Radiographic Comparison of Open and Minimally Invasive Distal Chevron Metatarsal Osteotomy in Patients With Hallux Valgus.

This study aimed to compare radiographic outcomes of open and minimally invasive surgery (MIS) in patients with hallux valgus. We reviewed data of patients with hallux valgus who underwent open or minimally invasive distal chevron osteotomy at our institution. Radiographic assessment was completed preoperatively, immediate postoperatively, and one year postoperatively using eight weight bearing parameters . The classic distal chevron osteotomy method was used for open surgery and a modified method that added percutaneous K-wire fixation to the minimal invasive Chevron-Akin (third-generation MIS) was used for correction of the distal metatarsal articular angle (DMAA). A total of 65 feet (33 open surgeries and 32 MIS) were included. The HVA, IMA, and DMAA improved significantly following surgery regardless of surgical method (p<0.001). Other radiographic indicators showed no statistically significant differences after surgery. DMAA improved by 71.0±14.2% after surgery, and the open surgery group showed less significant reduction in DMAA (49.7±25.7%, p<0.001). Other parameters showed no difference between the two groups regarding relative postoperative changes. The MIS group showed shorter operation time (p<0.001) and hospitalization period (p=0.034) than did the open surgery group. Therefore, the MIS group is expected to be cost-effective. Radiographic measurements revealed comparable outcomes of MIS compared with open surgery. Additionally, adding percutaneous K-wire fixation during MIS had an advantage in correcting DMAA compared with open surgery. Furthermore, the correction of DMAA could reduce recurrence of valgus deformity of the hallux.

Reliability and validity of a mobile application for femoral anteversion measurement in adult patients.

BACKGROUND: Femoral torsion is primarily measured by computed tomography (CT), which has cost and radiation exposure concerns. Recently, femoral anteversion measurement by a simple radiograph-based mobile application was developed for patients with cerebral palsy. This study aimed to validate the use of a mobile application that can reconstruct a three-dimensional model of the femur from conventional radiographs for adults. METHODS: Medical records of 76 patients undergoing conventional femur anteroposterior/lateral radiography and femur CT were reviewed. To measure femoral anteversion on the reconstructed 3-dimensional images from both the mobile application and CT, we drew a line which connects the posterior margins of each femoral condyle and another line which passes through the center of the femoral head and the midpoint of the femoral neck. After the reliability test, a single examiner measured femoral anteversion on the mobile application and CT. Pearson's correlation analysis was used to assess the correlation between anteversion on the mobile application and CT. RESULTS: Femoral anteversion measured on both CT and the mobile application showed excellent reliability (intraclass correlation coefficients: 0.808-0.910). The correlation coefficient between femoral anteversion measured using CT and the mobile application was 0.933 (p < 0.001). The correlation of femoral anteversion between CT and the mobile application was relatively higher in the absence of metallic implants (correlation coefficient: 0.963, p < 0.001) than in the presence of metallic implants (correlation coefficient: 0.878, p < 0.001). CONCLUSIONS: Using two simple radiographs, the mobile application showed excellent validity and reliability for femoral anteversion measurement in adults as compared to CT. With the high accessibility and cost-effectiveness of this mobile application, femoral torsion measurement might be easily performed with simple radiography in clinical settings in the near future.

Patellofemoral Chondromalacia Does Not Influence Radiographic and Clinical Outcomes following High Tibial Osteotomy.

Effect of patellofemoral (PF) chondromalacia on results of high tibial osteotomy (HTO) has not been identified. Therefore, the objective of the present study was to analyze the effect of PF chondromalacia on relatively short-term radiographic and clinical outcomes of HTO. Patients who underwent open wedge HTO (OWHTO) from February 2010 to January 2015 were enrolled. A total of 101 knees were divided into two groups: 56 knees without PF chondromalacia in group A, while 45 knees with PF chondromalacia extended to subchondral bone in group B. Radiologic outcomes were compared using mechanical tibiofemoral angle, ratio of weight-bearing line (WBL), and minimal joint space width of the lateral compartment. Clinical outcomes were compared using range of motion in affected knee, visual analog scale, modified Lysholm score, and Kujala score. The mean mechanical tibiofemoral angle was 4.6 degree in group A and 4.8 degree in group B. The mean ratio of WBL was 63.8% in group A and 63.6% in group B at final. The mean minimum joint space width of the lateral compartment was 5.8 mm in group A and 5.8 mm in group B on standing AP radiograph. It was 5.3 mm in group A and 5.4 mm in group B on Rosenburg view at final. The mean ROM was 137.2 degree in group A and 137.5 degree in group B. The mean visual analog scale was 2.1 in group A and 2.3 in group B at final. The mean modified Lysholm score was 90.6 in group A and 89.1 in group B at final. The mean Kujala score was 90.2 in group A and 89.1 in group B at final. PF chondromalacia does not influence short-term radiographic and clinical outcomes following OWHTO.

Effects of Glenoid and Humeral Bone Defects on Recurrent Anterior Instability of the Shoulder.

For proper treatment of recurrent anterior instability of the shoulder with a bone defect, the defect size should be assessed preoperatively with three-dimensional computed tomography or magnetic resonance imaging. In general, the risk of postoperative recurrence of instability is estimated on the basis of preoperative imaging of bipolar bone defects: more than 20%-25% glenoid bone loss and off-track Hill-Sachs lesions have been considered risk factors for recurrence. In patients with a glenoid bone defect more than 20%-25%, a bone graft procedure, such as the Latarjet procedure, is preferred regardless of the glenoid track concept, because compared with arthroscopic stabilization procedure, it provides greater postoperative stability. For patients with a borderline glenoid bone defect (around 20%), surgeons should discuss surgical options with the patients, considering their demand and physical activity level. In addition, the surgeon should take care to prevent postoperative instability and long-term complications. Arthroscopic soft-tissue reconstruction including labral repair and capsular plication combined with the additional remplissage procedure is an anatomical procedure and could be considered as one of the primary treatment methods for patients with glenoid bone defects around 20%. Therefore, treatment strategies for recurrent anterior shoulder instability combined with bone defects should be determined more flexibly on the basis of the patient's individual condition.

Minimal Clinically Important Differences and Correlating Factors for the Rowe Score and the American Shoulder and Elbow Surgeons Score After Arthroscopic Stabilization Surgery for Anterior Shoulder Instability.

PURPOSE: To determine the minimal clinically important differences (MCIDs) for the Rowe score and the American Shoulder and Elbow Surgeons (ASES) score after arthroscopic stabilization surgery for anterior shoulder instability and to evaluate the effect of various patient- and treatment-related factors on MCIDs. METHODS: The study enrolled 216 patients who underwent arthroscopic stabilization surgery for anterior shoulder instability. The patients were categorized into "no-change" and "minimal-change" groups by a 15-item questionnaire at the 1-year postoperative visit. The Rowe and ASES scores were assessed preoperatively and at the 1-year postoperative follow-up visit. MCIDs were calculated using an anchor-based method. Correlations between MCIDs and several factors were evaluated using Spearman correlation analysis and univariate regression analysis. RESULTS: On the basis of the questionnaires administered at the 1-year postoperative follow-up visit, 10 patients were assigned to the no-change group and 33 patients were placed in the minimal-change group. MCIDs for the Rowe and ASES scores were 9.7 and 8.5, respectively. Body mass index was negatively correlated with the MCID for the Rowe score (P = .01). Number of dislocations, symptom duration, and presence of Hill-Sachs lesions were positively correlated with the MCID for the ASES score (P = .02, P = .04, and P = .02, respectively). Other variables such as age, sex, and arm dominance were not related to the MCIDs for either the Rowe or ASES score. CONCLUSIONS: In patients who underwent arthroscopic stabilization surgery, differences of at least 9.7 in the Rowe score and 8.5 in the ASES score were clinically relevant. Patients with a greater body mass index required a smaller change in the Rowe score and patients with a greater number of dislocations, a longer symptom duration, or a Hill-Sachs lesion required a larger change in the ASES score to feel clinically relevant changes. LEVEL OF EVIDENCE: Level IV, case series.

Effects of Bone Incorporation After Arthroscopic Stabilization Surgery for Bony Bankart Lesion Based on Preoperative Glenoid Defect Size.

BACKGROUND: Recurrent shoulder instability occurs more frequently after soft tissue surgery when the glenoid defect is greater than 20%. However, for lesions less than 20%, no scientific guidance is available regarding what size of bone fragments may affect shoulder functional restoration after bone incorporation. Purpose/Hypothesis: The purpose was to analyze how preoperative glenoid defect size and bone fragment incorporation alter postoperative clinical outcomes, we compared the functional outcomes of shoulders with and without bony Bankart lesion. It was hypothesized that differences in postoperative clinical outcomes between patients with and without bony fragments would be found only in patients with a larger glenoid defect. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 223 patients who underwent arthroscopic stabilization surgery for recurrent anterior shoulder instability were divided into two groups based on the presence of anterior glenoid bone fragments. In each group, postoperative shoulder functional outcomes, sports activity level, and recurrence rates were evaluated according to preoperative glenoid defect size (small, <10%; medium, 10%-15% and 15%-20%; large, >20%). RESULTS: In patients with small or medium defects, no significant differences were found in postoperative clinical outcomes and sports activity levels between the two groups. However, in patients with a large defect, the patients with bone fragments (mean ± SD American Shoulder and Elbow Surgeons [ASES] score, 92.3 ± 2.7; Rowe score, 90.9 ± 5.4) showed significantly superior clinical outcomes compared with patients who did not have fragments (ASES score, 87.3 ± 6.2, P = .02; Rowe score, 84.8 ± 7.3, P = .04). Among patients without bone fragments, recurrence increased significantly with increasing preoperative glenoid defect size (recurrence rates: 0% in small defects, 7.4% in medium defects, 22.2% in large defects), whereas patients with bone fragments showed no tendency for increasing or decreasing recurrence rates (0% in small defects, 7.9% in medium defects, 5.9% in large defects). CONCLUSION: In the treatment of bony Bankart lesion, the effect of bone fragment incorporation was different according to preoperative glenoid defect size. In patients with preoperative glenoid defects less than 20% of the glenoid width, bone fragment incorporation after arthroscopic bony Bankart repair did not alter clinical outcomes, sports activity levels, or recurrence rates, whereas in patients with defects greater than 20% of the glenoid width, bone fragment incorporation improved clinical outcomes and recurrence rates.

Effect of Metabolic Syndrome on the Functional Outcome of Corticosteroid Injection for Lateral Epicondylitis: Retrospective Matched Case-Control Study.

Both obesity and diabetes mellitus are well-known risk factors for tendinopathies. We retrospectively compared the efficacy of single corticosteroid injections in treating lateral epicondylitis in patients with and without metabolic syndrome (MetS). Fifty-one patients with lateral epicondylitis and MetS were age- and sex-matched with 51 controls without MetS. Pain severity, Disability of the Arm, Shoulder, and Hand score, and grip strength were assessed at base line and at 6, 12 and 24 weeks post-injection. The pain scores in the MetS group were greater than those in the control group at 6 and 12 weeks. The disability scores and grip strength in the MetS group were significantly worse than those of the control group at 6 weeks. However, there were no significant differences at 24 weeks between the groups in terms of pain, disability scores and grip strengths. After 24 weeks, three patients (6%) in the control group and five patients (10%) in the MetS group had surgical decompression (p = 0.46). Patients with MetS are at risk for poor functional outcome after corticosteroid injection for lateral epicondylitis in the short term, but in the long term there was no difference in outcomes of steroid injection in patients with and without MetS.