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Paediatric ankle cartilage lesions: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle
Hurley, Daire J; Davey, Martin S; Hurley, Eoghan T; Murawski, Christopher D; Calder, James D F; D'Hooghe, Pieter; van Bergen, Christiaan J A; Walls, Raymond J; Ali, Zakariya; Altink, J Nienke; Batista, Jorge; Bayer, Steve; Berlet, Gregory C; Buda, Roberto; Dahmen, Jari; DiGiovanni, Christopher W; Ferkel, Richard D; Gianakos, Arianna L; Giza, Eric; Glazebrook, Mark; Guillo, Stéphane; Hangody, Laszlo; Haverkamp, Daniel; Hintermann, Beat; Hogan, MaCalus V; Hua, Yinghui; Hunt, Kenneth; Jamal, M Shazil; Karlsson, Jón; Kearns, Stephen; Kerkhoffs, Gino M M J; Lambers, Kaj; Lee, Jin Woo; McCollum, Graham; Mercer, Nathaniel P; Mulvin, Conor; Nunley, James A; Paul, Jochen; Pearce, Christopher; Pereira, Helder; Prado, Marcelo; Raikin, Steven M; Savage-Elliott, Ian; Schon, Lew C; Shimozono, Yoshiharu; Stone, James W; Stufkens, Sjoerd A S; Sullivan, Martin; Takao, Masato; Thermann, Hajo; Thordarson, David; Toale, James; Valderrabano, Victor; Vannini, Francesca; van Dijk, C Niek; Walther, Markus; Yasui, Youichi; Younger, Alastair S; Kennedy, John G
BACKGROUND:The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Pediatric Ankle Cartilage Lesions" developed at the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS:Forty-three international experts in cartilage repair of the ankle representing 20 countries convened to participate in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within four working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterised as follows: consensus: 51-74%; strong consensus: 75-99%; unanimous: 100%. RESULTS:A total of 12 statements on paediatric ankle cartilage lesions reached consensus during the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. Five achieved unanimous support, and seven reached strong consensus (>75% agreement). All statements reached at least 84% agreement. CONCLUSIONS:This international consensus derived from leaders in the field will assist clinicians with the management of paediatric ankle cartilage lesions.
PMID: 35774008
ISSN: 2059-7762
CID: 5295002
Clinical Outcomes After Suture Tape Augmentation for Ankle Instability: A Systematic Review
Mercer, Nathaniel P; Kanakamedala, Ajay C; Azam, Mohammad T; Hurley, Eoghan T; Samsonov, Alan P; Walls, Raymond J; Kennedy, John G
Background/UNASSIGNED:There is minimal literature on the use of suture tape augmentation in the treatment of chronic lateral ankle instability (CLAI), prompting an investigation on its use and effect during surgery of the lateral ankle. Purpose/UNASSIGNED:To evaluate the evidence for the use of suture tape augmentation in the treatment of CLAI and the outcomes after this procedure. Study Design/UNASSIGNED:Systematic review; Level of evidence, 4. Methods/UNASSIGNED:A literature search was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they evaluated the use of suture tape for CLAI. Outcome measures included the Foot and Ankle Ability Measure, American Orthopaedic Foot and Ankle Society (AOFAS) score, return to play, and radiological improvement in anterior talar translation and talar tilt angle. Quantitative and qualitative analyses were performed. Results/UNASSIGNED:= .77). Conclusion/UNASSIGNED:Suture tape augmentation did not significantly improve clinical or radiological outcomes in the setting of modified Broström repair for CLAI. There is currently insufficient evidence to recommend suture tape augmentation for all patients at this time.
PMCID:9134450
PMID: 35647213
ISSN: 2325-9671
CID: 5283502
Terminology for osteochondral lesions of the ankle: proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle
Murawski, Christopher D; Jamal, M Shazil; Hurley, Eoghan T; Buda, Roberto; Hunt, Kenneth; McCollum, Graham; Paul, Jochen; Vannini, Francesca; Walther, Markus; Yasui, Youichi; Ali, Zakariya; Altink, J Nienke; Batista, Jorge; Bayer, Steve; Berlet, Gregory C; Calder, James D F; Dahmen, Jari; Davey, Martin S; D'Hooghe, Pieter; DiGiovanni, Christopher W; Ferkel, Richard D; Gianakos, Arianna L; Giza, Eric; Glazebrook, Mark; Hangody, Laszlo; Haverkamp, Daniel; Hintermann, Beat; Hua, Yinghui; Hurley, Daire J; Karlsson, Jón; Kearns, Stephen; Kennedy, John G; Kerkhoffs, Gino M M J; Lambers, Kaj; Lee, Jin Woo; Mercer, Nathaniel P; Mulvin, Conor; Nunley, James A; Pearce, Christopher; Pereira, Helder; Prado, Marcelo; Raikin, Steven M; Savage-Elliott, Ian; Schon, Lew C; Shimozono, Yoshiharu; Stone, James W; Stufkens, Sjoerd A S; Sullivan, Martin; Takao, Masato; Thermann, Hajo; Thordarson, David; Toale, James; Valderrabano, Victor; van Bergen, Christiaan J A; van Dijk, C Niek; Walls, Raymond J; Younger, Alastair S; Hogan, MaCalus V
BACKGROUND:The evidence supporting best practice guidelines in the field of cartilage repair of the ankle is based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "terminology for osteochondral lesions of the ankle" developed at the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS:Forty-three international experts in cartilage repair of the ankle representing 20 countries were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within four working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed, and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed on in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterised as follows: consensus, 51%-74%; strong consensus, 75%-99%; unanimous, 100%. RESULTS:A total of 11 statements on terminology and classification reached consensus during the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. Definitions are provided for osseous, chondral and osteochondral lesions, as well as bone marrow stimulation and injury chronicity, among others. An osteochondral lesion of the talus can be abbreviated as OLT. CONCLUSIONS:This international consensus derived from leaders in the field will assist clinicians with the appropriate terminology for osteochondral lesions of the ankle.
PMID: 35546437
ISSN: 2059-7762
CID: 5214552
Osteochondral Lesions of the Tibial Plafond and Ankle Instability With Ankle Cartilage Lesions: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle
Dahmen, Jari; Bayer, Steve; Toale, James; Mulvin, Conor; Hurley, Eoghan T; Batista, Jorge; Berlet, Gregory C; DiGiovanni, Christopher W; Ferkel, Richard D; Hua, Yinghui; Kearns, Stephen; Lee, Jin Woo; Pearce, Christopher J; Pereira, Hèlder; Prado, Marcelo P; Raikin, Steven M; Schon, Lew C; Stone, James W; Sullivan, Martin; Takao, Masato; Valderrabano, Victor; van Dijk, C Niek; Ali, Zakariya; Altink, J Nienke; Buda, Roberto; Calder, James D F; Davey, Martin S; D'Hooghe, Pieter; Gianakos, Arianna L; Giza, Eric; Glazebrook, Mark; Hangody, Laszlo; Haverkamp, Daniel; Hintermann, Beat; Hogan, MaCalus V; Hunt, Kenneth J; Hurley, Daire J; Jamal, M Shazil; Karlsson, Jón; Kennedy, John G; Kerkhoffs, Gino M M J; Lambers, Kaj T A; McCollum, Graham; Mercer, Nathaniel P; Nunley, James A; Paul, Jochen; Savage-Elliott, Ian; Shimozono, Yoshiharu; Stufkens, Sjoerd A S; Thermann, Hajo; Thordarson, David; Vannini, Francesca; van Bergen, Christiaan J A; Walls, Raymond J; Walther, Markus; Yasui, Youichi; Younger, Alastair S E; Murawski, Christopher D
BACKGROUND:An international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to present the consensus statements on osteochondral lesions of the tibial plafond (OLTP) and on ankle instability with ankle cartilage lesions developed at the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. METHODS:Forty-three experts in cartilage repair of the ankle were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 4 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed on in unanimous fashion within the working groups. A final vote was then held. RESULTS:A total of 11 statements on OLTP reached consensus. Four achieved unanimous support and 7 reached strong consensus (greater than 75% agreement). A total of 8 statements on ankle instability with ankle cartilage lesions reached consensus during the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. One achieved unanimous support, and seven reached strong consensus (greater than 75% agreement). CONCLUSION:These consensus statements may assist clinicians in the management of these difficult clinical pathologies. LEVEL OF EVIDENCE:Level V, mechanism-based reasoning.
PMID: 34983250
ISSN: 1944-7876
CID: 5294962
Paul W. Lapidus: The Father of Foot and Ankle Surgery
Dankert, John F; Kirby, David J; Kennedy, John G; Walls, Raymond
Paul W. Lapidus' work has formed the foundation of modern foot and ankle surgery. Variations of his popularizedtechnique, the Lapidus procedure, remain in regular usetoday for the management and correction of hallux valgus.We revisit Dr. Lapidus' career and accomplishments withan emphasis on his importance to the expanding divisionof foot and ankle surgery at the Hospital for Joint Diseases.
PMID: 34842515
ISSN: 2328-5273
CID: 5152282
Orthopaedic Foot and Ankle Surgeon Industry Compensation Reported by the Open Payments Database
Pathak, Neil; Galivanche, Anoop R; Lukasiewicz, Adam M; Mets, Elbert J; Mercier, Michael R; Bovonratwet, Patawut; Walls, Raymond J; Grauer, Jonathan N
Background. The current study aims to characterize and explore trends in Open Payments Database (OPD) payments reported to orthopaedic foot and ankle (F&A) surgeons. OPD payments are classified as General, Ownership, or Research. Methods. General, Ownership, and Research payments to orthopaedic F&A surgeons were characterized by total payment sum and number of transactions. The total payment was compared by category. Payments per surgeon were also assessed. Median payments for all orthopaedic F&A surgeons and the top 5% compensated were calculated and compared across the years. Medians were compared through Mann-Whitney U tests. Results. Over the period, industry paid over $39 million through 29,442 transactions to 802 orthopaedic F&A surgeons. The majority of this payment was General (64%), followed by Ownership (34%) and Research (2%). The median annual payments per orthopaedic F&A surgeon were compared to the 2014 median ($616): 2015 ($505; P = .191), 2016 ($868; P = .088), and 2017 ($336; P = .084). Over these years, the annual number of compensated orthopaedic F&A surgeons increased from 490 to 556. Averaged over 4 years, 91% of the total orthopaedic F&A payment was made to the top 5% of orthopaedic F&A surgeons. The median payment for this group increased from $177 000 (2014) to $192 000 (2017; P = .012). Conclusion. Though median payments to the top 5% of orthopaedic F&A surgeons increased, there was no overall change in median payment over four years for all compensated orthopaedic F&A surgeons. These findings shed insight into the orthopaedic F&A surgeon-industry relationship. Levels of Evidence:III, Retrospective Study.
PMID: 32059613
ISSN: 1938-7636
CID: 4684862
Survey of Patient Insurance Status on Access to Specialty Foot and Ankle Care Under the Affordable Care Act
Kim, Chang-Yeon; Wiznia, Daniel H; Roth, Alexander S; Walls, Raymond J; Pelker, Richard R
BACKGROUND: The purpose of this study was to assess the effect of insurance type (Medicaid, Medicare, and private insurance) on access to foot and ankle surgeons for total ankle arthroplasty. METHODS: We called 240 foot and ankle surgeons who performed total ankle arthroplasty in 8 representative states (California, Massachusetts, Ohio, New York, Florida, Georgia, Texas, and North Carolina). The caller requested an appointment for a fictitious patient to be evaluated for a total ankle arthroplasty. Each office was called 3 times to assess the responses for Medicaid, Medicare, and BlueCross. From each call, we recorded appointment success or failure and any barriers to an appointment, such as need for a referral. RESULTS: Patients with Medicaid were less likely to receive an appointment compared to patients with Medicare (19.8% vs 92.0%, P < .0001) or BlueCross (19.8% vs 90.4%, P < .0001) and experienced more requests for referrals compared to patients with Medicare (41.9% vs 1.6%, P < .0001) or BlueCross (41.9% vs 4%, P < .0001). Waiting periods were longer for patients with Medicaid compared to those with Medicare (22.6 days vs 11.7 days, P = .004) or BlueCross (22.6 days vs 10.7 days, P = .001). Reimbursement rates did not correlate with appointment success rate or waiting period. CONCLUSION: Despite the passage of the PPACA, patients with Medicaid continue to have difficulty finding a surgeon who will provide care, increased need for a primary care referral, and longer waiting periods for appointments. LEVEL OF EVIDENCE: Level II, prognostic study.
PMID: 27026727
ISSN: 1944-7876
CID: 2693912
Total knee replacement under tourniquet control: A prospective study of the peripheral arterial vasculature using colour-assisted duplex ultrasonography
Walls, Raymond J; O'Malley, Judi; O'Flanagan, Seamus J; Kenny, Paddy J; Leahy, Austin L; Keogh, Peter
BACKGROUND AND PURPOSE/OBJECTIVE:A tourniquet may potentiate rare and devastating arterial complications after total knee replacement (TKR) in patients with peripheral vascular disease (PVD). Most prior studies that evaluated peripheral arterial blood flow primarily used the ankle-brachial index (ABI). METHODS:We assessed the prevalence and risk factors for PVD in a cohort undergoing TKR. Clinical and radiological evaluations, including duplex ultrasonography, were performed one week prior to, and six weeks post-TKR performed under tourniquet control. Forty patients were analysed (20 male, 20 female; mean age 67 yrs, range: 53-80 yrs). MAIN FINDINGS/RESULTS:Hypertension (50%) and hypercholesterolaemia (50%) were the most common co-morbidities. Distal pulses were present in all patients preoperatively. Six patients (15%) had arterial calcification on their preoperative knee X-rays. Three patients (7.5%) had moderate PVD. There was no change in blood flow postoperatively in patients with or without PVD (p > 0.05). Vascular stenosis was less than 50% in all patients preoperatively and postoperatively. No postoperative vascular complications occurred. CONCLUSIONS:Severe PVD is not common in patients undergoing TKR. Performing total knee replacement under tourniquet control does not adversely affect the vasculature in patients with less than 50% vascular occlusion.
PMID: 25449170
ISSN: 1479-666x
CID: 4684842
Effects of home-based resistance training and neuromuscular electrical stimulation in knee osteoarthritis: a randomized controlled trial
Bruce-Brand, Robert A; Walls, Raymond J; Ong, Joshua C; Emerson, Barry S; O'Byrne, John M; Moyna, Niall M
BACKGROUND:Quadriceps femoris muscle (QFM) weakness is a feature of knee osteoarthritis (OA) and exercise programs that strengthen this muscle group can improve function, disability and pain. Traditional supervised resistance exercise is however resource intensive and dependent on good adherence which can be challenging to achieve in patients with significant knee OA. Because of the limitations of traditional exercise programs, interest has been shown in the use of neuromuscular electrical stimulation (NMES) to strengthen the QFM. We conducted a single-blind, prospective randomized controlled study to compare the effects of home-based resistance training (RT) and NMES on patients with moderate to severe knee OA. METHODS:41 patients aged 55 to 75 years were randomised to 6 week programs of RT, NMES or a control group receiving standard care. The primary outcome was functional capacity measured using a walk test, stair climb test and chair rise test. Additional outcomes were self-reported disability, quadriceps strength and cross-sectional area. Outcomes were assessed pre- and post-intervention and at 6 weeks post-intervention (weeks 1, 8 and 14 respectively). RESULTS:There were similar, significant improvements in functional capacity for the RT and NMES groups at week 8 compared to week 1 (p ≤ 0.001) and compared to the control group (p < 0.005), and the improvements were maintained at week 14 (p ≤ 0.001). Cross sectional area of the QFM increased in both training groups (NMES: +5.4%; RT: +4.3%; p = 0.404). Adherence was 91% and 83% in the NMES and RT groups respectively (p = 0.324). CONCLUSIONS:Home-based NMES is an acceptable alternative to exercise therapy in the management of knee OA, producing similar improvements in functional capacity. TRIAL REGISTRATION/BACKGROUND:Current Controlled Trials ISRCTN85231954.
PMCID:3493368
PMID: 22759883
ISSN: 1471-2474
CID: 4684822
The role of pre-operative assessment and ringfencing of services in the control of methicillin resistant Staphlococcus aureus infection in orthopaedic patients
Kelly, J C; O'Briain, D E; Walls, R; Lee, S I; O'Rourke, A; Mc Cabe, J P
BACKGROUND:MRSA is a major economic and health issue internationally and as such is of particular importance in the appropriate management of orthopaedic patients. Bone, joint and implant infection can lead to unfavourable outcomes with a long protracted in hospital stay inevitable. The cost for the patient, the hospital and society are substantial. MATERIALS AND METHODS/METHODS:This study was a review of a prospectively maintained database from our unit over three time points from 2005 to 2007. At each time point a new infection control measure was implemented in an effort to reduce MRSA infections. Total rates of MRSA infection and colonisation in all orthopaedic patients were recorded, before and after separation of trauma and elective services, and after the introduction of a screening pre assessment clinic. RESULTS:12259 orthopaedic patients were reviewed over the three years. The mean age of MRSA infected patients was 71. A higher proportion of female patients were infected than male patients. The mean length of stay for infected patients was 23.4 days. The rate of infection dropped from 0.49% in 2005 to 0.24%in 2007. After the introduction of these measures there was a substantial reduction in organ space and deep tissue infections. CONCLUSION/CONCLUSIONS:The separation of emergency and elective orthopaedic services coupled with effective pre-operative screening has resulted in a significant reduction in MRSA infection despite an ever increasing prevalance.
PMID: 22385528
ISSN: 1479-666x
CID: 4775082