Retrospective chart review: Weightbearing CT scans and the measurement of the Lisfranc ligamentous complex.

BACKGROUND: Lisfranc Ligamentous Complex (LLC) injuries are commonly misdiagnosed due to their unreliable projection on plain films. Weightbearing CT (WBCT) scans are a relatively new imaging modality that has not yet been utilized to establish widely referenced baseline anatomic positions. METHODS: A retrospective chart review was conducted of patients who had undergone weightbearing CT of the bilateral lower extremities with one-hundred and twelve being included (56 patients). Measurements of the Lisfranc joint were collected by two independent reviewers. Uninjured symmetric anatomy was used to describe a baseline for normal anatomic variation and to evaluate for sex-based or age-related differences. These measurements were then compared against the injured side. RESULTS: In patients without Lisfranc injury, the 1st metatarsal base to 2nd metatarsal base distance (Base M1-M2) was 2.7 + /- 0.7 mm; 2nd metatarsal base to medial cuneiform (M2-C1) was 3.7 + /- 0.7 mm; intercuneiform distance was 1.2 + /- 0.3 mm; and sagittal descent 12.2 + /- 5.4 mm. Patients with injury to LLC had a larger M1-M2 base distance (Δ = 0.5903, p < 0.0001) and M2-C1 interval (Δ = 1.8008, p < 0.0001) compared to uninjured side. Males had significantly higher M2-C1 (p = 0.0031), intercuneiform distance (p = 0.0039), and sagittal descent (p = 0.0008) compared to female patients. No significant differences were found between left versus right side in any of the measurements. Intercuneiform distance (p = 0.0039) was found to significantly decrease as age increased, while sagittal descent significantly increased with increased age (p = 0.0066). CONCLUSION: Weightbearing CT has high utility in identification of Lisfranc injuries particularly when comparing injured and uninjured sides, which may be its greatest utility in defining injuries. This is evident in the excellent diagnostic ability of the M2-C1 measurement. By defining baseline anatomic measurements for Lisfranc complex parameters in our patient population, we provide normal parameters for comparison when evaluating potential subtle injuries. LEVEL OF EVIDENCE: III.

Sex-Based Differences in Outcomes After Hip Arthroscopic Surgery for Femoroacetabular Impingement: A Systematic Review.

Background: While sex-based differences in outcomes after hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) are often recorded, no studies have been dedicated to analyzing the literature as a whole. Purpose: To investigate whether sex is a predictor of outcomes in studies evaluating hip arthroscopic surgery for FAIS. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched the PubMed, Embase, Cochrane, Ovid, and PubMed Central databases for English-language studies that evaluated sex-specific outcomes in human populations. The search terms used were as follows: ("Hip Arthroscopy") AND ("Femoroacetabular Impingement" OR "FAI") AND ("Sex" OR "Gender" OR "Male" OR "Female"). Studies with evidence levels 2 through 4 were included. The studies were then screened, followed by data extraction. Modified Harris Hip Score (mHHS) outcomes and return-to-sport (RTS) rates were recorded. These were analyzed using random-effects meta-analysis. Heterogeneity was calculated using the I 2 statistic. Results: Of 256 full-text articles screened, 48 articles were included in this analysis; of these, 14 studies (29%) concluded that female sex was a negative predictor of postoperative outcomes, while 6 studies (13%) found female sex to be positive predictor. The remaining 28 studies (58%) found no sex-based differences in postoperative outcomes. Of 7 studies (416 male and 519 female) included in the mHHS analysis, 2 studies concluded that male patients had significantly higher postoperative mHHS scores. Of 6 studies (502 male and 396 female) included in the RTS analysis, 1 study concluded that male patients had a significantly higher RTS rate. Conclusion: Almost one-third of the included studies determined that female sex was a negative predictor of postoperative outcomes, 13% found female sex to be a positive predictor, and 58% found no sex-based differences. Our study illustrates an insufficiency of high-level evidence supporting sex-specific differences in outcomes after hip arthroscopic surgery, but findings indicated that the postoperative mHHS score and RTS rate may be influenced by sex.

Publicly Accessible Rehabilitation Protocols for Acromioclavicular Joint Reconstruction Are Widely Variable.

PURPOSE: The purpose of this study was to assess the availability and variability of publicly accessible acromioclavicular (AC) joint reconstruction rehabilitation protocols. METHODS: Protocols were identified by searching the websites of orthopedic surgery residency programs in the United States located from the Fellowship and Residency Electronic Interactive Database Access System. Private practice groups with publicly available protocols were also included. RESULTS: Twenty-one protocols were included for review. Four of 14 (29%) protocols suggested starting passive range of motion (ROM) at postoperative week 2. Six of 20 (30%) protocols recommended initiation of full ROM at 6 weeks. Active ROM beginning at 6 weeks was recommended by 6 of 20 (30%) protocols. Six of 16 (38%) protocols recommended initiating active assisted ROM at 6 weeks. Sling immobilization for 6 weeks was recommended by 8 of 18 (44%) protocols. Shoulder isometric exercise initiated at 4 weeks was recommended by 4 of 13 (31%) protocols. Seven of 21 (33%) protocols recommended initiating shoulder strengthening at 12 weeks postoperatively. Return to sport time was included in 17 (81%) protocols with a range of 12 to 48 weeks (mean, 22 weeks). CONCLUSIONS: There was substantial variability in publicly accessible AC joint rehabilitation protocols, including a wide range in the recommendations for appropriate time to return to sport. Although strengthening exercises, active ROM, and active assisted ROM were recommended by most protocols, there were considerable differences in recommendations for when to initiate these rehabilitation components. CLINICAL RELEVANCE: Rehabilitation is important for outcomes of AC joint reconstruction. This study shows the variability present in rehabilitation recommendations among online-accessible AC joint reconstruction rehabilitation protocols.

Initial Response of Mature, Experienced Runners to Barefoot Running: Transition to Forefoot Strike.

INTRODUCTION: Forefoot strike has been advocated for many runners because of the relatively lower impact and push-off forces compared to a heel strike. The purpose of this study was to explore the ability of mature (> 30 years old), experienced runners to transition from a heel foot strike to a forefoot strike when first introduced to barefoot running on a treadmill. We hypothesized: 1) mature runners who heel strike while wearing traditional training shoes would persist in heel striking immediately following a switch to barefoot, 2) mean shoe heel-to-toe drop would be significantly greater in runners who persist in heel striking when running barefoot compared to those who transition to a forefoot strike pattern, and 3) there would be a significant decrease in heel striking in the barefoot condition as running speeds increased. METHODS: This was a controlled crossover laboratory study. Thirty-three experienced runners (average 23.4 miles per week) with an average age of 45.6 years were recruited for this study. The participants first ran in their standard running shoes and subsequently barefoot. A motion capture system was utilized to detect and analyze any transition from heel strike to forefoot strike made by study participants. RESULTS: Of the 26 participants who were classified as heel strike runners in their running shoes, 50% (13/26, p = 0.001) transitioned to forefoot strike when changing from running in shoes to running barefoot. CONCLUSIONS: The injuries associated with transition from standard running shoes to barefoot running or minimalist shoes may be influenced by the persistence of heel striking in mature runners. Older experienced runners may have limited ability to transition from heel to forefoot striking when first introduced to barefoot running. Mature runners should be cautious when beginning a minimalist shoe or barefoot running regimen.