Richard Ferkel - Academia.edu (original) (raw)
Papers by Richard Ferkel
Arthroscopy, Apr 1, 1996
A retrospective review of the first 612 patients undergoing consecutive ankle arthroscopy in the ... more A retrospective review of the first 612 patients undergoing consecutive ankle arthroscopy in the practices of two experienced arthroscopists was under-taken. All inpatient records, outpatient charts, and operative reports were reviewed. Indications for surgery included pain, swelling, locking, and instability that failed to respond to nonoperative management. The results of our investigation revealed an overall complication rate of 9.0% (55 complications). There were 27 neurological complications (4.4% of all arthroscopies) accounting for 49.1% of the complications noted. Specifically, the superficial peroneal nerve was injured in 15 cases, the sural nerve in 6, the saphenous nerve in 5, and the deep peroneal nerve in 1. All nerve injuries occurred through direct injury by portal or distractor pin placement. No cases of neurological injury caused by tourniquet compression or compartment syndrome were seen. Also, 1 case of reflex sympathetic dystrophy was identified.
American Journal of Sports Medicine, Aug 30, 2008
Osteochondral lesions of the talus were first described in the literature in 1856 by Alexander Mu... more Osteochondral lesions of the talus were first described in the literature in 1856 by Alexander Munro. Although awareness and knowledge of these lesions has evolved over the years, diagnosis is usually delayed due to little or no radiographic findings. Patients usually present with nonspecific complaints that are chronic in nature and that have been treated within the realm of conservative options. Recent advances in imaging techniques have allowed physicians to detect these lesions at an earlier stage. Surgical intervention is necessary in most cases to mitigate pain, and enhanced arthroscopic techniques have allowed for improved surgical management. Methods: This was a retrospective study that reviewed 50 patients who had sustained osteochondral lesions of the talus. Of the 50 individuals, 27 were male and 23 were female, averaging 32 years of age. The mean follow-up was 71 months. Inclusion criteria included sub-acute and/or chronic osteochondral lesions of the talus with no prior ankle injuries or surgery. Each patient was treated with a minimum of 4 months conservative therapy prior to arthroscopic intervention. Surgical treatments included drilling of the osteochondral lesions of the talus (n=4), excision of osteochondral lesions of the talus and abrasion arthroplasty (n=6), and excision of osteochondral lesions of the talus with drilling (n=40). All patients were evaluated using 3 separate scoring systems including the Alexander, modified Weber, and American Orthopaedic Foot and Ankle Society (AOFAS) Ankle/Hindfoot scores. Plain radiographic films, CAT scans and MRI studies were also evaluated. Results: The Alexander score revealed 32% excellent, 40% good, 20% fair, and 8% poor results. The modified Weber score revealed 38% excellent, 26% good, 30% fair, and 6% poor results. All patients returned to their pre-injury activity level, however 12% had to modify their activities. There was no correlation with clinical outcome when examining pre-op CT or MRI stage, location of the lesion based on the Weber score, sex, age, laterality, or length of follow up. In comparison, arthroscopic surgical grade did produce correlation with clinical outcome. At final follow up, patients with stage 0 or I arthritis (based on radiographic findings) had better outcomes that those with stage II or III arthritis. Conclusion: Good or excellent results were noted with arthroscopic treatment of chronic osteochondral lesions. However, pain and disability may persist in some patients, particularly those noted to have unstable osteochondral defects at the time of arthroscopy. Additionally, this study notes that significant correlation exists between the arthroscopic classification of lesions and clinical outcomes.
Arthroscopy, Dec 1, 1990
A specific pattern of injury to the superior labrum of the shoulder was identified arthroscopical... more A specific pattern of injury to the superior labrum of the shoulder was identified arthroscopically in twenty-seven patients included in a retrospective review of more than 700 shoulder arthroscopies performed at our institution. The injury of the superior labrum begins posteriorly and extends anteriorly, stopping before or at the mid-glenoid notch and including the "anchor" of the biceps tendon to the labrum. We have labeled this injury a "SLAP lesion" (Superior Labrum Anterior and Posterior). There were 23 males and four females with an average age of 37.5 years. Time from injury to surgery averaged 29.3 months. The most common mechanism of injury was a compression force to the shoulder, usually as the result of a fall onto an outstretched arm, with the shoulder positioned in abduction and slight forward flexion at the time of the impact. The most common clinical complaints were pain, greater with overhead activity, and a painful "catching" or "popping" in the shoulder. No imaging test accurately defined the superior labral pathology preoperatively. We divided the superior labrum pathology into four distinct types. Treatment was performed arthroscopically based on the type of SLAP lesion noted at the time of surgery. The SLAP lesion, which has not been previously described, can be diagnosed only arthroscopically and may be treated successfully by arthroscopic techniques alone in many patients.
Foot & Ankle Orthopaedics, 2021
Background: The purpose of this article is to document the normal arthroscopic appearance of the ... more Background: The purpose of this article is to document the normal arthroscopic appearance of the posterior ankle capsular and ligamentous structures, and variations in their anatomical relationships. Methods: 102 ankle arthroscopy videotapes were evaluated retrospectively for the configuration of the posterior capsuloligamentous structures. Based on these observations, the variations in the appearance and position of the posterior tibiofibular ligament (PTFL) and transverse (tibiofibular) ligament (TTFL) were documented. In addition, differences in the appearance of the flexor hallucis longus (FHL) were also noted. Results: All patients had evidence of both a PTFL and TTFL, which formed a labrum or meniscus-like addition to the posterior distal tibia. No patients demonstrated disruption of the PTFL; 3 had tears of the TTFL. We noted 4 distinct patterns of the PTFL and the TTFL. Thirty-four patients (33%) had a gap of ≥2 mm between the 2 ligamentous structures. Thirty-three (32.4%) had a gap <2 mm between the PTFL and TTFL. Twenty-six (25.5%) had a confluence of the 2 ligaments without a gap. Nine (9%) demonstrated a sizable gap between the 2 ligaments, and the TTFL appeared as a “cord-like” structure. Conclusion: To our knowledge, this is the first article to describe the variations in the arthroscopic normal posterior capsuloligamentous structures and FHL of the ankle. Level of Evidence: Level IV, case series.
Orthopedic Clinics of North America, 1994
Arthroscopic examination of the ankle joint permits complete examination of the intra-articular s... more Arthroscopic examination of the ankle joint permits complete examination of the intra-articular structures. With recent advances in equipment and additional experience, numerous ankle problems can be handled arthroscopically. These problems include treatment of soft-tissue and bony impingement, osteochondral lesions of the talus, removal of loose bodies, treatment of acute and chronic fractures, lateral ankle stabilization, and arthroscopic fusion procedures.
Foot & ankle international, 2018
The evidence supporting best practice guidelines in the field of cartilage repair of the ankle ar... more The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Subchondral Pathology" developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was...
Rehabilitation for the Postsurgical Orthopedic Patient, 2013
Foot & Ankle International, 2018
Background: The evidence supporting best practice guidelines in the field of cartilage repair of ... more Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on Post-treatment Follow-up, Imaging and Outcome Scores developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Methods: Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the a...
Orthopaedic Journal of Sports Medicine
Background: Despite marked improvements in stability after lateral ankle ligament repair, many pa... more Background: Despite marked improvements in stability after lateral ankle ligament repair, many patients do not return to their preinjury activity level. There are few studies addressing athletes’ assessment of their ability to return to play after lateral ankle ligament reconstruction for recurrent instability. Purpose: To determine the rate of return to the preinjury activity level among physically active patients after the modified Broström procedure (MBP) for recurrent lateral ankle instability. Study Design: Case series; Level of evidence, 4. Methods: Included were patients who had undergone a primary MBP by a single surgeon over a 6-year period and had a minimum 24 months of follow-up. A telephone questionnaire was conducted to ascertain the patient’s ability to return to sport and/or work activity at final follow-up. Activity levels were evaluated utilizing the Tegner activity score. Outcome scores and other measured variables were compared between patients who returned to the...
Background: Osteochondral lesions of the talus (OLT) are rela-tively uncommon but may be a cause ... more Background: Osteochondral lesions of the talus (OLT) are rela-tively uncommon but may be a cause of significant pain and disability. Although the majority of patients have an osteochon-dral lesion of the talus that is unilateral, bilateral involvement has been reported in 10 % to 25 % of cases. In addition, factors that cause one side to be symptomatic and the contralateral side to be asymptomatic have never been evaluated. Materials and Methods: A database containing all patients at our institution with an OLT has been maintained for the past 23 years. This was reviewed and patients with bilateral involvement identified. A chart review was performed to determine location and size of the OLT, which were symptomatic, associated with trauma, and required surgery. Results: Between 1984 and 2007, 526 patients with an OLT were seen. Fifty-two patients had bilateral OLT, for an overall bilateral incidence of 10%. Of these, 16 patients required no surgery (Group 1), 31 required only unilat...
Osteochondral lesions of the talus (OLT) and tibial plafond pose significant challenges for treat... more Osteochondral lesions of the talus (OLT) and tibial plafond pose significant challenges for treatment. There are many factors that influence results, including the size of the lesion, location of the lesion, containment of the OLT, subchondral cysts, status of the cartilage cap, as well as other associated pathology. Great research is occurring throughout the world to try to find better techniques and materials to treat these lesions. The future is very exciting, but much work needs to be done to develop a technique that will produce true type II articular cartilage, hold up for a lifetime, that will be safe, cheap, and easy to perform, preferably arthroscopically. At this time, we have options for our athletes with osteochondral lesions of the tibia and/or talus, but significant questions still exist as to the best technique to return athletes long term to their desired sport.
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 2021
Noninvasive ankle distraction technique is the standard of care for ankle arthroscopic surgery. N... more Noninvasive ankle distraction technique is the standard of care for ankle arthroscopic surgery. Noninvasive distraction can be performed safely and with fewer complications when compared side-by-side with the nondistraction dorsiflexion technique. Moreover, distraction techniques allow a single surgeon to operate in the most convenient supine position and in a "hands-free" manner, with adequate space to avoid iatrogenic chondral damage. In addition, distraction allows for dedicated inflow and outflow portals to sufficiently irrigate the joint. Although the nondistraction technique allows excellent visualization of the anterior joint, it fails to provide appropriate visualization of the entire joint, using both anterior and posterior portals. Pathology that is best accessed from the posterior portal includes posterior osteochondral lesions, loose bodies, tears of the transverse ligament, acute ankle fractures, posterior tibial osteophytes, and occasionally an os trigonum. F...
Cartilage injuries of the talus can be challenging to treat. In the USA, 250,000–300,000 patients... more Cartilage injuries of the talus can be challenging to treat. In the USA, 250,000–300,000 patients with symptomatic cartilage injuries undergo surgical treatment, most commonly in the knee. Though the majority of ankle osteochondral lesions can be managed with debridement, microfracture, and/or drilling with good results, many, especially those >150 mm2, have poorer outcomes [1–3]. In fact, that number may be even smaller as Ramponi et al., reported in their recent systematic review. They found that lesions of 107.4 mm2 might be the maximum size for drilling or microfracture for good outcomes [4]. For larger lesions, there are other treatment options available. These include osteochondral allografts, osteochondral autografts (single plug or mosaicplasty), autologous chondrocyte implantation (ACI), juvenile allografts, micronized cartilage matrix, and resurfacing procedures (Fig. 10.1). Factors influencing choice of surgical procedure include: size of lesion, location of lesion, co...
The Indian Journal of Pediatrics, 2000
Achterberg J, Duquiane L, Huebbe M, Williams C. PowerPoint presentation handouts and college stud... more Achterberg J, Duquiane L, Huebbe M, Williams C. PowerPoint presentation handouts and college student learning outcomes. Int J Scholarship Teaching Learning. 2007;1(1):1-13. The use of Microsoft PowerPoint slides and handouts has become increasingly prevalent in educational settings. It has been proposed that using handouts may decrease students’ need for notetaking and provide more opportunity to listen and engage in classroom discussion. However, some have suggested that handouts may detract from student learning by promoting “absence” and lack of attention. With respect to learning styles, students with a linguistic learning preference may perform better with increased auditory exposure to class material. Thus, for these types of learners handouts may provide more listening time because less time can be spent taking notes, and one would expect this type of learner to demonstrate better performance when PowerPoint handouts are provided. On the other hand, bodily/ kinesthetic learne...
Foot & Ankle International
Background: The purpose of this study was to evaluate the effects of noninvasive ankle distractio... more Background: The purpose of this study was to evaluate the effects of noninvasive ankle distraction on intraoperative somatosensory evoked potentials (SSEPs) and peripheral nerve sensibility of the foot during ankle arthroscopy. Methods: Twenty patients undergoing ankle arthroscopy were prospectively evaluated using noninvasive ankle traction. All had preoperative clinical examination with baseline neurologic evaluation and static 2-point discrimination (2PD) test. Intraoperative SSEPs were monitored continuously throughout surgery. Thirty pounds of traction was applied using noninvasive traction. A 50% decrease in amplitude or a 10% increase in latency was considered significant. At 2 weeks postoperatively, the 2PD test was repeated. Pre- and postoperative 2PD was compared and subsequently correlated with intraoperative SSEPs. Results: Three patients sustained significant SSEP signal alterations during surgery. The changes were transient and directly related to application of tracti...
Revista Española de Artroscopia y Cirugía Articular
Foot & Ankle International
Background: The impact of patient sex on the prevalence of foot and ankle injuries has been estab... more Background: The impact of patient sex on the prevalence of foot and ankle injuries has been established. Reporting of differences on treatment outcomes is lacking. The purpose of this study was to identify trends in sex-specific outcomes across high-impact journals over a 5-year time period. Methods: Two independent investigators reviewed journal issues published during 2 calendar years (2011 and 2016) in the 5 highest-impact orthopedic foot and ankle/sports subspecialty journals ( Foot & Ankle International [ FAI], Foot and Ankle Surgery [ FAS], American Journal of Sports Medicine [ AJSM], Arthroscopy, and Knee Surgery, Sports Traumatology, Arthroscopy [ KSSTA]). Studies were stratified into those that involved sex-specific analysis (SSA), where sex was a variable in a multifactorial statistical model, and those that only reported sex as a demographic characteristic or utilized sex-matched cohorts. Results: A total of 473 studies evaluating a total of 273 128 patients met criteria....
Foot & ankle international, 2018
The evidence supporting best practice guidelines in the field of cartilage repair of the ankle ar... more The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Debridement, Curettage and Bone Marrow Stimulation" developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available ev...
Cartilage, 2018
The objective of this study was to characterize magnetic resonance imaging (MRI) findings and cor... more The objective of this study was to characterize magnetic resonance imaging (MRI) findings and correlate with clinical results in patients who underwent autologous chondrocyte implantation (ACI) of osteochondral lesions of the talus (OLT). Twenty-four grafts were evaluated at a mean 65.8 months after ACI for OLT. MRI was performed on a 1.5-T GE scanner using multiple sequences. Graft appearance was compared with preoperative MRI and evaluated for 6 criteria: defect fill, surface regularity, signal pattern, bone marrow edema, subchondral plate irregularity, and presence of cystic lesions. Clinical outcome was measured with the American Orthopaedic Foot and Ankle Society (AOFAS) clinical outcome score. Of 24 grafts, 22 (92%) demonstrated >75% defect fill. Eighteen (75%) had a mildly irregular and 6 (25%) had a moderately irregular articular surface. The signal pattern of the repair tissue was heterogenous in 23 (96%); 14 (58%) layered and 9 (38%) mottled. Fourteen grafts (58%) showe...
Arthroscopy, Apr 1, 1996
A retrospective review of the first 612 patients undergoing consecutive ankle arthroscopy in the ... more A retrospective review of the first 612 patients undergoing consecutive ankle arthroscopy in the practices of two experienced arthroscopists was under-taken. All inpatient records, outpatient charts, and operative reports were reviewed. Indications for surgery included pain, swelling, locking, and instability that failed to respond to nonoperative management. The results of our investigation revealed an overall complication rate of 9.0% (55 complications). There were 27 neurological complications (4.4% of all arthroscopies) accounting for 49.1% of the complications noted. Specifically, the superficial peroneal nerve was injured in 15 cases, the sural nerve in 6, the saphenous nerve in 5, and the deep peroneal nerve in 1. All nerve injuries occurred through direct injury by portal or distractor pin placement. No cases of neurological injury caused by tourniquet compression or compartment syndrome were seen. Also, 1 case of reflex sympathetic dystrophy was identified.
American Journal of Sports Medicine, Aug 30, 2008
Osteochondral lesions of the talus were first described in the literature in 1856 by Alexander Mu... more Osteochondral lesions of the talus were first described in the literature in 1856 by Alexander Munro. Although awareness and knowledge of these lesions has evolved over the years, diagnosis is usually delayed due to little or no radiographic findings. Patients usually present with nonspecific complaints that are chronic in nature and that have been treated within the realm of conservative options. Recent advances in imaging techniques have allowed physicians to detect these lesions at an earlier stage. Surgical intervention is necessary in most cases to mitigate pain, and enhanced arthroscopic techniques have allowed for improved surgical management. Methods: This was a retrospective study that reviewed 50 patients who had sustained osteochondral lesions of the talus. Of the 50 individuals, 27 were male and 23 were female, averaging 32 years of age. The mean follow-up was 71 months. Inclusion criteria included sub-acute and/or chronic osteochondral lesions of the talus with no prior ankle injuries or surgery. Each patient was treated with a minimum of 4 months conservative therapy prior to arthroscopic intervention. Surgical treatments included drilling of the osteochondral lesions of the talus (n=4), excision of osteochondral lesions of the talus and abrasion arthroplasty (n=6), and excision of osteochondral lesions of the talus with drilling (n=40). All patients were evaluated using 3 separate scoring systems including the Alexander, modified Weber, and American Orthopaedic Foot and Ankle Society (AOFAS) Ankle/Hindfoot scores. Plain radiographic films, CAT scans and MRI studies were also evaluated. Results: The Alexander score revealed 32% excellent, 40% good, 20% fair, and 8% poor results. The modified Weber score revealed 38% excellent, 26% good, 30% fair, and 6% poor results. All patients returned to their pre-injury activity level, however 12% had to modify their activities. There was no correlation with clinical outcome when examining pre-op CT or MRI stage, location of the lesion based on the Weber score, sex, age, laterality, or length of follow up. In comparison, arthroscopic surgical grade did produce correlation with clinical outcome. At final follow up, patients with stage 0 or I arthritis (based on radiographic findings) had better outcomes that those with stage II or III arthritis. Conclusion: Good or excellent results were noted with arthroscopic treatment of chronic osteochondral lesions. However, pain and disability may persist in some patients, particularly those noted to have unstable osteochondral defects at the time of arthroscopy. Additionally, this study notes that significant correlation exists between the arthroscopic classification of lesions and clinical outcomes.
Arthroscopy, Dec 1, 1990
A specific pattern of injury to the superior labrum of the shoulder was identified arthroscopical... more A specific pattern of injury to the superior labrum of the shoulder was identified arthroscopically in twenty-seven patients included in a retrospective review of more than 700 shoulder arthroscopies performed at our institution. The injury of the superior labrum begins posteriorly and extends anteriorly, stopping before or at the mid-glenoid notch and including the "anchor" of the biceps tendon to the labrum. We have labeled this injury a "SLAP lesion" (Superior Labrum Anterior and Posterior). There were 23 males and four females with an average age of 37.5 years. Time from injury to surgery averaged 29.3 months. The most common mechanism of injury was a compression force to the shoulder, usually as the result of a fall onto an outstretched arm, with the shoulder positioned in abduction and slight forward flexion at the time of the impact. The most common clinical complaints were pain, greater with overhead activity, and a painful "catching" or "popping" in the shoulder. No imaging test accurately defined the superior labral pathology preoperatively. We divided the superior labrum pathology into four distinct types. Treatment was performed arthroscopically based on the type of SLAP lesion noted at the time of surgery. The SLAP lesion, which has not been previously described, can be diagnosed only arthroscopically and may be treated successfully by arthroscopic techniques alone in many patients.
Foot & Ankle Orthopaedics, 2021
Background: The purpose of this article is to document the normal arthroscopic appearance of the ... more Background: The purpose of this article is to document the normal arthroscopic appearance of the posterior ankle capsular and ligamentous structures, and variations in their anatomical relationships. Methods: 102 ankle arthroscopy videotapes were evaluated retrospectively for the configuration of the posterior capsuloligamentous structures. Based on these observations, the variations in the appearance and position of the posterior tibiofibular ligament (PTFL) and transverse (tibiofibular) ligament (TTFL) were documented. In addition, differences in the appearance of the flexor hallucis longus (FHL) were also noted. Results: All patients had evidence of both a PTFL and TTFL, which formed a labrum or meniscus-like addition to the posterior distal tibia. No patients demonstrated disruption of the PTFL; 3 had tears of the TTFL. We noted 4 distinct patterns of the PTFL and the TTFL. Thirty-four patients (33%) had a gap of ≥2 mm between the 2 ligamentous structures. Thirty-three (32.4%) had a gap <2 mm between the PTFL and TTFL. Twenty-six (25.5%) had a confluence of the 2 ligaments without a gap. Nine (9%) demonstrated a sizable gap between the 2 ligaments, and the TTFL appeared as a “cord-like” structure. Conclusion: To our knowledge, this is the first article to describe the variations in the arthroscopic normal posterior capsuloligamentous structures and FHL of the ankle. Level of Evidence: Level IV, case series.
Orthopedic Clinics of North America, 1994
Arthroscopic examination of the ankle joint permits complete examination of the intra-articular s... more Arthroscopic examination of the ankle joint permits complete examination of the intra-articular structures. With recent advances in equipment and additional experience, numerous ankle problems can be handled arthroscopically. These problems include treatment of soft-tissue and bony impingement, osteochondral lesions of the talus, removal of loose bodies, treatment of acute and chronic fractures, lateral ankle stabilization, and arthroscopic fusion procedures.
Foot & ankle international, 2018
The evidence supporting best practice guidelines in the field of cartilage repair of the ankle ar... more The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Subchondral Pathology" developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was...
Rehabilitation for the Postsurgical Orthopedic Patient, 2013
Foot & Ankle International, 2018
Background: The evidence supporting best practice guidelines in the field of cartilage repair of ... more Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on Post-treatment Follow-up, Imaging and Outcome Scores developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Methods: Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the a...
Orthopaedic Journal of Sports Medicine
Background: Despite marked improvements in stability after lateral ankle ligament repair, many pa... more Background: Despite marked improvements in stability after lateral ankle ligament repair, many patients do not return to their preinjury activity level. There are few studies addressing athletes’ assessment of their ability to return to play after lateral ankle ligament reconstruction for recurrent instability. Purpose: To determine the rate of return to the preinjury activity level among physically active patients after the modified Broström procedure (MBP) for recurrent lateral ankle instability. Study Design: Case series; Level of evidence, 4. Methods: Included were patients who had undergone a primary MBP by a single surgeon over a 6-year period and had a minimum 24 months of follow-up. A telephone questionnaire was conducted to ascertain the patient’s ability to return to sport and/or work activity at final follow-up. Activity levels were evaluated utilizing the Tegner activity score. Outcome scores and other measured variables were compared between patients who returned to the...
Background: Osteochondral lesions of the talus (OLT) are rela-tively uncommon but may be a cause ... more Background: Osteochondral lesions of the talus (OLT) are rela-tively uncommon but may be a cause of significant pain and disability. Although the majority of patients have an osteochon-dral lesion of the talus that is unilateral, bilateral involvement has been reported in 10 % to 25 % of cases. In addition, factors that cause one side to be symptomatic and the contralateral side to be asymptomatic have never been evaluated. Materials and Methods: A database containing all patients at our institution with an OLT has been maintained for the past 23 years. This was reviewed and patients with bilateral involvement identified. A chart review was performed to determine location and size of the OLT, which were symptomatic, associated with trauma, and required surgery. Results: Between 1984 and 2007, 526 patients with an OLT were seen. Fifty-two patients had bilateral OLT, for an overall bilateral incidence of 10%. Of these, 16 patients required no surgery (Group 1), 31 required only unilat...
Osteochondral lesions of the talus (OLT) and tibial plafond pose significant challenges for treat... more Osteochondral lesions of the talus (OLT) and tibial plafond pose significant challenges for treatment. There are many factors that influence results, including the size of the lesion, location of the lesion, containment of the OLT, subchondral cysts, status of the cartilage cap, as well as other associated pathology. Great research is occurring throughout the world to try to find better techniques and materials to treat these lesions. The future is very exciting, but much work needs to be done to develop a technique that will produce true type II articular cartilage, hold up for a lifetime, that will be safe, cheap, and easy to perform, preferably arthroscopically. At this time, we have options for our athletes with osteochondral lesions of the tibia and/or talus, but significant questions still exist as to the best technique to return athletes long term to their desired sport.
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 2021
Noninvasive ankle distraction technique is the standard of care for ankle arthroscopic surgery. N... more Noninvasive ankle distraction technique is the standard of care for ankle arthroscopic surgery. Noninvasive distraction can be performed safely and with fewer complications when compared side-by-side with the nondistraction dorsiflexion technique. Moreover, distraction techniques allow a single surgeon to operate in the most convenient supine position and in a "hands-free" manner, with adequate space to avoid iatrogenic chondral damage. In addition, distraction allows for dedicated inflow and outflow portals to sufficiently irrigate the joint. Although the nondistraction technique allows excellent visualization of the anterior joint, it fails to provide appropriate visualization of the entire joint, using both anterior and posterior portals. Pathology that is best accessed from the posterior portal includes posterior osteochondral lesions, loose bodies, tears of the transverse ligament, acute ankle fractures, posterior tibial osteophytes, and occasionally an os trigonum. F...
Cartilage injuries of the talus can be challenging to treat. In the USA, 250,000–300,000 patients... more Cartilage injuries of the talus can be challenging to treat. In the USA, 250,000–300,000 patients with symptomatic cartilage injuries undergo surgical treatment, most commonly in the knee. Though the majority of ankle osteochondral lesions can be managed with debridement, microfracture, and/or drilling with good results, many, especially those >150 mm2, have poorer outcomes [1–3]. In fact, that number may be even smaller as Ramponi et al., reported in their recent systematic review. They found that lesions of 107.4 mm2 might be the maximum size for drilling or microfracture for good outcomes [4]. For larger lesions, there are other treatment options available. These include osteochondral allografts, osteochondral autografts (single plug or mosaicplasty), autologous chondrocyte implantation (ACI), juvenile allografts, micronized cartilage matrix, and resurfacing procedures (Fig. 10.1). Factors influencing choice of surgical procedure include: size of lesion, location of lesion, co...
The Indian Journal of Pediatrics, 2000
Achterberg J, Duquiane L, Huebbe M, Williams C. PowerPoint presentation handouts and college stud... more Achterberg J, Duquiane L, Huebbe M, Williams C. PowerPoint presentation handouts and college student learning outcomes. Int J Scholarship Teaching Learning. 2007;1(1):1-13. The use of Microsoft PowerPoint slides and handouts has become increasingly prevalent in educational settings. It has been proposed that using handouts may decrease students’ need for notetaking and provide more opportunity to listen and engage in classroom discussion. However, some have suggested that handouts may detract from student learning by promoting “absence” and lack of attention. With respect to learning styles, students with a linguistic learning preference may perform better with increased auditory exposure to class material. Thus, for these types of learners handouts may provide more listening time because less time can be spent taking notes, and one would expect this type of learner to demonstrate better performance when PowerPoint handouts are provided. On the other hand, bodily/ kinesthetic learne...
Foot & Ankle International
Background: The purpose of this study was to evaluate the effects of noninvasive ankle distractio... more Background: The purpose of this study was to evaluate the effects of noninvasive ankle distraction on intraoperative somatosensory evoked potentials (SSEPs) and peripheral nerve sensibility of the foot during ankle arthroscopy. Methods: Twenty patients undergoing ankle arthroscopy were prospectively evaluated using noninvasive ankle traction. All had preoperative clinical examination with baseline neurologic evaluation and static 2-point discrimination (2PD) test. Intraoperative SSEPs were monitored continuously throughout surgery. Thirty pounds of traction was applied using noninvasive traction. A 50% decrease in amplitude or a 10% increase in latency was considered significant. At 2 weeks postoperatively, the 2PD test was repeated. Pre- and postoperative 2PD was compared and subsequently correlated with intraoperative SSEPs. Results: Three patients sustained significant SSEP signal alterations during surgery. The changes were transient and directly related to application of tracti...
Revista Española de Artroscopia y Cirugía Articular
Foot & Ankle International
Background: The impact of patient sex on the prevalence of foot and ankle injuries has been estab... more Background: The impact of patient sex on the prevalence of foot and ankle injuries has been established. Reporting of differences on treatment outcomes is lacking. The purpose of this study was to identify trends in sex-specific outcomes across high-impact journals over a 5-year time period. Methods: Two independent investigators reviewed journal issues published during 2 calendar years (2011 and 2016) in the 5 highest-impact orthopedic foot and ankle/sports subspecialty journals ( Foot & Ankle International [ FAI], Foot and Ankle Surgery [ FAS], American Journal of Sports Medicine [ AJSM], Arthroscopy, and Knee Surgery, Sports Traumatology, Arthroscopy [ KSSTA]). Studies were stratified into those that involved sex-specific analysis (SSA), where sex was a variable in a multifactorial statistical model, and those that only reported sex as a demographic characteristic or utilized sex-matched cohorts. Results: A total of 473 studies evaluating a total of 273 128 patients met criteria....
Foot & ankle international, 2018
The evidence supporting best practice guidelines in the field of cartilage repair of the ankle ar... more The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Debridement, Curettage and Bone Marrow Stimulation" developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available ev...
Cartilage, 2018
The objective of this study was to characterize magnetic resonance imaging (MRI) findings and cor... more The objective of this study was to characterize magnetic resonance imaging (MRI) findings and correlate with clinical results in patients who underwent autologous chondrocyte implantation (ACI) of osteochondral lesions of the talus (OLT). Twenty-four grafts were evaluated at a mean 65.8 months after ACI for OLT. MRI was performed on a 1.5-T GE scanner using multiple sequences. Graft appearance was compared with preoperative MRI and evaluated for 6 criteria: defect fill, surface regularity, signal pattern, bone marrow edema, subchondral plate irregularity, and presence of cystic lesions. Clinical outcome was measured with the American Orthopaedic Foot and Ankle Society (AOFAS) clinical outcome score. Of 24 grafts, 22 (92%) demonstrated >75% defect fill. Eighteen (75%) had a mildly irregular and 6 (25%) had a moderately irregular articular surface. The signal pattern of the repair tissue was heterogenous in 23 (96%); 14 (58%) layered and 9 (38%) mottled. Fourteen grafts (58%) showe...