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  • 1
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    Comparing Symptomatic and Asymptomatic Flatfeet Using Known Markers of Progressive Collapsing Foot Deformity (PCFD): A Case Control Study
    SAGE Publications ; 2023
    In:  Foot & Ankle Orthopaedics Vol. 8, No. 4 ( 2023-10)
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 8, No. 4 ( 2023-10)
    Abstract: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Flattening of the longitudinal arch of the foot (Flatfoot) can represent a normal spectrum of foot morphology and alignment. The issue comes when the foot is collapsing progressively, what is now termed Progressive Collapsing Foot Deformity (PCFD). Literature on asymptomatic flatfoot is scarce since asymptomatic patients do not seek medical attention. Alignment differences between asymptomatic flatfoot and PCFD have not been established and might represent a key-step in understanding predictors of PCFD. The objective of this prospective study was to compare established PCFD measures in a cohort of asymptomatic flatfoot, PCFD patients and healthy controls. We hypothesized that asymptomatic flatfeet alignment would differ from both symptomatic PCFD patients and healthy controls. Methods: In this prospective comparative study, patients with asymptomatic flatfeet were recruited to undergo a weight-bearing CT (WBCT) scan. This cohort (22 feet, 10 males, 12 females) was compared to two other prospective cohorts (22 symptomatic PCFD and 22 healthy controls). Along with demographic data, PCFD measurements performed include Foot and Ankle Offset (FAO), Forefoot Arch Angle (FAA), Middle Facet Uncoverage, and the Transverse Arch Plantar (TAP) angle. Normality of variables was assessed using the Shapiro-Wilk test. Chi-squared or analysis of variance (ANOVA) test was performed to compare each parameter between the three groups. A post-hoc Bonferroni test was then performed to assess significance between each group pairing. P-values of 〉 0.05 were considered significant. Results: All three groups were comparable on BMI (p=0.10), Age (p=0.75) and Gender (p=0.78). All measurements taken differed significantly between the symptomatic PCFD and healthy controls (Table 1). FAO was significantly different between controls vs asymptomatic (p 〈 0.001) and asymptomatic vs symptomatic (p 〈 0.001). FAA was also significantly different between asymptomatic and both symptomatic (p=0.001) and control groups (p=0.001). Middle facet uncoverage differed between the asymptomatic and control group (p=0.001) but the asymptomatic and symptomatic group were similar (p=0.106). While the TAP angle was significantly different between asymptotic and symptomatic groups (p=0.013), the asymptomatic and control groups failed to reach significance (p=0.061) (Table 1). On average, deformity measurements for asymptomatic flatfeet were in between the values for healthy controls and symptomatic PCFD (Figures 1-3). Conclusion: To our knowledge this is the first prospective study to compare healthy controls, asymptomatic flatfoot and symptomatic PCFD patients. We observed that asymptomatic flatfoot patients usually had measurements of PCFD that would fall in between normal alignment asymptomatic controls and symptomatic PCFD patients. Further, the asymptomatic group differed significantly from both other groups on every measure but two. Our data supports the idea that asymptomatic flatfoot should be considered a risk factor for Progressive Collapsing Foot Deformity. Our data can hopefully shine light in finding predictive markers for the development of PCFD.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/2473011423S00136
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2874570-X
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  • 2
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    No Difference in Knee Kinematics Between Anterior Cruciate Ligament–First and Posterior Cruciate Ligament–First Fixation During Single-Stage Multiligament Knee Reconstruction: A Biomechanical Study
    SAGE Publications ; 2022
    In:  Orthopaedic Journal of Sports Medicine Vol. 10, No. 9 ( 2022-09-01), p. 232596712211185-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 10, No. 9 ( 2022-09-01), p. 232596712211185-
    Abstract: For combined reconstruction of both the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL), there is no consensus regarding which graft should be tensioned and fixed first. Purpose: The purpose of this study was to determine which sequence of graft tensioning and fixation better restores normal knee kinematics. The hypothesis was that ACL-first fixation would more closely restore normal knee kinematics, graft force, and the tibiofemoral orientation in the neutral (resting) position compared with PCL-first fixation. Study Design: Controlled laboratory study. Methods: A total of 15 unpaired human cadaveric knees were examined using a robotic testing system under the following 4 conditions: (1) 89.0-N anterior tibial load at different knee angles; (2) 89.0-N posterior tibial load at different knee angles; (3) combined rotational 7.0-N·m valgus and 5.0-N·m internal rotation load (simulated pivot shift) at 0°, 15°, and 30° of flexion; and (4) 5.0-N·m external rotation load at 0°, 15°, and 30° of flexion. The 4 evaluated knee states were (1) intact ACL and PCL (intact), (2) ACL and PCL deficient (deficient), (3) combined anatomic ACL-PCL reconstruction fixing the ACL first (ACL-first), and (4) combined anatomic ACL-PCL reconstruction fixing the PCL first (PCL-first). A 9.0 mm–diameter quadriceps tendon autograft was used for the ACL graft, tensioned with 40.0 N at 30° of flexion. A 9.5 mm–diameter hamstring tendon autograft (gracilis and semitendinosus, quadrupled loop, and augmented with an additional allograft strand if needed), tensioned with 40.0 N at 90° of flexion, was used for the PCL graft. Results: There were no statistically significant differences between ACL-first and PCL-first fixation regarding knee kinematics. ACL-first fixation restored anterior tibial translation to the intact state at all tested knee angles, while PCL-first fixation showed higher anterior tibial translation than the intact state at 90° of flexion (9.05 ± 3.05 and 5.87 ± 2.40 mm, respectively; P = .018). Neither sequence restored posterior tibial translation to the intact state at 30°, 60°, and 90° of flexion. At 15° of flexion, PCL-first fixation restored posterior tibial translation to the intact state, whereas ACL-first fixation did not. Conclusion: There were no differences in knee laxity between ACL-first and PCL-first fixation with the ACL graft fixed at 30° and the PCL graft fixed at 90°. Clinical Relevance: This study showed that there was no evidence to support the use of one tensioning sequence over the other in single-stage multiligament knee reconstruction.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/23259671221118587
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 3
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    Evaluation of Results of Calcaneo-Stop Procedure in Treatment of Pediatric Flexible Flatfoot
    Egypts Presidential Specialized Council for Education and Scientific Research ; 2018
    In:  The Medical Journal of Cairo University Vol. 86, No. March ( 2018-03-01), p. 333-339
    Details
    In: The Medical Journal of Cairo University, Egypts Presidential Specialized Council for Education and Scientific Research, Vol. 86, No. March ( 2018-03-01), p. 333-339
    Type of Medium: Online Resource
    ISSN: 2536-9806
    URL: Article
    DOI: 10.21608/mjcu.2018.55131
    Language: English
    Publisher: Egypts Presidential Specialized Council for Education and Scientific Research
    Publication Date: 2018
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  • 4
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    Foot and Ankle Offset in the Setting of Severe Rotational Foot and Ankle Deformities
    SAGE Publications ; 2023
    In:  Foot & Ankle Orthopaedics Vol. 8, No. 4 ( 2023-10)
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 8, No. 4 ( 2023-10)
    Abstract: Ankle; Hindfoot Introduction/Purpose: Foot and Ankle Offset (FAO) is a clinically relevant measurement technique used to objectively evaluate the foot and ankle that has been shown to be reliable and validated in common mild foot deformities. It represents a measurement of the offset between the body weight vector and the ground reaction force vector, thus making it a biomechanically relevant measurement. However, FAO has not been validated in the setting of severe ankle deformity. The goal of this paper was to evaluate the validity of FAO measurements in the setting of severe foot and ankle deformities by utilizing a novel rotational FAO measurement technique to account for the deformity. Methods: This study included 57 feet (36 patients) that had a history of severe cavovarus deformity. Each participant received a Weightbearing CT (WBCT) scan that was then used to measure FAO. This measurement was taken three times, once using the traditional measurement technique and two additional times using a modified technique with a 15-day washout period between each measurement. This modified technique allowed for alignment of the talus in a neutral position through rotational correction in the axial, coronal, and sagittal planes to identify the most proximal and central point of the talus. Patients were broken into three groups based on the alignment of their foot and ankle. Normal alignment was defined as a FAO of 2.3% ± 2.9%, varus alignment as -11.6% ± 6.9%, and valgus alignment as 11.4% ± 5.7%. The measurements from the different techniques were compared to identify validity between them and the intraobserver reliability was assessed. Results: The mean traditional FAO was 2.37 ± 4.65% (95% CI=1.16–3.59) and modified FAO was 2.51 ± 4.6 (95% CI=1.3–3.71). The mean modified FAO values between the different alignment groups were found to be significantly different (p 〈 .0001). Significant differences were also found when comparing varus to valgus (p 〈 .001), varus to physiologic (p = .002) and valgus to physiologic alignment (p=.002). Traditional FAO and modified FAO measurements were found to have a significant correlation between one another (r(54) = 0.92, p 〈 .001). There was found to be a high positive correlation between the variables of the two techniques (r=0.92) with the intraobserver reliabilities (ICC=0.95) for FAO measurements being excellent. The agreement between traditional FAO and modified FAO measurements was considered excellent as well (ICC=0.99). Conclusion: The Traditional and Modified FAO methods produce significantly similar FAO values even in the setting of severe ankle deformities. Thus, Traditional FAO measures demonstrated the capacity to objectively portray disease progression in not only mild, but also severe forms of ankle deformities, despite the unique and severe physiological contortions of the foot and ankle in these patients. Therefore, the Traditional FAO measurement method could potentially be used to provide a more detailed depiction of the misalignment in the foot and ankle, and providers could more accurately treat these patients and potentially supply them with better outcomes.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/2473011423S00155
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2874570-X
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  • 5
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    Augmenting ACL Repair With Suture Tape Improves Knee Laxity: A Biomechanical Study
    SAGE Publications ; 2023
    In:  Orthopaedic Journal of Sports Medicine Vol. 11, No. 4 ( 2023-04-01), p. 232596712211460-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 11, No. 4 ( 2023-04-01), p. 232596712211460-
    Abstract: Anterior cruciate ligament (ACL) repair is an alternative to reconstruction; however, suture tape support may be necessary to achieve adequate outcomes. Purposes: To investigate the influence of suture tape augmentation (STA) of proximal ACL repair on knee kinematics and to evaluate the effect of the 2 flexion angles of suture tape fixation. Study Design: Controlled laboratory study. Methods: Fourteen cadaveric knees were tested using a 6 degrees of freedom robotic testing system under anterior tibial (AT) load, simulated pivot-shift (PS) load, and internal rotation (IR) and external rotation loads. Kinematics and in situ tissue forces were evaluated. Knee states tested were (1) ACL intact, (2) ACL cut, (3) ACL repair with suture only, (4) ACL repair with STA fixed at 0° of knee flexion, and (5) ACL repair with STA fixed at 20° of knee flexion. Results: ACL repair alone did not restore the intact ACL AT translation at 0°, 15°, 30°, or 60° of flexion. Adding suture tape to the repair significantly decreased AT translation at 0°, 15°, and 30° of knee flexion but not to the level of the intact ACL. With PS and IR loadings, only ACL repair with STA fixed at 20° of flexion was not significantly different from the intact state at all knee flexion angles. ACL suture repair had significantly lower in situ forces than the intact ACL with AT, PS, and IR loadings. With AT, PS, and IR loadings, adding suture tape significantly increased the in situ force in the repaired ACL at all knee flexion angles to become closer to that of the intact ACL state. Conclusion: For complete proximal ACL tears, suture repair alone did not restore normal knee laxity or normal ACL in situ force. However, adding suture tape to augment the repair resulted in knee laxity closer to that of the intact ACL. STA with fixation at 20° of knee flexion was superior to fixation with the knee in full extension. Clinical Relevance: The study findings suggest that ACL repair with STA fixed at 20° could be considered in the treatment of femoral sided ACL tears in the appropriate patient population.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/23259671221146013
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 6
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    Deformities Influencing Different Classes in Progressive Collapsing Foot
    SAGE Publications ; 2023
    In:  Foot & Ankle Orthopaedics Vol. 8, No. 4 ( 2023-10)
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 8, No. 4 ( 2023-10)
    Abstract: Midfoot/Forefoot; Hindfoot Introduction/Purpose: The current classification system of progressive collapsing foot deformity (PCFD) is comprised of 5 possible classes. PCFD is understood to be a complex, three-dimensional deformity occurring in many regions along the foot and ankle. The question remains whether a deformity in one area impacts other areas. The objective of this study is to assess how each one of the classes is influenced by other classes by evaluating each associated angular measurement. We hypothesized that positive and linear correlations would occur for each class with at least one other class and that this influence would be high. Methods: We retrospectively assessed weight-bearing computed tomography (WBCT) measurements of 32 feet with PCFD diagnosis. The classes and their associated radiographic measurements were defined as follows: class A (hindfoot valgus) measured by the hindfoot moment arm (HMA), class B (midfoot abduction) measured by the talonavicular coverage angle (TNCA), class C (medial column instability) measured by Meary’s angle, class D (peritalar subluxation) measured by the medial facet uncoverage (MFU), and class E (ankle valgus) measured using the talar tilt angle (TTA). Multivariate analyses were completed comparing each class measurement to the other classes. A p-value 〈 0.05 was considered significant. Results: Class A showed a substantial positive correlation with class C (ρ=0.71; R2=0.576; p 0.001). Class B was substantially correlated with class D (ρ=0.74; R2=0.613; p 0.001). Class C showed a substantial positive correlation with class A (ρ=0.71; R2=0.576; p 0.001) and class D (ρ=0.75; R2=0.559; p 0.001). Class D showed a substantial positive correlation with class B and class C (ρ=0.74; R2=0.613; p 0.001), (ρ=0.75; R2=0.559; p 0.001) respectively. Class E did not show correlation with class B, C, or D (ρ=0.24; R2=0.074; p=0.059), (ρ=0.17; R2=0.071; p=0.179), and (ρ=0.22; R2=0.022; p=0.082) respectively. The average values of each class radiographic markers are listed in Figure 1. Conclusion: This study was able to find relations between components of PCFD deformity with exception of ankle valgus deformity (Class E). Measurements associated with each class were influenced by others, and in some instances, with pronounced strength such as between class A and C as well as between Class B and D. Surgical procedures to address certain class deformities could indirectly address other classes as well, which ultimately decreases surgical procedures numbers or complexity. The presented data may support the notion that PCFD is a three-dimensional complex deformity and suggests a possible relation among its ostensibly independent features.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/2473011423S00141
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2874570-X
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  • 7
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    Clinical studies of single-stage combined ACL and PCL reconstruction variably report graft tensioning, fixation sequence, and knee flexion angle at time of fixation
    Springer Science and Business Media LLC ; 2021
    In:  Knee Surgery, Sports Traumatology, Arthroscopy Vol. 29, No. 4 ( 2021-04), p. 1238-1250
    Details
    In: Knee Surgery, Sports Traumatology, Arthroscopy, Springer Science and Business Media LLC, Vol. 29, No. 4 ( 2021-04), p. 1238-1250
    Type of Medium: Online Resource
    ISSN: 0942-2056 , 1433-7347
    URL: Article
    DOI: 10.1007/s00167-020-06171-6
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 1473170-8
    SSG: 31
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  • 8
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    Artificial intelligence and ChatGPT in Orthopaedics and sports medicine
    Springer Science and Business Media LLC ; 2023
    In:  Journal of Experimental Orthopaedics Vol. 10, No. 1 ( 2023-07-26)
    Details
    In: Journal of Experimental Orthopaedics, Springer Science and Business Media LLC, Vol. 10, No. 1 ( 2023-07-26)
    Abstract: Artificial intelligence (AI) is looked upon nowadays as the potential major catalyst for the fourth industrial revolution. In the last decade, AI use in Orthopaedics increased approximately tenfold. Artificial intelligence helps with tracking activities, evaluating diagnostic images, predicting injury risk, and several other uses. Chat Generated Pre-trained Transformer (ChatGPT), which is an AI-chatbot, represents an extremely controversial topic in the academic community. The aim of this review article is to simplify the concept of AI and study the extent of AI use in Orthopaedics and sports medicine literature. Additionally, the article will also evaluate the role of ChatGPT in scientific research and publications. Level of evidence : Level V, letter to review.
    Type of Medium: Online Resource
    ISSN: 2197-1153
    URL: Article
    DOI: 10.1186/s40634-023-00642-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2780021-0
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  • 9
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    Gaussian beam scintillation index for slant path in weak turbulence: closed form expressions
    Springer Science and Business Media LLC ; 2019
    In:  Optical and Quantum Electronics Vol. 51, No. 4 ( 2019-4)
    Details
    In: Optical and Quantum Electronics, Springer Science and Business Media LLC, Vol. 51, No. 4 ( 2019-4)
    Type of Medium: Online Resource
    ISSN: 0306-8919 , 1572-817X
    URL: Article
    DOI: 10.1007/s11082-019-1810-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 2000642-1
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  • 10
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    Plane wave scintillation index in slant path atmospheric turbulence: closed form expressions for uplink and downlink
    Springer Science and Business Media LLC ; 2020
    In:  Optical and Quantum Electronics Vol. 52, No. 7 ( 2020-07)
    Details
    In: Optical and Quantum Electronics, Springer Science and Business Media LLC, Vol. 52, No. 7 ( 2020-07)
    Type of Medium: Online Resource
    ISSN: 0306-8919 , 1572-817X
    URL: Article
    DOI: 10.1007/s11082-020-02463-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2000642-1
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