Quality Assessment of Modern Total Ankle Arthroplasty Clinical Outcomes Research.

Research demonstrating improved outcomes with third-generation ankle replacement implants has resulted in increasing utilization of total ankle arthroplasty over the past 3 decades. The purpose of this study was to examine the quality and trends of clinical outcomes research being published on third-generation total ankle arthroplasty implants. Two fellowship-trained foot and ankle surgeons reviewed all peer-reviewed, Medline-indexed English-language clinical outcomes studies evaluating total ankle arthroplasty published between 2006 and 2019. Articles were assessed for study design and indicators of study quality. A total of 694 published articles were reviewed and 231 met all inclusion criteria. The majority (78%) of studies were retrospective, most of which were case series (54%) or cohorts (32%). Ten percent (10%) of studies were funded by industry and 28% did not disclose funding sources. Thirty-eight percent (38%) of studies reported a conflict of interest and 6% did not disclose whether or not there were conflicts. The average patient follow-up time across studies was 72 months. We found that although the study of outcomes with third-generation total ankle arthroplasty prostheses is steadily increasing, most studies are Level IV, retrospective case series. Some studies have disclosed industry funding and/or a conflict of interest, and a considerable number did not disclose potential funding and/or financial conflicts. Future investigators should strive to design studies with the highest quality methodology possible.

Treatment of Metatarsalgia with Proximal Osteotomies.

Metatarsalgia is among the most common sources of forefoot pain. Proximal metatarsal osteotomies are an important technique in the armamentarium of the surgeon treating metatarsalgia that has failed nonoperative management. Proximal osteotomies can provide powerful deformity correction with precise control to both shorten and elevate the metatarsal head. However, they can be technically challenging, difficult to attain satisfactory fixation, require increased postoperative immobilization, and can result in transfer lesions. There are numerous described techniques with little supporting evidence and more research is needed to establish the optimal procedure to reliably alleviate patient's symptoms while minimizing complications.

The effect of strain and age on the mechanical properties of rat Achilles tendons.

BACKGROUND: Achilles tendon (AT) ruptures are common in the middle age population; however, the pathophysiology and influence of age on AT ruptures is not fully understood. This study evaluates the effect and interactions between, strain and age on the in vitro biomechanical properties of ATs. METHODS: Bilateral ATs were harvested from 17 young (8 months) and 14 middle-aged (24 months) rats and underwent stress-relaxation using Fung's quasilinear viscoelastic (QLV) modeling and load-to-failure testing. RESULTS: The initial viscoelastic response (parameter B) in middle-age animals was dependent on the amount of strain applied to the tendon and was significantly increased in middle-aged animals at higher strain. Higher strain in older animals led to a prolonged relaxation time (parameter tau 2). There was a trend toward an increased magnitude of the relaxation response (parameter C) at higher strain in the middle-aged animals. Middle-aged animals had a significantly lower mean stress at ultimate failure (p=0.01), while Young's modulus was similar in both groups (p=0.46). CONCLUSIONS: The passive biomechanical properties of the rat AT change with age and the influence stress-relaxation response of the AT, thereby possibly predisposing the AT of older animals to fail at lower loads compared to younger animals. LEVEL OF EVIDENCE: Not applicable, this is a basic science study.