242 results on '"De Cesar Netto C"'
Search Results
2. Does MMP-3 polymorphism have a role in the etiology of the posterior tibial tendinopathy?
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Godoy-Santos, A.L., Diniz Fernandes, T., Massa, B.F.S., de Cesar-Netto, C., Santos, M.C., and Rammelt, S.
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- 2017
- Full Text
- View/download PDF
3. Tibiofibular syndesmosis in asymptomatic ankles: initial kinematic analysis using four-dimensional CT
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Mousavian, A., Shakoor, D., Hafezi-Nejad, N., Haj-Mirzaian, A., de Cesar Netto, C., Orapin, J., Schon, L.C., and Demehri, S.
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- 2019
- Full Text
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4. AAFD: Conventional Radiographs are not Enough! I Need the Third Dimension
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Bernasconi A, de Cesar Netto C, Barg A, Burssens A, Richter A, Weight Bearing CT International Study Group, Lintz F., Bernasconi, A, de Cesar Netto, C, Barg, A, Burssens, A, Richter, A, Weight Bearing CT International Study, Group, and Lintz, F.
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030222 orthopedics ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Foot and ankle surgery ,Computed tomography ,030229 sport sciences ,Conventional radiographs ,medicine.disease_cause ,Surgical planning ,Weight-bearing ,Conventional radiography ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Physical medicine and rehabilitation ,medicine ,Deformity ,Orthopedics and Sports Medicine ,Surgery ,Ankle ,medicine.symptom ,business - Abstract
There is an increasing amount of literature suggesting that 3-dimensional (3D) weight-bearing computed tomography (WBCT) imaging overcomes the inherent limits of traditional bidimensional imaging in foot and ankle surgery. This seems to have a significant impact on the study and on the clinical management of adult acquired flatfooot deformity (AAFD) that by definition is a 3D complex deformity. In this study, we reviewed the recent literature about the use of WBCT in AAFD, starting from a critical analysis about the biases related to conventional radiography and to non-standing CT. Then, we focused on the effects of load on the 3D architecture of the foot and ankle in AAFD. Finally, we discussed the benefits and future perspectives for the use of WBCT in the management of this condition and as a surgical planning tool as well.
- Published
- 2019
5. 3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement
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Lintz F, Mast J, Bernasconi A, Mehdi N, de Cesar Netto C, Fernando C, International WBCT Society, Buedts K., Lintz, F, Mast, J, Bernasconi, A, Mehdi, N, de Cesar Netto, C, Fernando, C, International WBCT, Society, and Buedts, K.
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Ankle replacement ,Periprosthetic ,Arthritis ,Computed tomography ,Weight-Bearing ,Arthroplasty, Replacement, Ankle ,Imaging, Three-Dimensional ,Postoperative Complications ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Cysts ,Implant failure ,Cone-Beam Computed Tomography ,Middle Aged ,medicine.disease ,Surgery ,Female ,Radiology ,business ,Ankle Joint - Abstract
Background: We investigated the association between hindfoot residual malalignment assessed on weightbearing computed tomography (WBCT) images and the development of periprosthetic cysts (PPCs) after total ankle replacement (TAR). We hypothesized that PPCs would be found predominantly medially in the varus configuration and laterally in the valgus configuration. Methods: Cases of primary TAR with available WBCT imaging of the ankle were included in this retrospective study. The location of the PPC was marked and the following volumes were calculated: total (TCV), medial (MCV), central (CCV), and lateral (LCV) cyst volumes. Hindfoot alignment was measured as Foot and Ankle Offset (FAO), with 95% confidence intervals (95% CIs) calculated to define varus (95% CI) groups. Cyst volumes were compared between these 2 groups. The American Orthopaedic Foot & Ankle Society (AOFAS) score at the time of the WBCT was also retrieved. Receiver operating characteristic (ROC) curves were used to determine FAO thresholds for predicting an increased risk of PPC. Results: Forty-eight TARs (mean follow-up, 44.6 months) were included, 81% of which had at least 1 PPC. The mean FAO was 0.12% (95% CI, –1.12 to 1.36). Patients with greater residual malalignment ( P < .001) and those with longer follow-up ( P < .001) presented with increased TCV. In varus cases, the MCV was greater than the LCV ( P = .042), with a threshold FAO value of −2.75% or less predicting an increased MCV. In valgus cases, the LCV was greater than the MCV ( P = .049), with a FAO threshold value of 4.5% or more predicting an increased LCV. Conclusion: In this series, the PPC volume after primary TAR significantly correlated with postoperative hindfoot malalignment and longer follow-up. Level of Evidence: Level III, retrospective comparative series.
- Published
- 2019
6. Relationship between Chronic Lateral Ankle Instability and Hindfoot Varus using Weight Bearing Cone Beam Computed Tomography: a retrospective study
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Lintz F, Bernasconi A, Baschet L, Fernando C, Mehdi N, Weight Bearing CT International Study Group, de Cesar Netto C., Lintz, F, Bernasconi, A, Baschet, L, Fernando, C, Mehdi, N, Weight Bearing CT International Study, Group, and de Cesar Netto, C.
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- 2019
7. Foot alignment in Symptomatic National Basketball Association (NBA) Players Using Weightbearing Cone Beam CT measurements
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de Cesar Netto C, Bernasconi A, Roberts L, Pontin PA, Lintz F, Saito GH, Roney A, Elliott AJ, O’Malley MJ., de Cesar Netto, C, Bernasconi, A, Roberts, L, Pontin, Pa, Lintz, F, Saito, Gh, Roney, A, Elliott, Aj, and O’Malley, Mj.
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- 2019
8. Open Re-rupture of the Achilles Tendon Following Minimally Invasive Repair: A Case Report
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de Cesar Netto C, Bernasconi A, Roberts L, Saito GH, Hamilton WG, O'Malley MJ., de Cesar Netto, C, Bernasconi, A, Roberts, L, Saito, Gh, Hamilton, Wg, and O'Malley, Mj.
- Published
- 2018
9. Instability of the First Ray and Hallux Valgus in Patients with Adult Acquired Flatfoot Deformity (AAFD); A Weightbearing CT study
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Roney A, de Cesar Netto C, Sofka C, Sturnick D, Roberts L, Deland J, Bernasconi A, Ellis SJ., Roney, A, de Cesar Netto, C, Sofka, C, Sturnick, D, Roberts, L, Deland, J, Bernasconi, A, and Ellis, Sj.
- Published
- 2018
10. Ankle fusion percutaneous home run screw fixation: Technical aspects and soft tissue structures at risk
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Roberts, L., primary, Godoy-Santos, A.L., additional, Hudson, P.W., additional, Phillips, S., additional, Nishikawa, D.R.C., additional, Shah, A., additional, and de Cesar Netto, C., additional
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- 2019
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11. Polymorphisms of estrogen receptors in menopausal women with posterior tibial tendon dysfunction
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Pontin, P.A., primary, de Cesar Netto, C., additional, Fonseca, F., additional, Baracat, E.C., additional, Carvalho, K., additional, Fernandes, T., additional, and Santos, A. Godoy, additional
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- 2017
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12. Weightbearing CT analysis of chronic lateral ankle instability: A multivariate study of 124 feet
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Lintz, F., primary, Bernasconi, A., additional, Mehdi, N., additional, de Cesar Netto, C., additional, Baschet, L., additional, and Richter, M., additional
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- 2017
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13. Effectiveness of transarticular lateral soft tissue release of the 1st metatarsophalangeal joint
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de Cesar Netto, C., primary, Sahranavard, B., additional, Chodaba, Y., additional, Hudson, P., additional, Cone, B., additional, Araoye, I., additional, and Shah, A., additional
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- 2017
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14. MR imaging of ankle arthroplasty implants: Findings of normal and symptomatic patients
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de Cesar Netto, C., primary, Fonseca, L. Furtado, additional, Thawait, G., additional, Maccario, C., additional, Schon, Lew, additional, and Fritz, J., additional
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- 2017
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15. Comparing weight bearing radiographs and weight bearing cone beam CT for flatfoot assessment
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de Cesar Netto, C., primary, Demehri, S., additional, Chodaba, Y., additional, Thawait, G., additional, Fonseca, L., additional, Chinanuvathana, A., additional, Mousavian, A., additional, Shakoor, D., additional, and Schon, L., additional
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- 2017
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16. Outcomes of flexor digitorum longus (FDL) tendon transfer in the treatment of Achilles tendinopathy
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de Cesar Netto, C., primary, Chinanuvathana, A., additional, Chodaba, Y., additional, Fonseca, L., additional, Tan, E., additional, Dein, E., additional, and Schon, L., additional
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- 2017
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17. Hindfoot alignment in flatfoot deformity: A comparison between clinical and WBCT examinations
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de Cesar Netto, C., primary, Demehri, S., additional, Chodaba, Y., additional, Tawait, G., additional, Chinanuvathana, A., additional, Mousavian, A., additional, and Schon, L., additional
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- 2017
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18. The use of antibiotic beads as adjuvant therapy for limb salvage in foot and ankle infection
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de Cesar Netto, C., primary, Atwater, L., additional, Chodaba, Y., additional, Tan, E., additional, Chinanuvathana, A., additional, O’Daly, A.E., additional, Dein, E., additional, and Schon, L., additional
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- 2017
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19. Flatfoot hindfoot alignment: A comparison of clinical assessment and weightbearing conebeam CT
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de Cesar Netto, C., primary, Demehri, S., additional, Chinanuvathana, A., additional, Mousavian, A., additional, Thawait, G., additional, Shakoor, D., additional, Fonseca, L., additional, and Schon, L., additional
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- 2017
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20. Curved retrograde TTC fusion nails: Neurovascular structures at risk and entry point safe-zone
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de Cesar Netto, C., primary, Araoye, I., additional, Chodaba, Y., additional, Hudson, P., additional, Cone, B., additional, Sahranavard, B., additional, and Shah, A., additional
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- 2017
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21. Achilles tendinopathy induced by serial injections of collagenase: A new experimental model
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de Cesar Netto, C., primary, Godoy-Santos, A. Leme, additional, Pontin, P., additional, Lima, F.D. Oliveira, additional, Pereira, C.A. Martins, additional, Natalino, R., additional, Fonseca, L., additional, Bispo, G., additional, Lourenço, S., additional, Pires de Camargo, O., additional, Schon, L., additional, and Fernandes, T. Diniz, additional
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- 2017
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22. Adult acquired flatfoot deformity: Comparison of weightbearing and nonweightbearing CT examinations
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de Cesar Netto, C., primary, Demehri, S., additional, Dein, E.J., additional, Thawait, G., additional, Zhang, H., additional, Furtado da Fonseca, L., additional, Zahoor, T., additional, Lee, M., additional, Yi, G., additional, Chinanuvathana, A., additional, Ficke, J.R., additional, and Schon, L., additional
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- 2016
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23. SEMAC MRI of total ankle arthroplasty
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de Cesar Netto, C., primary, Dein, E.J., additional, Zhang, H., additional, da Fonseca, L. Furtado, additional, Zahoor, T., additional, Fritz, J., additional, and Schon, L., additional
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- 2016
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24. Influence of reader experience on reliability of flatfoot measurements using weightbearing CT
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de Cesar Netto, C., primary, Demehri, S., additional, Dein, E.J., additional, Thawait, G., additional, Zhang, H., additional, Furtado da Fonseca, L., additional, Zahoor, T., additional, Lee, M., additional, Yi, G., additional, Chinanuvathana, A., additional, Bennett, E., additional, Ficke, J.R., additional, and Schon, L., additional
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- 2016
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25. Sagittal balance of total ankle arthroplasty: Radiography versus metal artifact reduction MRI
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de Cesar Netto, C., primary, Dein, E.J., additional, Zhang, H., additional, da Fonseca, L. Furtado, additional, Zahoor, T., additional, Lee, M., additional, Chinanuvathana, A., additional, Fritz, J., additional, Aynardi, M., additional, and Schon, L., additional
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- 2016
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26. Cuboid Edema Syndrome Following Fixation of Proximal Fifth Metatarsal Fractures in Professional Athletes
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Cesar de Cesar Netto, Martin J. O’Malley, Andrew J. Elliott, Alessio Bernasconi, Lauren Roberts, William G. Hamilton, Roberts, L, Bernasconi, A, de Cesar Netto, C, Elliott, A, Hamilton, W, and O’Malley, Mj.
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Adult ,Male ,medicine.medical_specialty ,Fractures, Stress ,Bone Screws ,law.invention ,Intramedullary rod ,Fractures, Bone ,Young Adult ,Fixation (surgical) ,Postoperative Complications ,law ,Edema ,medicine ,Humans ,Orthopedics and Sports Medicine ,Elite athletes ,Podiatry ,Metatarsal Bones ,Cuboid ,Stress fractures ,business.industry ,Syndrome ,Tarsal Bones ,medicine.disease ,Magnetic Resonance Imaging ,Fracture Fixation, Intramedullary ,Surgery ,Athletes ,Athletic Injuries ,medicine.symptom ,business - Abstract
Stress fractures of the proximal fifth metatarsal are common injuries in elite athletes. Fixation using an intramedullary screw represents the most popular surgery performed for treating these injuries, with excellent results in most cases. However, multiple reports in the literature highlight the possibility of painful hardware, usually related to the presence of the screw head, following intramedullary fixation In this case report, we outline 4 cases of professional athletes who developed lateral-based foot symptoms following complete healing of their surgically treated proximal fifth metatarsal fractures and were found to have significant cuboid edema on magnetic resonance images. We also outline recommendations regarding specific surgical technique considerations aiming to minimize this possible complication. Level of Evidence: Level V: Case report.
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- 2019
27. Multiplanar Semiautomatic Assessment of Foot and Ankle Offset in Adult Acquired Flatfoot Deformity
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Nacime Salomão Barbachan Mansur, Francois Lintz, Jonathan T. Deland, Scott J. Ellis, Jonathan H. Garfinkel, Alessio Bernasconi, Cesar de Cesar Netto, Katrina E. Bang, de Cesar Netto, C., Bang, K., Mansur, N. S., Garfinkel, J. H., Bernasconi, A., Lintz, F., Deland, J. T., and Ellis, S. J.
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hindfoot alignment ,Adult ,Male ,Offset (computer science) ,adult acquired flatfoot deformity ,Computed tomography ,Weight-Bearing ,Young Adult ,AAFD ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,Retrospective Studies ,Orthodontics ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,foot and ankle offset ,Middle Aged ,Flatfoot deformity ,Flatfoot ,FAO ,medicine.anatomical_structure ,weightbearing CT ,weightbearing computed tomography ,Surgery ,Female ,measurement ,Ankle ,business ,Tomography, X-Ray Computed ,Foot (unit) ,WBCT - Abstract
Background: Semiautomatic 3-dimensional (3D) biometric weightbearing computed tomography (WBCT) tools have been shown to adequately demonstrate the relationship between the center of the ankle joint and the tripod of the foot. The measurement of the foot and ankle offset (FAO) represents an optimized biomechanical assessment of foot alignment. The objective of this study was to evaluate the correlation between FAO and traditional adult acquired flatfoot deformity (AAFD) markers, measured in different planes. We hypothesized that the FAO would significantly correlate with other radiographic markers of pronounced AAFD. Methods: In this retrospective comparative study, we included 113 patients with stage II AAFD, 43 men and 70 women, mean age of 53.5 (range, 20-86) years. 3D coordinates (x, y, and z planes) of the foot tripod (most plantar voxel of the first and fifth metatarsal heads, and calcaneal tuberosity) and the center of the ankle joint (most proximal and central voxel of the talar dome) were assessed by 2 blinded and independent fellowship-trained orthopedic foot and ankle surgeons. The FAO was automatically calculated using the 3D coordinates by dedicated software. Multiple WBCT parameters related to the severity of the deformity in the coronal, sagittal, and transverse planes were manually measured. Results: We found overall good to excellent intra- (range, 0.75-0.99) and interobserver (range, 0.73-0.99) reliability for manual AAFD measurements. FAO semiautomatic measurements demonstrated excellent intra- (0.99) and interobserver (0.99) reliabilities. Hindfoot moment arm (HMA) ( P < .00001), subtalar horizontal angle ( P < .00001), talonavicular coverage angle ( P = .00004), and forefoot arch angle ( P = .0001) were the only variables found to significantly influence and correlate with FAO measurements, with an R2 value of 0.79. An HMA value of 19.8 mm was found to be a strong threshold predictor of increased values of FAO, with mean values of FAO of 6.5 when the HMA was lower than 19.8 mm and 14.6 when the HMA was equal to or higher than 19.8 mm. Conclusion: We found that 3D WBCT semiautomatic measurements of FAO significantly correlated with some traditional markers of pronounced AAFD. Measurements of FAO were also found to be slightly more reliable than the manual measurements. The FAO offers a simple and more complete biomechanical and multiplanar assessment of the AAFD, representing in a single measurement the 3D components of the deformity. Level of Evidence: Level III, retrospective comparative study.
- Published
- 2020
28. Distance mapping of the foot and ankle joints using weightbearing CT: The cavovarus configuration
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Alessio Bernasconi, Maui Jepsen, Maria Ruiz, Sorin Siegler, Cesar de Cesar Netto, Francois Lintz, Lintz, F., Jepsen, M., De Cesar Netto, C., Bernasconi, A., Ruiz, M., and Siegler, S.
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musculoskeletal diseases ,Tarsometatarsal joints ,Adult ,Male ,Facet (geometry) ,Adolescent ,Distance mapping ,Weightbearing CT ,Weight-Bearing ,Young Adult ,Subtalar joint ,medicine ,Humans ,Orthopedics and Sports Medicine ,Joint (geology) ,Aged ,Retrospective Studies ,Orthodontics ,business.industry ,Joint pressure ,Subtalar Joint ,Middle Aged ,Varu ,body regions ,medicine.anatomical_structure ,Case-Control Studies ,Talipes Cavus ,Talonavicular joint ,Asymptomatic Diseases ,Female ,Ankle ,business ,Tomography, X-Ray Computed ,Foot (unit) ,Ankle Joint ,Follow-Up Studies - Abstract
Introduction The goal of this study was to characterize the abnormal joint surface interaction at the ankle, hindfoot and midfoot joints of the cavovarus foot using distance mapping on weightbearing computed tomography (WBCT) images by comparing a series of cavovarus feet to a series of normally-aligned feet. Methods In this case-control study, ten feet (10 patients) with asymptomatic cavovarus shape (cases; N = 10) were compared to 10 matched-paired (by age, gender and body mass index) normally-aligned feet (10 patients) (controls; N = 10). Three-dimensional models were produced from the images and distance maps representing joint surface configuration were generated for the ankle, hindfoot and midfoot joints. The distance maps for each joint were then compared between the two groups and between regions in the same group. Results In the cavovarus group there was a significant increase in surface-to-surface distance at the posterior tibiotalar joint and a reduced distance at the anterior part, together with a greater distance at the posterior half of the medial gutter. Also, a decrease in surface-to-surface distance on the anterior half of the anterior facet and an increased distance on the posterior quadrants of the posterior facet of the subtalar joint were found. At the sinus tarsi, the lateral aspect of the talonavicular joint, the naviculocuneiform and the tarsometatarsal joints there was a statistically significant increase in surface-to-surface distance in cavovarus patients as compared to controls. Conclusion Distance mapping analysis on WBCT images identified significant differences in surface-to-surface interaction at the foot and ankle joints between cavovarus and normally-aligned feet. Level of evidence Level III, case-control study.
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- 2020
29. Tendoscopy for early stages (I and II) posterior tibial tendon dysfunction
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Julien Laborde, Alessio Bernasconi, Cesar de Cesar Netto, Francois Lintz, Nazim Mehdi, Bernasconi, A, Mehdi, N, Laborde, J, de Cesar Netto, C, and Lintz, F.
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business.industry ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,Anatomy ,business ,Posterior Tibial Tendon Dysfunction - Published
- 2020
30. Is adjunction of advanced platelet-rich fibrin (A-PRF) useful in first metatarsophalangeal joint arthrodesis? A retrospective cohort study
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Alessio Bernasconi, Cesar de Cesar Netto, Julien Cailliez, Francois Lintz, Nazim Mehdi, Matthieu Wargny, Jean Alain Colombier, Bernasconi, A, Cailliez, J, de Cesar Netto, C, Wargny, M, Mehdi, N, and Lintz, F.
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Male ,Metatarsophalangeal Joint ,medicine.medical_specialty ,Visual Analog Scale ,Arthrodesis ,medicine.medical_treatment ,Joint arthrodesis ,Cohort Studies ,03 medical and health sciences ,Hallux rigidus ,0302 clinical medicine ,Osteogenesis ,Platelet-Rich Fibrin ,Hallux Rigidus ,medicine ,Humans ,Orthopedics and Sports Medicine ,Podiatry ,Aged ,Retrospective Studies ,030203 arthritis & rheumatology ,business.industry ,Forefoot ,Gold standard ,Retrospective cohort study ,030229 sport sciences ,Middle Aged ,medicine.disease ,digestive system diseases ,Platelet-rich fibrin ,Surgery ,Case-Control Studies ,Female ,business ,Complication - Abstract
Purpose First metatarsophalangeal (MTPJ1) fusion represents the gold standard treatment for end-stage hallux rigidus (HR). The aim of this study was to assess efficacy and safety of A-PRF in promoting union after MTPJ1 arthrodesis. Our hypothesis was that the use of A-PRF may reduce the non-union rate and the time to fusion in the treatment of HR. Methods 14 patients that had undergone MTPJ1 arthrodesis with A-PRF adjunction with 21 standard MTPJ1 fusions were retrospectively reviewed. The fusion rate and time to fusion (clinically and radiographically) were assessed at 6, 12 weeks and at the longest follow-up; the clinical status at final follow-up through forefoot AOFAS, EQ5d, SEFAS and VAS-pain scores; the complication rate. Results At 6-weeks, bony union was achieved in 100% of patients in the A-PRF group compared to 70% in the control group, but this difference was not statistically significant (p = 0.22). At final follow-up (41 months), union rate in the control group reached 92% (one non-union). AOFAS, VAS and EQ-5d scores showed similar results for the two groups (p = 0.86, p = 0.12 and p = 0.61, respectively); only SEFAS score revealed a difference favoring the A-PRF group (p = 0.04). No revision surgery or complication was recorded in any group. Conclusions A tendency for increased union rate was mainly found at 6 weeks in patients treated with MTPJ1 fusion associated to A-PRF compared to isolated fusion. The use of A-PRF was not associated with an increased complication rate at final follow-up. Level of evidence Level 3, therapeutic study, retrospective comparative study.
- Published
- 2019
31. Joystick of the Talus for Correcting Malalignment During Arthroscopic Ankle Arthrodesis: A Surgical Tip
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Cesar de Cesar Netto, Nazim Mehdi, Francois Lintz, Louis Dagneaux, Julien Laborde, Alessio Bernasconi, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université de Montpellier (UM), Bernasconi, A, Mehdi, N, Laborde, J, de Cesar Netto, C, Dagneaux, L, and Lintz, F.
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medicine.medical_specialty ,medicine.medical_treatment ,Arthrodesis ,Ankle arthrodesis ,Osteoarthritis ,[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery ,Effective solution ,03 medical and health sciences ,0302 clinical medicine ,Technical Note ,medicine ,Orthopedics and Sports Medicine ,Reduction (orthopedic surgery) ,Orthopedic surgery ,030222 orthopedics ,biology ,business.industry ,030229 sport sciences ,medicine.disease ,biology.organism_classification ,Surgery ,Valgus ,medicine.anatomical_structure ,Coronal plane ,Ankle ,business ,RD701-811 - Abstract
International audience; Ankle arthrodesis has been widely reported as an effective solution in treating tibiotalar joint osteoarthritis. The arthroscopic tibiotalar approach for arthrodesis has also been proven to give excellent results in terms of bone fusion rates and reduction of wound-related pain and complications. Historically, ankle malalignment has represented one of the main contraindications for the arthroscopic procedure, but interestingly some investigators have shown that the coronal joint deformity may be addressed arthroscopically as well. Other investigators have also demonstrated that part of the valgus/varus is due to malrotation of the talus within the mortise; therefore, controlling the talar position becomes crucial for correcting more severe deformities. We present here a technique for correcting tibiotalar malalignment during arthroscopic arthrodesis in varus or valgus ankles, performed through a K-wire used as a joystick to manage the talar position on both the coronal and axial planes.
- Published
- 2018
32. Surgical reconstruction in severe infected diabetic foot: A staged treatment algorithm.
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Godoy-Santos, A. Leme, Amodio, D., Wei, T., Pires, A., Munhoz-Lima, A. L., de Cesar-Netto, C., and Armstrong, D.
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DIABETIC foot , *TREATMENT of diabetic foot , *PATIENTS - Published
- 2017
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33. Progressive First Metatarsal Shortening Is Observed Following Dermal Allograft Interpositional Arthroplasty in Hallux Rigidus: Short Report.
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Fayed AM, Jones M, Carvalho KAM, Luo E, Acker A, Barbachan Mansur NS, and de Cesar Netto C
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Background: The main goal of this study was to evaluate postoperative changes in the length of the first metatarsal (M1) and the proximal phalanx of the hallux (P1) after acellular dermal allograft interpositional arthroplasty (ADA-IPA). We hypothesized that there would be a shortening of the first ray at the first metatarsal, the proximal phalanx, or both., Methods: In this retrospective study, we assessed patients who underwent ADA-IPA between 2019 and 2022. On standing anteroposterior (AP) foot radiographs, we measured first metatarsal (M1), second metatarsal (M2), proximal phalanx (P1), and the entire hallux (HX) lengths. M1/M2 and P1/HX ratios were calculated. The first metatarsophalangeal joint space was calculated. All measurements were recorded preoperatively, at 6 weeks postoperatively, and at final follow-up., Results: The pilot study included 11 patients. At final follow-up, we found shortening of M1 and P1 in comparison to the preoperative length, as evidenced by lower M1/M2 (82.6 ± 2.3 vs 75.4 ± 5.1; P = .001) and P1/HX ratios (53.4 ± 2.3 vs 48.9 ± 7.9; P = .001). Follow-up length was negatively correlated with M1/M2 ( r = -0.76, P = .003)., Conclusion: ADA-IPA might be associated with shortening of both first metatarsal and proximal phalanx, with the former showing progressive shortening., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Disclosure forms for all authors are available online.
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- 2024
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34. Influence of Tibial Component Design Features and Interference Fit on Implant-Bone Micromotion in Total Ankle Replacement: A Finite Element Study.
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Clarke G, Johnson JE, de Cesar Netto C, and Anderson DD
- Abstract
Background: Implant survivorship in uncemented total ankle replacement (TAR) is dependent on achieving initial stability. This is because early micromotion between the implant and bone can disrupt the process of osseointegration, leading to poor long-term outcomes. Tibial implant fixation features are designed to resist micromotion, aided by bony sidewall retention and interference fit. The goal of this study was to investigate design-specific factors influencing implant-bone micromotion in TAR tibial components with interference fit., Methods: Three implant designs with fixation features representative of current TAR tibial components (ARC, SPIKES, KEEL) were virtually inserted into models of the distal tibias of 2 patients with end-stage ankle arthritis. Tibia models were generated from deidentified patient computed tomography scans, with material properties for modeling bone behavior and compaction during press-fit. Finite element analysis (FEA) was used to simulate 2 fixation configurations: (1) no sidewalls or interference fit, and (2) sidewalls with interference fit. Load profiles representing the stance phase of gait were applied to the models, and implant-bone micromotions were computed from FEA output., Results: Sidewalls and interference fit substantially influenced implant-bone micromotions across all designs studied. When sidewalls and interference fit were modeled, average micromotions were less than 11 µm, consistent across the stance phase of gait. Without sidewalls or interference fit, micromotions were largest near either heel strike or toe-off. In the absence of sidewalls and interference fit, the amount of micromotion generally aligned inversely with the size of implant fixation features; the ARC design had the largest micromotion (~540 µm average), whereas the KEEL design had the smallest micromotion (~15 µm)., Conclusion: This study presents new insights into the effect of TAR fixation features on implant-bone micromotion. With sidewalls and interference fit, micromotion is predicted to be minimal for implants, whereas with no sidewalls and no interference fit, micromotion depended primarily on the implant design., Clinical Relevance: This study presents new insights into the effect of TAR primary fixation features on implant-bone micromotion. Although design features heavily influenced implant stability in the model, their influence was greatly diminished when interference fit was introduced. The results of this study show the relative importance of design features and interference fit in the predicted initial stability of uncemented TAR, potentially a key factor in implant survivorship., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Disclosure forms for all authors are available online.
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- 2024
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35. Magnetic Resonance Imaging of Total Ankle Arthroplasty: State-of-The-Art Assessment of Implant-Related Pain and Dysfunction.
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Fritz J, Rashidi A, and de Cesar Netto C
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- Humans, Ankle Joint surgery, Ankle Joint diagnostic imaging, Pain, Postoperative etiology, Prosthesis Design, Male, Artifacts, Female, Prosthesis Failure, Arthroplasty, Replacement, Ankle adverse effects, Magnetic Resonance Imaging methods, Joint Prosthesis adverse effects
- Abstract
Total ankle arthroplasty (TAA) is an effective alternative for treating patients with end-stage ankle degeneration, improving mobility, and providing pain relief. Implant survivorship is constantly improving; however, complications occur. Many causes of pain and dysfunction after total ankle arthroplasty can be diagnosed accurately with clinical examination, laboratory, radiography, and computer tomography. However, when there are no or inconclusive imaging findings, magnetic resonance imaging (MRI) is highly accurate in identifying and characterizing bone resorption, osteolysis, infection, osseous stress reactions, nondisplaced fractures, polyethylene damage, nerve injuries and neuropathies, as well as tendon and ligament tears. Multiple vendors offer effective, clinically available MRI techniques for metal artifact reduction MRI of total ankle arthroplasty. This article reviews the MRI appearances of common TAA implant systems, clinically available techniques and protocols for metal artifact reduction MRI of TAA implants, and the MRI appearances of a broad spectrum of TAA-related complications., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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36. Cone-Beam Weight-Bearing Computed Tomography of Ankle Arthritis and Total Ankle Arthroplasty.
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de Carvalho KAM, Barbachan Mansur NS, DaCosta A, Godoy-Santos AL, and de Cesar Netto C
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- Humans, Arthroplasty, Replacement, Ankle adverse effects, Ankle Joint diagnostic imaging, Ankle Joint surgery, Weight-Bearing, Osteoarthritis diagnostic imaging, Osteoarthritis surgery, Cone-Beam Computed Tomography
- Abstract
Weight-bearing computed tomography has multiple advantages in evaluating the hindfoot and ankle. It can assess hindfoot and ankle alignment, pathology in ankle arthritis, and complications related to total ankle replacements. It is an essential tool in ankle osteoarthritis diagnostic, preoperative planning, and total ankle replacement outcomes. It allows for better accuracy and reproducibility of alignment and implant size. In addition, it has the potential to more assertively detect complications related to weight bearing., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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37. Multiaxial 3D MRI of the Ankle: Advanced High-Resolution Visualization of Ligaments, Tendons, and Articular Cartilage.
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Fritz B, de Cesar Netto C, and Fritz J
- Subjects
- Humans, Ankle Injuries diagnostic imaging, Ligaments, Articular diagnostic imaging, Ligaments diagnostic imaging, Magnetic Resonance Imaging methods, Imaging, Three-Dimensional, Ankle Joint diagnostic imaging, Cartilage, Articular diagnostic imaging, Tendons diagnostic imaging, Tendons anatomy & histology
- Abstract
MRI is a valuable tool for diagnosing a broad spectrum of acute and chronic ankle disorders, including ligament tears, tendinopathy, and osteochondral lesions. Traditional two-dimensional (2D) MRI provides a high image signal and contrast of anatomic structures for accurately characterizing articular cartilage, bone marrow, synovium, ligaments, tendons, and nerves. However, 2D MRI limitations are thick slices and fixed slice orientations. In clinical practice, 2D MRI is limited to 2 to 3 mm slice thickness, which can cause blurred contours of oblique structures due to volume averaging effects within the image slice. In addition, image plane orientations are fixated and cannot be changed after the scan, resulting in 2D MRI lacking multiplanar and multiaxial reformation abilities for individualized image plane orientations along oblique and curved anatomic structures, such as ankle ligaments and tendons. In contrast, three-dimensional (3D) MRI is a newer, clinically available MRI technique capable of acquiring high-resolution ankle MRI data sets with isotropic voxel size. The inherently high spatial resolution of 3D MRI permits up to five times thinner (0.5 mm) image slices. In addition, 3D MRI can be acquired image voxel with the same edge length in all three space dimensions (isotropism), permitting unrestricted multiplanar and multiaxial image reformation and postprocessing after the MRI scan. Clinical 3D MRI of the ankle with 0.5 to 0.7 mm isotropic voxel size resolves the smallest anatomic ankle structures and abnormalities of ligament and tendon fibers, osteochondral lesions, and nerves. After acquiring the images, operators can align image planes individually along any anatomic structure of interest, such as ligaments and tendons segments. In addition, curved multiplanar image reformations can unfold the entire course of multiaxially curved structures, such as perimalleolar tendons, into one image plane. We recommend adding 3D MRI pulse sequences to traditional 2D MRI protocols to visualize small and curved ankle structures to better advantage. This article provides an overview of the clinical application of 3D MRI of the ankle, compares diagnostic performances of 2D and 3D MRI for diagnosing ankle abnormalities, and illustrates clinical 3D ankle MRI applications., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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38. Trends in the Use of Weightbearing Computed Tomography.
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Bernasconi A, Dechir Y, Izzo A, D'Agostino M, Magliulo P, Smeraglia F, de Cesar Netto C, International Weightbearing Ct Society, and Lintz F
- Abstract
Background: This review aimed to critically appraise the most recent orthopedic literature around cone beam weightbearing computed tomography (WBCT), summarizing what evidence has been provided so far and identifying the main research trends in the area. Methods: This scoping review was performed on studies published between January 2013 and December 2023 on the Pubmed database. All studies (both clinical and nonclinical) in which WBCT had been used were critically analyzed to extract the aim (or aims) of the study, and the main findings related to the role of this imaging modality in the diagnostic pathway. Results: Out of 1759 studies, 129 were selected. One hundred five manuscripts (81%) dealt with elective orthopedic conditions. The majority of the analyses (88 studies; 84%) were performed on foot and ankle conditions, while 13 (12%) studies looked at knee pathologies. There was a progressive increase in the number of studies published over the years. Progressive Collapsing Foot Deformity (22 studies; 25%) and Hallux Valgus (19 studies; 21%) were frequent subjects. Twenty-four (19%) manuscripts dealt with traumatic conditions. A particular interest in syndesmotic injuries was documented (12 studies; 60%). Conclusions: In this review, we documented an increasing interest in clinical applications of weightbearing CT in the orthopedic field between 2013 and 2023. The majority of the analyses focused on conditions related to the foot and the ankle; however, we found several works investigating the value of WBCT on other joints (in particular, the knee).
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- 2024
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39. Ankle osteoarthritis: Toward new understanding and opportunities for prevention and intervention.
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Anderson DD, Wilken J, Ledoux W, Lenz AL, Easley ME, and de Cesar Netto C
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The ankle infrequently develops primary osteoarthritis (OA), especially when compared to the hip and the knee. Ankle OA instead generally develops only after trauma. The consequences of end-stage ankle OA can nonetheless be extremely debilitating, with impairment comparable to that of end-stage kidney disease or congestive heart failure. Disconcertingly, evidence suggests that ankle OA can develop more often than is generally appreciated after even low-energy rotational ankle fractures and chronic instability associated with recurrent ankle sprains, albeit at a slower rate than after more severe trauma. The mechanisms whereby ankle OA develops after trauma are poorly understood, but mechanical factors are implicated. A better understanding of the prevalence and mechanical etiology of post-traumatic ankle OA can lead to better prevention and mitigation. New surgical and conservative interventions, including improved ligamentous repair strategies and custom carbon fiber bracing, hold promise for advancing treatment that may prevent residual ankle instability and the development of ankle OA. Studies are needed to fill in key knowledge gaps here related to etiology so that the interventions can target key factors. New technologies, including weight bearing CT and biplane fluoroscopy, offer fresh opportunities to better understand the relationships between trauma, ankle alignment, residual ankle instability, OA development, and foot/ankle function. This paper begins by reviewing the epidemiology of post-traumatic ankle OA, presents evidence suggesting that new treatment options might be successful at preventing ankle OA, and then highlights recent technical advances in understanding of the origins of ankle OA to identify directions for future research., (© 2024 The Author(s). Journal of Orthopaedic Research® published by Wiley Periodicals LLC on behalf of Orthopaedic Research Society.)
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- 2024
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40. Quantification of First Metatarsal Joint Surface Interactions in Hallux Rigidus Using Distance and Coverage Mapping: A Case-Control Study.
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Jones MT, Braza S, Mallavarapu V, Behrens A, Jasper R, Stebral H, Carvalho KAM, Barbachan Mansur NS, Dibbern K, and de Cesar Netto C
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- Humans, Case-Control Studies, Retrospective Studies, Female, Middle Aged, Male, Adult, Aged, Weight-Bearing physiology, Imaging, Three-Dimensional, Pain Measurement, Hallux Rigidus diagnostic imaging, Hallux Rigidus physiopathology, Metatarsophalangeal Joint diagnostic imaging, Metatarsophalangeal Joint physiopathology, Cone-Beam Computed Tomography
- Abstract
Background: Weightbearing cone-beam computed tomography (WBCT) has proven useful for analysis of structural changes of the foot and ankle when compared to conventional radiographs. WBCT allows for extraction of distance and coverage mapping metrics, which may provide novel insight into hallux rigidus (HR). This study retrospectively assessed HR joint space using distance and coverage mapping in a case-control study., Methods: WBCT images of the foot and ankle for 20 symptomatic HR and 20 control patients were obtained. Three-dimensional models were created and analyzed using a custom semiautomatic measurement algorithm. Distance and coverage mapping metrics for the first metatarsophalangeal and metatarsosesamoid joints were extracted from the models and compared between cohorts. Relationships between these metrics and visual analog scale (VAS) scores, a patient-reported outcome of pain, were assessed in HR patients., Results: Overall first metatarsophalangeal joint space narrowing was noted in HR patients when compared to controls by an average of 11.8% ( P = .02). However, no significant changes in the overall coverage of the joint were noted. Decreased joint space width and increased surface-to-surface coverage were only and particularly observed at the plantar medial quadrant of the first metatarsal head in HR patients relative to controls. VAS score was significantly but weakly correlated with dorsolateral quadrant coverage ( R
2 = 0.26, P = .03)., Conclusion: Distance and coverage mapping serve as a complementary option to current techniques of quantifying HR changes. These metrics can expand the scope of future work investigating joint articulation changes in HR., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Cesar de Cesar Netto, MD, PhD, reports consulting fees; support for attending meetings and/or travel; and stock or stock options from CurveBeam. Disclosure forms for all authors are available online.- Published
- 2024
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41. Hindfoot Alignment in Flexible Cavovarus Deformity Under Orthostatic and Coleman Block Test Positions: A Weightbearing Computed Tomography Study.
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Pires EA, Lobo CFT, Fonseca FC, Sposeto RB, Barbachan Mansur NS, Easley ME, de Cesar Netto C, and Godoy-Santos AL
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- Humans, Adult, Talipes Cavus diagnostic imaging, Talipes Cavus physiopathology, Female, Male, Case-Control Studies, Imaging, Three-Dimensional, Middle Aged, Young Adult, Foot diagnostic imaging, Foot physiopathology, Weight-Bearing physiology, Tomography, X-Ray Computed methods
- Abstract
Background: Flexible cavovarus deformity is prevalent and the Coleman block test is frequently used to assess the first ray plantarflexion malpositioning in the overall deformity as well as the flexibility of the hindfoot. The objective was to assess and compare the weightbearing computed tomography (WBCT) 3-dimensional (3D) changes in clinical and bone alignment in flexible cavovarus deformity patients when performing the Coleman block test when compared to normal standing position and to controls., Methods: Twenty patients (40 feet) with flexible cavovarus deformity and 20 volunteer controls (40 feet) with normal foot alignment underwent WBCT imaging of the foot and ankle. Cavovarus patients were assessed in normal orthostatic and Coleman block test positions. Foot and ankle offset (FAO), hindfoot alignment angle (HAA), talocalcaneal angle (TCA), subtalar vertical angle (SVA) and talonavicular coverage angle (TNCA) and a CT-simulated soft tissue envelope image, WBCT clinical hindfoot alignment angle (WBCT-CHAA), were evaluated by 2 readers. Measurements were compared between cavovarus nonstressed and stressed positions and to controls. P values of .05 or less were considered significant., Results: The intra- and interobserver intraclass correlation coefficient were good or excellent for all WBCT measurements. Cavovarus patients demonstrated significant correction of WBCT-CHAA (9.7 ± 0.4 degrees), FAO (2.6 ± 0.4%), and TNCA (8.8 ± 1.8 degrees) when performing the Coleman block test (all P values <.0001). However, WBCT-CHAA and FAO measurements were still residually deformed and significantly different from controls ( P values of .001 and <.0001, respectively). TNCA values corrected to values similar to healthy controls ( P = .29). No differences were observed in cavovarus patients during Coleman block test for the coronal measures: HAA, TCA, and SVA measurements., Conclusion: In this study, we observed improvement in the overall 3D WBCT alignment (FAO), axial plane adduction deformity (TNCA), as well as CT simulated clinical hindfoot alignment (WBCT-CHAA) in flexible cavovarus deformity patients when performing a Coleman block test. However, we did not find improvement in measures of coronal alignment of the hindfoot, indicating continued varus positioning of the hindfoot in these patients., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Disclosure forms for all authors are available online.
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- 2024
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42. Utilization of telemedicine for diagnosis and follow-up within foot and ankle orthopaedic surgery: A narrative review of the literature.
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Talaski GM, Baumann AN, Kermanshahi N, Walley KC, Anastasio AT, and de Cesar Netto C
- Abstract
Background: Telemedicine has seen increasing adoption in healthcare over the past two decades, with proven clinical efficacy in several medical specialties. Orthopedics surgery has shown potential benefits from telemedicine implementation., Objective: This review aims to evaluate the impact of telemedicine on clinical outcomes and patient and physician preferences in foot and ankle orthopedics, providing insight into the potential role of telemedicine within this subspecialty., Methods: Multiple databases were searched for relevant articles on telemedicine in foot and ankle orthopedics. Inclusion criteria encompassed articles on telemedicine use and foot and ankle orthopedic care. Data included patient demographics, reasons for visits, duration of telemedicine, and outcomes. Analysis involved descriptive statistics, and a narrative approach to describe outcomes., Results: Out of 218 articles, 12 met the inclusion criteria, comprising a total of 1,535 patients. Telemedicine visits were used for follow-up care, opinion consultations, monitoring, postoperative care, and treatment of various orthopedic conditions. Clinical outcomes demonstrated equivalence to in-person care. Patients expressed satisfaction with telemedicine but preferred in-person visits for future appointments. Physicians held neutral attitudes towards telemedicine, with concerns about the lack of physical examination., Conclusion: This review highlights the benefits of telemedicine in foot and ankle orthopedics. Telemedicine provides an alternative to in-person visits, improving patient access to care and offering cost and time savings. However, patient and physician preferences for in-person visits suggest a need to address concerns related to physical examination limitations. Telemedicine can supplement traditional care, but further research is required to explore its applicability in new patient consultations and optimize physician engagement.
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- 2024
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43. Correction of progressive collapsing foot deformity classes after isolated arthroscopic subtalar arthrodesis.
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Bernasconi A, Lalevée M, Fernando C, Izzo A, de Cesar Netto C, and Lintz F
- Abstract
Introduction: Subtalar osteoarthritis in the context of flatfoot (recently renamed Progressive Collapsing Foot Deformity (PCFD)) may be treated through subtalar joint (SJ) arthrodesis with anticipated consequences on three-dimensional bony configuration. This study investigates the correction of PCFD-related deformities achieved after Anterolateral Arthroscopic Subtalar Arthrodesis (ALAPSTA)., Methods: In this retrospective study, we evaluated pre- and post-operative (at 6 months) weight bearing computed tomography (WBCT) images of patients diagnosed with PCFD with a degenerated SJ (2 A according to PCFD classification) and/or peritalar subluxation (2D) with or without associated flexible midfoot and/or forefoot deformities (1B, 1 C and 1E) which underwent ALAPSTA as a standalone procedure between 2017 and 2020. Multiple measurements were used to assess and compare pre and post-operative PCFD classes., Results: Thirtythree PCFD (33 patients, median age 62) were included in the study. Preoperative medial facet subluxation was 28.3 % (IQR, 15.1 to 49.3 %). Overall PCFD 3D deformity improved with a reduction of the foot and ankle offset from 9.3 points (IQR, 7.8 to 12) to 4 (IQR, 0.9 to 7) (p < 0.001). Class A-hindfoot valgus (median tibiocalcaneal angle and median calcaneal moment arm improved by 9.4 degrees (p < 0.001) and 11 mm (p < 0.001), respectively), class B-midfoot abduction (median talonavicular coverage angle improved by 20.5 degrees, p < 0.001) and class C-forefoot varus (median sagittal talo-first metatarsal angle improved by 10.2 degrees (p < 0.001)) were significantly corrected after surgery. Class D was difficult to assess due to the fusion procedure. No patient had a pre-operative valgus deformity at the ankle (no class E), and no significant change of the talar tilt was observed (p = 0.12)., Conclusion: In this series, ALAPSTA performed as a standalone procedure to treat patients diagnosed with PCFD with a degenerated subtalar joint and/or peritalar subluxation was effective not only at correcting hindfoot alignment but also flexible midfoot abduction and flexible forefoot varus., Level of Evidence: Level IV, case series., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Alessio Bernasconi reports financial support was provided by EFAS RESEARCH FOUNDATION-MEDARTIS RESEARCH GRANT. Alessio Bernasconi reports a relationship with CurveBeam that includes: equity or stocks. Cesar de Cesar Netto reports a relationship with CurveBeam that includes: equity or stocks. Francois Lintz reports a relationship with CurveBeam that includes: equity or stocks. Alessio Bernasconi reports a relationship with International WBCT Society that includes: board membership. Cesar de Cesar Netto reports a relationship with International WBCT Society that includes: board membership. Francois Lintz reports a relationship with International WBCT Society that includes: board membership. Outside the work reported in this paper: Dr. Bernasconi is a member of the youth and media committee of the European Foot & Ankle Society (EFAS). Dr. de Cesar Netto reports personal fees from Nextremity, grants, personal fees, non-financial support and other from Paragon 28, personal fees from Zimmer-Biomet, personal fees from Ossio, outside the submitted work; and AOFAS Committee Member, FAI Media Board Member, AAOS Committee Member. Dr. Lintz reports personal fees and other from Newclip Technics, personal fees and other from Disior, outside the submitted work; and Board member of the Association Française de Chirurgie du Pied (AFCP); member of the media committee of the European Foot & Ankle Society (EFAS). If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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44. Influence of sidewall retention and interference fit in total ankle replacement on implant-bone micromotion: A finite element study.
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Johnson JE, Clarke GA, de Cesar Netto C, and Anderson DD
- Subjects
- Humans, Prosthesis Design, Tibia surgery, Male, Middle Aged, Aged, Female, Ankle Joint surgery, Joint Prosthesis, Finite Element Analysis, Arthroplasty, Replacement, Ankle instrumentation
- Abstract
The success of uncemented total ankle replacement (TAR) is linked to initial stability because bony ingrowth depends upon limited early micromotion. Tibial implant design fixation features resist micromotion aided by bony sidewall retention and interference fit. Our goal was to investigate factors influencing implant-bone micromotion in TAR. Two TAR tibial components were virtually inserted into CT-derived computer models of two distal tibias from patients with end-stage ankle arthritis. Density-based inhomogeneous material assignment was used to model bone compaction during press-fit. Finite element analysis (FEA) was used to simulate three fixation cases: (1) no sidewalls + line-to-line fit, (2) sidewalls + line-to-line fit, and (3) sidewalls + 50, 100, or 200 µm interference fit. Kinetic profiles from the stance phase of gait were simulated and micromotions computed from FEA output. Without sidewalls or interference fit, micromotions were largest in early and late stance, with largest micromotions (averaging ~150-250 µm) observed near heel strike. Micromotions decreased 39%-62% when sidewalls were retained. When interference fit was also modeled, micromotions decreased another 37%-61% to ~10 µm. Micromotion differences between patients persisted with sidewall retention but largely disappeared with interference fit. This study presents new insights into the effects of TAR fixation features on implant-bone micromotion. Stability appeared to be influenced by surrounding bone quality, but this influence was greatly diminished when interference fit was introduced. More complete understanding of TAR implant features and performance is needed, but our results show the importance of bone quality and interference fit in the stability of uncemented TAR., (© 2024 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals LLC on behalf of Orthopaedic Research Society.)
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- 2024
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45. Spontaneous Reduction in the Intermetatarsal Angle in Distal First Metatarsal Osteotomies with No Lateral Head Displacement in Hallux Valgus.
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Coillard JY, Rey R, Civinini A, Billuart F, Schmidt E, de Cesar Netto C, Sacco R, and Lalevée M
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Background: The outcomes of first metatarsal (M1) distal osteotomies in hallux valgus (HV) can be improved, especially for intermetatarsal angle (IMA) correction, which is mainly based on lateral displacement of the M1 head (i.e., translation) through the osteotomy. Conversely, there is a spontaneous reduction in the IMA in first metatarsophalangeal joint (MTP1) arthrodesis. But we do not know whether this can be applied to distal osteotomies. We propose a distal osteotomy, called 3D chevron, which combines supination and varization of the M1 head. This might realign soft tissues around the MTP1, potentially leading to a spontaneous reduction in the IMA by an analogous mechanism to MTP1 fusion. Therefore, our study aimed to assess whether spontaneous reductions in IMAs exist in distal M1 osteotomies in the absence of lateral translations of M1 heads., Methods: A prospective continuous series of 25 3D chevrons was performed. Two groups were formed during surgery. Patients requiring no M1 head lateral displacement were included in the "successful correction without translation" group, and patients requiring M1 head lateral displacement were included in the "failed correction without translation" group. Radiographic analysis was performed preoperatively and at 1 year postoperatively., Results: Twenty-two women and three men, with a mean age of 44.8 ± 14.2 years and a mean body mass index of 22.6 ± 4.1 kg/m
2 , underwent follow-up at one year after surgery. The "successful correction without translation" group was composed of HV with milder deformities (13/25 HVs, median preoperative IMA = 13 (IQR 2)) compared to the "failed correction without translation" group (median IMA = 16 (IQR 2.25) p < 0.001). Spontaneous reductions in IMAs were observed in the "successful correction without translation" group, with a median decrease in the IMA of 6 degrees (CI95%[5.5; 8.0]; p < 0.001) between preoperative and 1-year radiographs., Conclusion: Distal osteotomies allow for spontaneous reduction in the IMA in HV. First metatarsal head translation through an osteotomy should not be considered as the only procedure to correct IMAs in distal osteotomies.- Published
- 2024
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46. The role of computed tomography with external rotation and dorsiflexion in decision making for acute isolated non-displaced posterior malleolar fractures Bartoníček and Rammelt type II: a prospective study.
- Author
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Godoy-Santos AL, Rodrigues JC, Barros-Santos D, de Cesar Netto C, Mansur NSB, de Carvalho KAM, Giordano V, and Rammelt S
- Abstract
Purpose: Our objective was to evaluate the syndesmotic and fracture instability using conventional ankle computed tomography (CT) with stress maneuvers., Methods: A consecutive sample of 123 individuals with an ankle sprain was assessed for eligibility. In total, 33 patients met the inclusion criteria. All patients underwent a magnetic resonance imaging (MRI) and CT scan with stress maneuvers (CTSM). The patterns of ligament tears f were classified using West Point grades I, IIA, IIB, III. Mann-Whitney test was used to test the differences in the numerical variables between injured and uninjured syndesmoses. The Spearman correlation tested the strength of the association between the tibial joint surface involved in posterior malleolus fracture and syndesmotic instability., Results: In MRI, two patterns of syndesmotic ligament injury predominated. A completely torn anterior inferior tibiofibular (AITFL) and interosseous tibiofibular ligaments (ITFL) and a completely torn AITFL were combined with a partially torn ITFL. In the neutral phase CTSM and during the stress phase the median difference of the narrowest tibiofibular distance between injured and uninjured syndesmoses was 0.2 mm (P = 0.057) and 2.3 mm (P < 0.0001), respectively. There was no association between the percentage of involvement of the posterior tibial joint surface in the posterior malleolar fracture and syndesmotic instability as measured with CTSM., Conclusion: The conventional computed tomography with external rotation and dorsiflexion represents a reproducible and accurate diagnostic option for detecting syndesmosis instability and fracture instability in acute isolated non-displaced posterior malleolar fractures Bartoníček and Rammelt type II., Level of Evidence: Prospective study among consecutive patients (Diagnosis); Level of evidence, 2., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)
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- 2024
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47. An Innovative Weightbearing Device for Weightbearing 3-Dimensional Imaging for Foot and Ankle Surgery Preoperative Planning.
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Barg A, Richter M, Burssens A, de Cesar Netto C, Ellis S, Godoy-Santos AL, and Lintz F
- Subjects
- Humans, Tomography, X-Ray Computed, Lower Extremity, Weight-Bearing, Ankle diagnostic imaging, Ankle surgery, Ankle Joint diagnostic imaging, Ankle Joint surgery
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- 2024
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48. Socioeconomic Status and Race Are Rarely Reported in Randomized Controlled Trials for Achilles Tendon Pathology in the Top 10 Orthopaedic Journals: A Systematic Review.
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Talaski GM, Baumann AN, Salmen N, Curtis DP, Walley KC, Anastasio AT, and de Cesar Netto C
- Abstract
Background: Randomized controlled trials (RCTs) are crucial in comparative research, and a careful approach to randomization methodology helps minimize bias. However, confounding variables like socioeconomic status (SES) and race are often underreported in orthopaedic RCTs, potentially affecting the generalizability of results. This study aimed to analyze the reporting trends of SES and race in RCTs pertaining to Achilles tendon pathology, considering 4 decades of data from top-tier orthopaedic journals., Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and used PubMed to search 10 high-impact factor orthopaedic journals for RCTs related to the management of Achilles tendon pathology. The search encompassed all articles from the inception of each journal until July 11, 2023. Data extraction included year of publication, study type, reporting of SES and race, primary study location, and intervention details., Results: Of the 88 RCTs identified, 68 met the inclusion criteria. Based on decade of publication, 6 articles (8.8%) reported on SES, whereas only 2 articles (2.9%) reported on race. No RCTs reported SES in the pre-1999 period, but the frequency of reporting increased in subsequent decades. Meanwhile, all RCTs reporting race were published in the current decade (2020-2030), with a frequency of 20%. When considering the study location, RCTs conducted outside the United States were more likely to report SES compared with those within the USA., Conclusion: This review revealed a concerning underreporting of SES and race in Achilles tendon pathology RCTs. The reporting percentage remains low for both SES and race, indicating a need for comprehensive reporting practices in orthopaedic research. Understanding the impact of SES and race on treatment outcomes is critical for informed clinical decision making and ensuring equitable patient care. Future studies should prioritize the inclusion of these variables to enhance the generalizability and validity of RCT results., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online., (© The Author(s) 2024.)
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- 2024
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49. The Role of the Transverse Arch in Progressive Collapsing Foot Deformity.
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Schmidt E, Lalevée M, Kim KC, Carvalho KAM, Dibbern K, Lintz F, Barbachan Mansur NS, and de Cesar Netto C
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- Humans, Retrospective Studies, Foot, Weight-Bearing, Foot Deformities diagnostic imaging, Metatarsal Bones, Tarsal Bones diagnostic imaging, Flatfoot diagnostic imaging
- Abstract
Background: The transverse arch (TA) has recently been shown to significantly increase the intrinsic stiffness of the midfoot when coupled with the medial longitudinal arch (MLA). Progressive collapsing foot deformity (PCFD) is a complex deformity that ultimately results in a loss of stiffness and collapse of the MLA. The role of the TA has not been investigated in patients diagnosed with this disorder using weightbearing CT (WBCT). Therefore, this study aims to answer the following questions: (1) Is the curvature of the TA decreased in PCFD? (2) Where within the midfoot does TA curvature flattening happen in PCFD?, Methods: A retrospective review of weightbearing CT images was conducted for 32 PCFD and 32 control feet. The TA curvature was assessed both indirectly using previously described methods and directly using a novel measurement termed the transverse arch plantar (TAP) angle that assesses the angle formed between the first, second, and fifth metatarsals in the coronal plane. Location of TA collapse was also assessed in the coronal plane., Results: The TAP angle was significantly higher in PCFD (mean 115.2 degrees, SD 10.7) than in the control group (mean 100.8 degrees, SD 7.9) ( P < .001). No difference was found using the calculated normalized TA curvature between PCFD (mean 17.1, SD 4.8) and controls (mean 18.3, SD 4.0) ( P = .266). Location of collapse along the TA in PCFD was most significant at the second metatarsal and medial cuneiform., Conclusion: The TA is more collapsed in PCFD compared to controls. This collapse was most substantial between the plantar medial cuneiform and the plantar second metatarsal. This may represent a location of uncoupling of the TA and MLA., Level of Evidence: Level III, retrospective case control., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Francois Lintz, MD, MS, reports grants or contracts; consulting fees; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events; support for attending meetings and/or travel; and stock or stock options from CurveBeam LLC. Cesar de Cesar Netto, MD, PhD, reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events; and stock or stock options from CurveBeam LLC. ICMJE forms for all authors are available online.
- Published
- 2024
- Full Text
- View/download PDF
50. Normal Values for Distal Tibiofibular Syndesmotic Space With and Without Subject-Driven External Rotation Stress.
- Author
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Shamrock A, Den Hartog TJ, Dowley K, Day J, Barbachan Mansur NS, Carvalho KAM, de Cesar Netto C, and O'Malley M
- Subjects
- Male, Humans, Young Adult, Adult, Ankle Joint diagnostic imaging, Reference Values, Cross-Sectional Studies, Prospective Studies, Ligaments, Articular injuries, Ankle Injuries diagnostic imaging, Ankle Injuries surgery, Joint Instability diagnostic imaging, Joint Instability surgery
- Abstract
Background: The diagnosis and treatment of distal tibiofibular syndesmosis (DTFS) injury can be challenging, especially in cases of subtle instability that may be masked on 2-dimensional conventional radiographs. Weightbearing computed tomography (WBCT) has recently emerged as a useful diagnostic tool allowing direct assessment of distal tibiofibular area widening. The purpose of the current study was to examine and report normal threshold values for DTFS area measurements in a cohort of healthy volunteers, assessing the ankles in natural weightbearing position and under subject-driven external rotation stress., Methods: In this prospective study, we enrolled 25 healthy volunteers without a history of DTFS injury or high ankle sprain, previous foot and ankle surgery, or current ankle pain. Subjects with any prior ankle injuries were excluded. Study participants underwent bilateral standing nonstress and external rotation stress WBCT scans. The DTFS area (mm
2 ) was semiautomatically quantified on axial-plane WBCT images 1 cm proximal to the apex of the talar dome using validated software. Syndesmosis area values were compared between "unstressed" and "stressed" ankles, as well as left and right ankles. Statistical analysis was performed using independent t tests/Wilcoxon analysis with statistical significance defined as P <.05., Results: The study cohort consisted of 50 ankles in 25 patients (12 males, 48%) with a mean age of 28.7 ± 9.3 years. In the unstressed ankle, the mean pooled DTFS area was determined to be 103.8 + 20.8 mm2 . The mean syndesmosis area of unstressed left ankles (104.2 + 19.5 mm2 ) was similar to unstressed right ankles (109.2 + 17.2 mm2 ) in the cohort ( P = .117). With external rotation stress, the DTFS area of left ankles (mean difference -0.304 mm2 , CI -12.1 to 11.5; P = .082), right ankles (mean difference -5.5 mm2 , CI 16.7-5.7; P = .132), and all ankles (mean difference -2.9 mm2 , CI -10.8 to 5.1; P = .324) remained similar., Conclusion: This study presents normal values and range for DTFS area calculation. In uninjured ankles with expected intact ligaments, subject-driven external rotation stress did not result in significant widening of the DTFS space as imaged on with WBCT., Level of Evidence: Level II, cross-sectional study., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Cesar de Cesar Netto, MD, PhD, reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events and stock or stock options from CurveBeam. Martin O’Malley, MD, reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events from Curvebeam. ICMJE forms for all authors are available online.- Published
- 2024
- Full Text
- View/download PDF
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