Dong-Oh Lee

Intra-articular injection, subacromial injection, and hydrodilatation for primary frozen shoulder: a randomized clinical trial

BACKGROUNDnThe aim of this prospective randomized study was to compare the efficacy of 3 injection methods, intra-articular injection, subacromial injection, and hydrodilatation (HD), in the treatment of primary frozen shoulder.nnnMETHODSnPatients with primary frozen shoulder were randomized to undergo intra-articular injection (nu2009=u200929), subacromial injection (nu2009=u200929), or HD (nu2009=u200928). Evaluations using a visual analog scale for pain, Simple Shoulder Test, Constant score, and passive range of shoulder motion were completed before treatment and 1 month, 3 months, and 6 months after treatment.nnnRESULTSnAmong the 3 injection methods for primary frozen shoulder, HD resulted in a greater range of motion in forward flexion and external rotation, a lower visual analog scale score for pain after 1 month, and better outcomes for all functional scores after 1 month and 3 months of follow-up. However, there were no significant differences in any clinical outcomes among the 3 groups in the final follow-up at 6 months.nnnCONCLUSIONSnAlthough HD yielded more rapid improvement, the 3 injection methods for primary frozen shoulder resulted in similar clinical improvement in the final follow-up at 6 months.

Anatomical Reconstruction of Lateral Ankle Ligaments Using Free Tendon Allografts and Biotenodesis Screws

Background: Lateral ankle instability is one of the most common musculoskeletal disorders and can result in ankle damage. This study reports on the results of the anatomical reconstruction of ligaments using semitendinosus tendon allograft and bioabsorbable tenodesis screws for chronic lateral ankle instability, as well as the functional and radiological results of this procedure. Methods: From February 2007 to January 2013, 70 patients (72 ankles) underwent this procedure. Six patients were lost to follow-up, and ultimately 64 patients (66 ankles) were evaluated. Visual Analog Scale (VAS) pain scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores, Karlsson-Peterson ankle scores, and patient satisfaction were evaluated at a mean of 22.1 months (range, 12-68 months) postoperatively. The talar tilt angle and anterior translation were assessed radiographically in pre- and postoperative ankle stress views. The mean patient age at surgery was 30.1 years (range, 16-59 years). Results: The mean VAS pain score decreased from 5.5 to 1.3 (P < .05), and the mean AOFAS improved from 71.0 to 90.9 (P < .05). The mean Karlsson-Peterson score improved from 55.1 to 90.3, whereas talar tilt decreased from 14.8 degrees to 3.9 degrees. There was no significant difference in clinical outcomes between the pretensioned and nonpretensioned groups. Conclusion: This procedure yielded successful results, including satisfactory ankle stability and clinical outcomes, in ankles with poor lateral ligament tissues. Level of Evidence: Level IV, case series.

Anterior Heterotopic Ossification at the Talar Neck After Total Ankle Arthroplasty

Background: Recently, as total ankle arthroplasty (TAA) has been widely performed, its outcomes and complications have been reported. Heterotopic ossification (HO) after TAA has been reported in the posterior compartment of the ankle. We report on a series of HOs that developed in the anterior compartment of the ankle at the talar neck region after TAA. Methods: TAA was performed using the Hintegra and the Mobility in 54 ankles (Hintegra, 21 ankles; Mobility, 33 ankles) from 2004 to 2012. The outcome was assessed by visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, patient satisfaction, and radiographic evaluation. The HO was confirmed on the lateral ankle view. HO in the anterior compartment of the ankle was classified based on a modification of the Brooker classification. Results: After TAA, 13 HOs developed in 12 of the 54 ankles. Six HOs developed in the anterior compartment, and 7 HOs developed in the posterior compartment. The majority of the anterior compartment HO (5/6) was observed in the Mobility group. There was no significant relationship between HO and the clinical outcomes (VAS score, P = .62; AOFAS score, P = .31; ankle range of motion, P = .31). Conclusions: Besides the posterior ankle, the anterior compartment of the ankle in the talar neck region was demonstrated to be another potential area for HO after TAA. The development of anterior HO was strongly related to the wide exposure of the cancellous bony surface at the talar neck and therefore occurred more often with the Mobility than with the Hintegra prosthesis. Level of Evidence: Level III, retrospective comparative case series.

Outcome of subtalar instability reconstruction using the semitendinosus allograft tendon and biotenodesis screws

PurposeSubtalar instability (STI) has often been obscured by lateral ankle instability. Moreover, although there have been several reports of techniques for reconstructing STI, no clinical outcome results are known to have been published. The authors report the clinical and radiographic outcomes of the ligament reconstruction of STI with a recently reported novel technique utilising a semitendinosus tendon allograft and interference screws.MethodsThis study is based on 20 ankles that underwent ligament reconstruction for STI between 2009 and 2013. The average follow-up period was 15.0xa0±xa05xa0months, and the average age at surgery was 28.1xa0±xa010.8xa0years old. Visual analogue (VAS) pain scores, American Orthopedic Foot and Ankle Society (AOFAS) and Karlsson–Peterson ankle scores as well as patient satisfaction were evaluated. Radiographic evaluation of medial translations of calcaneus and subtalar tilt angles was preformed with ankle and Broden’s stress radiographs.ResultsThe VAS pain score decreased from 6.1xa0±xa01.1 preoperatively to 1.8xa0±xa01.2 post-operatively (pxa0<xa00.05). The AOFAS score improved from 66.0xa0±xa012.2 preoperatively to 89.6xa0±xa06.7 post-operatively, and the Karlsson–Peterson score improved from 57.0xa0±xa013.5 to 91.1xa0±xa06.8 (pxa0<xa00.05). There were no complications such as recurred STI or subtalar joint stiffness. All of the patients were satisfied with the surgery. Subtalar tilt angle decreased from 11.5° preoperatively to 3.0° post-operatively, and the calcaneal medial translations decreased from 7.4 to 3.9xa0mm.ConclusionThis is the first report on the comprehensive clinical and radiographic outcomes of STI reconstruction using a semitendinosus tendon allograft and interference screws. The novel technique of STI reconstruction was found to show encouraging clinical outcomes with high patient satisfaction.Levels of evidenceIV.

Transmissible Infection of Human 293T Cells With Porcine Endogenous Retroviruses Subgroup A From NIH-Miniature Pig

In pig-to-human xenotransplantation, zoonotic infections have been an important barrier. The risk of zoonosis has been emphasized in xenotransplantation after finding that porcine endogenous retroviruses (PERVs) can infect human cells in vitro. Until now, transmissions of PERVs from PK15 cells have been studied in vitro and in vivo, but transmission of PERVs originating from miniature pigs have not been extensively reported. Peripheral blood mononuclear cells from miniature swine showed PERV transmission to human cells. In contrast, specific pathogen-free (SPF) pig islet cells showed no PERV transmission when co-incubated with 293T cells. To evaluate the risk of zoonosis with our experimental mini pigs, we tested the infectivity of PERVs from NIH-miniature pig primary ear cells for human 293T cells. As a result, all subgroups of infectious PERV virion (PERV-A, -B, and -C) were detected in the primary cell culture media. Unlike PERV-C, PERV-A and -B infected human 293T cells. Interestingly, only proviral PERV-A replicated in 293T cells to produce virions after infection. Our results suggested that a prevention study of PERV xenotransmission from experimental miniature pigs should concentrate on PERV-A control.

Comparison of the outcomes between two 3-component total ankle implants.

Background: Total ankle arthroplasty (TAA) with the use of third generation implants has demonstrated favorable clinical results and improved survival. However, few studies have compared the different types of implants. The purpose of this study was to perform a retrospective evaluation of patient outcomes and complications by comparing TAA procedures performed with HINTEGRA versus MOBILITY systems. Methods: Fifty-two consecutively enrolled patients (28 men and 24 women; mean age 64.8 years) underwent TAA using HINTEGRA (21 ankles) or MOBILITY (33 ankles) between September 2004 and July 2012. Visual analog scale (VAS) pain scores and the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores were determined at each follow-up visit. The radiographs were reviewed to assess component positioning, radiolucency, heterotopic ossification, and other factors. The mean follow-up period was 28.3 months in the HINTEGRA group and 32.5 months in the MOBILITY group. Results: VAS decreased from 8.3 to 2.0 for the HINTEGRA group and from 7.9 to 2.7 for the MOBILITY group. The AOFAS score increased from 43.8 to 87.3 for the HINTEGRA group and from 46.6 to 83.7 for the MOBILITY group. Intra- and postoperative malleolar fractures were not noted in the HINTEGRA group, whereas 5 ankles (15.2%) in the MOBILITY group sustained this injury (P = .144). Ankle impingement syndrome was noted in 8 ankles (38.1%) in the HINTEGRA group and 3 (9.1%) in the MOBILITY group (P = .015). However, no significant differences in postoperative osteolysis and neuralgia were noted between the groups. Conclusions: Both implants exhibited favorable clinical outcome without significant differences. However, in terms of complications, ankle impingement syndrome was significantly more common in the HINTEGRA group, while intraoperative malleolar fracture was observed only in the MOBILITY group. Level of Evidence: Level III, comparative series.

Total Ankle Arthroplasty and Salvage of Complications

1. n nTotal ankle arthroplasty can be a powerful option in the treatment of end-stage arthritis, even when combined with ankle-hindfoot deformities. n n n n n2. n nPreoperative planning including the correction of alignment, presence of deformed bony structure, concomitant ankle instability, adjacent symptomatic arthritis, etc., should be meticulously evaluated. n n n n n3. n nSeveral adjunctive procedures should be kept in mind for correcting deformity because concomitant coronal plane deformities are often accompanied with ankle arthritis. n n n n n4. n nVarious intraoperative and postoperative complications such as malleolar fractures, malpositioning, ankle impingement, or infection can be expected, which are addressed with appropriate salvage techniques such as arthroscopic debridement, corrective osteotomy, and arthrodesis. n n n n n5. n nRecently, several total ankle implants with three-component design have been reported to have favorable outcomes with relatively pain-free ankle and acceptable range of motion.

Metatarsalgia and Toe Deformities

1. n nGenerally, abnormal plantar pressure distribution around forefoot is thought to be a cause of metatarsalgia and etiologic factors of primary metatarsalgia proposed for metatarsalgia include incompetence of first ray, a long second metatarsal, excessive plantar flexion of the forefoot, and/or contracture of the Achilles tendon complex. n n n n n2. n nSurgical treatment of metatarsalgia and intractable plantar keratosis is based on the osseous etiologies of the plantar keratosis. Weil distal metatarsal osteotomy and BRT proximal metatarsal osteotomy are frequently performed for metatarsalgia with long metatarsal and plantar-flexed metatarsal relatively. n n n n n3. n nMorton’s neuroma, Freiberg disease, sesamoid lesions, and lesser toe deformities due to inflammatory arthritis or neuromuscular imbalance can be categorized as etiologic disorders for secondary metatarsalgia. n n n n n4. n nVarious potential etiologic factors such as trauma, impaired vascularity, and/or systemic disorders are thought to be involved in the development of Freiberg disease. n n n n n5. n nLesser toe deformities can occur as isolated entities or be associated with deformities of the hallux, midfoot, or hindfoot. Etiology of lesser toe deformities includes congenital, neuromuscular, trauma, familial heritance, and the effect of bad footwear.

Ankle Osteoarthritis (II) – Arthrodesis

1. n nArthrodesis is a final, reliable, and traditional surgical option for intractable ankle or subtalar arthritis. n n n n n2. n nExact diagnosis including careful history taking and physical examination is important in finding the source of pain. n n n n n3. n nWhatever the location to be fused, the basic principles of arthrodesis cannot be overemphasized: (1) complete removal of cartilage, (2) handling of soft tissue, and (3) exposing healthy congruent cancellous surfaces and penetrating subchondral bone. n n n n n4. n nSurgeons should be familiar with several approaches and fixation methods according to the fusion site: ankle, subtalar, and tibiotalocalcaneal fusion. n n n n n5. n nBone grafting and rigid fixation is important because various conditions such as large bony defect can diminish the clinical outcome of fusion surgery.