Orthopaedics, Jul 1, 2023

Anatomic lateral ankle ligament reconstruction using free tendon graft with osseous tunnels has b... more Anatomic lateral ankle ligament reconstruction using free tendon graft with osseous tunnels has become a popular technique for revision reconstruction of the lateral ankle ligaments. With the procedure’s burgeoning popularity, an accompanying increase in postoperative complications is likely to occur. We report on one such complication: traumatic distal fibula fracture through the transosseous tunnels.

Foot & Ankle Orthopaedics, Jul 1, 2023

Ankle fractures are common musculoskeletal injuries that may result in tibiotalar joint dislocati... more Ankle fractures are common musculoskeletal injuries that may result in tibiotalar joint dislocations. Ankle fracture-dislocations occur via similar mechanisms as ankle fractures, although the persistence or magnitude of the deforming force is sufficient to disrupt any remaining bony or soft-tissue stability. Ankle fracture-dislocations likely represent distinct clinical entities, as the pathology, management, and patient outcomes following these injuries differ from those seen in more common ankle fractures without dislocation. Ankle fracture-dislocations have higher rates of concomitant injury including open fractures, chondral lesions, and intra-articular loose bodies. Long-term outcomes in ankle fracture-dislocations are worse than ankle fractures without dislocation. Higher rates of posttraumatic osteoarthritis and chronic pain have also been reported. In this review, we discuss the current literature regarding the history, management, and outcomes of ankle-fracture dislocations and highlight the need for future study.

Foot & Ankle Orthopaedics, Jul 1, 2023

Foot and Ankle Specialist, Dec 13, 2022

Background Symptomatic progressive collapsing foot deformity (PCFD) is frequently treated with re... more Background Symptomatic progressive collapsing foot deformity (PCFD) is frequently treated with reconstructive surgery. Multiple studies have documented successful treatment based on improvements in symptoms and physical examination findings. However, it is not well-established whether there are corresponding improvements in gait function following surgical treatment for PCFD. Methods A systematic review of biomechanical outcomes of treatments for flexible PCFD was conducted on PubMed. The 4 articles chosen involved patients with symptomatic flexible PCFD who underwent a reconstructive surgery. Surgical interventions included osteotomy, tendon transfer, and/or ligament repair or reconstruction. Primary outcomes involved objective quantifiable measurements of kinematic, kinetic, or temporospatial parameters. Results The initial search yielded 605 articles, from which 26 were retained after screening the title and abstract. Twenty-two were eliminated yielding 4 articles. Temporospatial, kinematic, and kinetic parameters were all altered after the patients underwent surgical intervention. Specifically, stride length, cadence, and walking speed all improved postoperatively. Walking kinetics also improved with restoration of normal motion in the frontal and sagittal planes and improvements in the dorsiflexion angle. There were also improvements in sagittal power. Discussion Surgical intervention to treat flexible PCFD improves objective biomechanical outcomes; however, more follow-up studies are needed to establish the reliability and durability of these improvements. Level of Evidence: Level III: Systematic review

Current Radiology Reports, Apr 21, 2015

Foot & Ankle Orthopaedics, Jul 1, 2023

Foot & Ankle Orthopaedics, Oct 1, 2022

Category: Ankle Introduction/Purpose: Suspected peroneal tendinopathy, tears, and subluxation are... more Category: Ankle Introduction/Purpose: Suspected peroneal tendinopathy, tears, and subluxation are often confirmed using magnetic resonance imaging (MRI) or diagnostic ultrasound (US). The choice between these two imaging modalities is commonly based on surgeon preference as the accuracy of these tests for the diagnosis of peroneal tendinopathy, tears, and subluxation is not known. The purpose of this study was to compare MRI and US to the intraoperative findings in patients who underwent surgery for the treatment of suspected peroneal tendinopathy, tears, and subluxations to determine the diagnostic accuracy of each imaging modality. Methods: The operative records and diagnostic images for 21 patients who underwent surgery for suspected peroneal tendinopathy, tears, or subluxation were retrospectively reviewed. Two fellowship trained musculoskeletal radiologists conducted a systematic blinded review of the stored MRI and US images. The results of this review were compared with the intraoperative findings to yield the sensitivity and specificity for each imaging modality. Results: For the diagnosis of peroneus brevis tears, both MRI and ultrasound were equally good at detecting tears. In the diagnosis of peroneus brevis tears, MRI was marginally better with a sensitivity and specificity of 100% versus ultrasound, which had a sensitivity of 90% and specificity of 100%. In the diagnosis of peroneal subluxation, ultrasound had a sensitivity of 100% and a specificity of 100% compared to MRI, which had a sensitivity of 33% and specificity of 100%. Conclusion: In comparing MRI and US to intraoperative findings for the diagnosis of peroneal tendinosis, tears and subluxation, we found ultrasound to be more effective at diagnosing peroneal tendinopathy and subluxation, while MRI was found to be slightly more accurate in the diagnosis of peroneus brevis tendon tears. Both MRI and ultrasound were effective for the diagnosis of peroneus longus tears.

Foot and Ankle Specialist, Oct 8, 2022

Background In minimally displaced Weber B ankle fractures, the distal fibular fracture fragment c... more Background In minimally displaced Weber B ankle fractures, the distal fibular fracture fragment can be externally rotated. This malrotation is difficult to detect on radiographs and, when left malreduced through nonoperative treatment, may contribute to altered joint mechanics, predisposing to posttraumatic osteoarthritis. This study evaluates the effects of fibular malrotation on tibiotalar joint contact mechanics. Methods Six cadaveric ankles were tested using a materials testing system (MTS) machine. A tibiotalar joint sensor recorded contact area and pressure. Samples were tested in the intact, neutrally rotated, and malrotated state. Each trial applied a 686N axial load and a 147N Achilles tendon load in neutral position, 15° dorsiflexion, and 15° plantarflexion. Results In the comparison of malrotated to intact ankles, peak contact pressure was found to be significantly greater at neutral flexion (intact 5.56 MPa ± 1.39, malrotated 7.21 MPa ± 1.07, P = .03), not significantly different in dorsiflexion, and significantly decreased in plantarflexion (intact 11.2 MPa ± 3.04, malrotated 9.01 MPa ± 1.84, P = .01). Significant differences in contact area were not found between conditions. Conclusion The findings suggest that fibular malrotation contributes to significant alterations in tibiotalar joint contact pressures, which may contribute to the development of posttraumatic osteoarthritis. When malrotation of the fibula is suspected on plain radiographs, a computer tomography (CT) scan should be obtained to evaluate its extent and further consideration should be given to surgical treatment. Levels of Evidence: Level V: Bench testing

Orthopaedic Journal of Sports Medicine, 2021

Background: Anterior cruciate ligament (ACL) ruptures are potentially career-threatening injuries... more Background: Anterior cruciate ligament (ACL) ruptures are potentially career-threatening injuries to National Football League (NFL) skill position players. A 2006 study showed a return-to-play (RTP) rate of 79% for NFL running backs (RBs) and wide receivers (WRs). Since then, a number of factors affecting RTP, including style of play as well as rules regarding hits to the head, have changed how defensive players tackle offensive ball carriers. Purpose/Hypothesis: To determine whether the RTP rate for RBs and WRs in the NFL has changed since data were collected in the 2000s. Additionally, we evaluated player performance before and after ACL reconstruction (ACLR). We hypothesized that there will be a lower RTP rate than previously reported as well as a decrease in performance statistics after ACLR. Study Design: Descriptive epidemiology study. Methods: Publicly available NFL injury reports between the 2009-2010 and 2015-2016 seasons were utilized for RBs and WRs who underwent ACLR. Successful RTP was indicated by playing in at least 1 NFL game after reconstruction. Position-specific performance statistics from before and after reconstruction were gathered for these players, and the RTP players were compared against the players who did not RTP (dnRTP group). Pre- and postinjury performance measures were also compared against a matched control group of NFL RBs and WRs who had not sustained an ACL injury. Results: Overall, 61.8% of players (64.5% of RBs, 60% of WRs) returned to play at a mean of 13.6 months. Prior to injury, the RTP group had played in significantly more career games and had significantly more rushes and receptions per game than the dnRTP group; however, there was no significant difference in performance after ACLR. The WR RTP group had significantly decreased performance in all measured categories when compared with the control group. Conclusion: Our study found a lower RTP rate in RBs and WRs than previous studies conducted in the early 2000s. WRs who achieved RTP had decreased performance when compared with noninjured controls.

American Journal of Sports Medicine, Sep 21, 2011

Background: Osteochondral allograft transplantation is technically demanding. It is not always po... more Background: Osteochondral allograft transplantation is technically demanding. It is not always possible to place the surface of the graft perfectly flush with the surrounding cartilage. One must often choose between placing at least some portion of the surface of the graft slightly elevated or recessed. The effect of this choice on joint contact pressure is unknown. Purpose: This study was undertaken to determine the effect of graft height mismatch on joint contact pressure in the ankle. Study Design: Controlled laboratory study. Methods: Ten human cadaveric ankles underwent osteochondral grafting by removal then replacement of an osteochondral plug. Six conditions were tested: intact, graft flush, graft elevated 1.0 mm, graft elevated 0.5 mm, graft recessed 0.5 mm, and graft recessed 1.0 mm. Joint contact pressures were measured with a Tekscan sensor while loads of 200 N, 400 N, 600 N, and 800 N were sequentially applied. Results: The peak contact pressure at the graft site for the flush condition was not significantly different from the intact condition for either medial or lateral lesions. In contrast, peak pressure on the opposite facet of the talar dome was significantly increased during the flush condition for the medial but not the lateral grafts. Elevated grafts experienced significantly increased contact pressures, whereas recessed grafts experienced significantly decreased pressures. These changes were greater for lateral than for medial lesions. Reciprocal changes in joint contact pressures were found on the opposite facet of the talus with elevated grafts on the lateral side and recessed grafts on the medial side. Conclusion: Flush graft placement can restore near-normal joint contact pressure. Elevated graft placement leads to significant increases in joint contact pressure at the graft site. Recessed graft placement leads to a transfer of pressure from the graft site to the opposite facet of the talus. Clinical Relevance: Osteochondral grafts in the talus should be placed flush if possible or else slightly recessed.

Foot & Ankle Orthopaedics, Jul 1, 2023

Foot & Ankle Orthopaedics, Jul 1, 2019

Foot and Ankle Specialist, Jul 9, 2016

Hindfoot (tibiotalocalcaneal or TTC) arthrodesis is commonly used to treat concomitant arthritis ... more Hindfoot (tibiotalocalcaneal or TTC) arthrodesis is commonly used to treat concomitant arthritis of the ankle and subtalar joints. Simultaneous fusion of both joints can be difficult to achieve especially in patients with impaired healing due to smoking, diabetes mellitus, or Charcot neuroarthropathy. Conventional intramedullary fixation devices allow for compression to be applied at the time of surgery, but this compression can be lost due to bone resorption or settling, leading to impaired healing. In contrast, the novel pseudoelastic intramedullary nail is designed to maintain compression at the arthrodesis sites throughout the healing process by the use of an internal pseudoelastic element. We present 2 cases of revision TTC arthrodesis using the pseudoelastic intramedullary nail. In the first case, an 80-year-old diabetic man with previous ankle and failed subtalar fusion with screws underwent revision TTC arthrodesis. In the second case, a 66-year-old man with Charcot neuroarthropathy and a failed TTC arthrodesis with a static intramedullary nail underwent revision tibiotalar arthrodesis. In both cases, computed tomography scan demonstrated successful union and patients were allowed full weight bearing by 3 months after surgery. These cases provide early evidence that sustained compression via an intramedullary nail can lead to rapid successful hindfoot fusion when standard approaches have failed. Therapeutic, Level IV: Case study.

Foot & Ankle Orthopaedics, Jul 1, 2020

Springer eBooks, 2020

Imaging of patients with suspected peroneal tendon disorders should include weight-bearing radiog... more Imaging of patients with suspected peroneal tendon disorders should include weight-bearing radiographs of the ankle and foot as they are useful for the detection of avulsion fractures and for the evaluation of cavovarus alignment. Advance imaging in the form of MRI or ultrasound imaging is often needed to differentiate between peroneal tendonitis (tendinosis and/or tenosysnovitis), tears, and subluxation. MRI has the advantages of supplying information about a wide array of related and concomitant conditions and being useful for pre-operative planning. In contrast, US is a less time consuming and less costly exam which provides equivalent diagnostic accuracy for tears and is superior in the detection of tendon subluxation. Both modalities are capable of providing information about the presence of the anatomic variants including low-lying peroneus brevis muscle belly, os peroneum, peroneus quartus, and hypertrophied peroneal tubercle.

Journal of Knee Surgery, Nov 13, 2013

Patellofemoral instability can be a disabling problem. Numerous techniques are employed for its t... more Patellofemoral instability can be a disabling problem. Numerous techniques are employed for its treatment. Medial patellofemoral ligament (MPFL) reconstruction in combination with other procedures has been explored by many orthopedic surgeons. The purpose of the study was to determine the effectiveness of isolated MPFL reconstruction in treating the symptoms associated with patellofemoral instability, preventing recurrence of patella dislocation, and returning patients to preinjury level of activity. This is a case series study. We conducted a clinical follow-up study on 56 knees (49 patients) after MPFL reconstruction for recurrent patellar instability with a mean follow-up of 4.3 years (range, 1.1-6.8). A single MPFL reconstruction technique was performed in all cases. Patient outcomes were evaluated using: International Knee Documentation Committee (IKDC) subjective knee form, Tegner activity score, functional hop test, and radiographs. Mean age at time of surgery was 24 years old (range, 13-49). Females comprised 75% of the sample. Mean interval from injury to surgery was 7.2 ± 8.6 years (range, 51 days-37 years). At follow-up, there were no recurrent dislocations reported, patella subluxation in 6 (11%) cases, and radiographic degenerative changes were none to mild in all patients. The series mean IKDC scores at follow-up was 76.3 ± 19.2 (range, 30-99), and Tegner activity scores were 5.6 ± 2.5. MPFL reconstruction is an option for treating the symptoms of patellar instability, preventing recurrent dislocation, and returning patients near to their preinjury level of activity. The level of evidence is IV.

Journal of the American Academy of Orthopaedic Surgeons, Oct 1, 2010

Stroke, Feb 1, 2013

Background: Physical activity reduces recurrent stroke risk, yet suitable community-based program... more Background: Physical activity reduces recurrent stroke risk, yet suitable community-based programs are lacking. Tai Chi (TC) and SilverSneakers® (SS) can be easily adapted for persons with disabilities. TC integrates physical movements with mindfulness, while SS focuses on strength and range of movement. Purpose: To examine the effects of TC and SS interventions on physical functioning compared to Usual Care (UC). Methods: A randomized trial was conducted among stroke survivors (n=145), aged ≥ 50 years, and at ≥ 3 months post-stroke (TC, n=53; SS, n=44; or UC, n=48). TC and SS groups attended a 1-hour class 3X/week for 12 weeks. The UC group received a weekly phone call along with written materials for participating in community-based physical activity. The Short Physical Performance Battery (SPPB) assessed balance, gait speed, and lower body strength; a two-minute step-in-place test (StepTest) assessed aerobic endurance. The Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) assessed amount of self-reported physical activity. Clinically meaningful changes in SPPB (small=0.5 points, substantial=1.0 points), and gait speed (small=0.05 m/sec, substantial=0.10 m/sec) were examined. Data were analyzed using 2 (time) X 3 (group) ANOVAs. Results: Subjects (47% women) were on average 70±10 years old, and 37±48 months post-stroke. The majority were married (58%), White (79%), college educated (79%), retired (80%), reporting an ischemic stroke (66%) with hemiparesis (73%). All groups reported a similar amount of physical activity (PASIPD=14.8±11.0 MET hrs/day, F 2,142 =1.04, p=0.36); and had substantial improvements in SPPB score (F 1,142 =85.29, p<0.01), with small improvements in gait speed (F 1,142 =25.97, p<0.01). There was a significant group by time interaction for the StepTest (F 2,142 =4.69, p<0.01); TC (t 53 =2.45, p=0.02) and SS (t 44 =4.63, p<0.01) had significantly better aerobic endurance over time, while this was not observed in the UC group (t 48 =1.58, p=0.12). Conclusions: A goal of stroke rehabilitation is to prevent disability and declines in physical functioning. TC and SS improved aerobic endurance, and both are suitable community-based programs that may aid in stroke recovery and community reintegration.

Foot & Ankle Orthopaedics, Oct 1, 2018

Foot & Ankle Orthopaedics, Oct 1, 2019