Kiwon Young

Measurement of first-ray mobility in normal vs. hallux valgus patients

Hypermobility of the first ray is one causative factor in development of hallux valgus and an important factor in the treatment of hallux valgus, but measuring first-ray motion is difficult. There are two known ways of measuring first-ray motion. One is measuring the bony angle on the lateral foot X-ray using a modified Coleman block. The other is using devices. However, neither is suitable for clinical application. We introduce a simple, fast and easy way of measuring first-ray range of motion. Using this method, we compared the first-ray motion between a normal group and a hallux valgus group. Forty normal and 60 hallux valgus patients were included in the measurement. We measured the first-ray range of motion in the following way: with one hand we held the 2nd, 3rd, 4th, and 5th rays at the metatarsal head level with a simple right-angled indicator. With the other hand, we held the first ray at the metatarsal head level using a simple right-angled device, such as a scale. Keeping the other rays fixed, we moved the first ray up and down and recorded the average distance (d) 10 times to reduce intra-measurement differences. We also measured and recorded the first metatarsal length (L) on the anteroposterior foot X-ray film. Finally, we calculated the first-ray range of motion (a) using the above data. We also measured the hallux valgus angle and intermetatarsal angle in the hallux valgus patient group. With this method, the average first-ray motion was 10.3° in the normal group and 12.9° in the hallux valgus patient group. If we define 14°, (that is, above the 95th percentile in the normal group) as having hypermobility, 38% of hallux valgus patients had first ray hypermobility. There was no correlation between first-ray hypermobility and either hallux valgus angle or intermetatarsal angle.

Factors influencing result of autologous chondrocyte implantation in osteochondral lesion of the talus using second look arthroscopy

This study is to know the factors that may affect cartilage repair after autologous chondrocyte implantation (ACI) for the treatment of an osteochondral lesion of the talus (OLT) as seen through a second look arthroscopy. A total of 38 patients who had ACI treatment for OLT underwent a second look arthroscopy 1 year after the ACI operation. A modified magnetic resonance observation of cartilage repair tissue (MOCART) scoring system was used to assess the outcome of the repaired cartilage. Influencing factors were sex, accompanied procedure, location, site, depth, pre‐operative AOFAS score, size and age. Factors that may affect cartilage repair after ACI treatment for OLT were evaluated. Of the different factors assessed, sex (P=0.75), accompanied procedure (P=0.50), depth (P=0.08), location (P=0.54), site (P=0.50) and pre‐operative AOFAS score (P=0.42) were found not to affect cartilage repair after ACI treatment for OLT. The size of the lesion (P=0.0021) and patients age (P=0.01) were the influential factors. As a result, factors affecting repaired cartilage formation after ACI of OLT were found through the second look arthroscopy. It was determined that not all of the factors affecting the clinical outcome after ACI for the repair of an OLT affected cartilage repair after ACI.

Factors Associated With Recurrent Fifth Metatarsal Stress Fracture

Background: Many surgeons agree that fifth metatarsal stress fractures have a tendency toward delayed union, nonunion, and possibly refracture. Difficulty healing seems to be correlated with fracture classification. However, refracture sometimes occurs after low-grade fracture, even long after apparent resolution. Methods: The records of 168 consecutive cases of fifth metatarsal stress fracture (163 patients) treated by modified tension band wiring from March 2002 to June 2011 were evaluated retrospectively. Mean length of follow-up was 23.6 months (range, 10-112 months). Forty-nine cases classified as Torg III were bone grafted initially also. All enrolled patients were elite athletes. Eleven patients experienced nonunion and 18 refracture. The 11 nonunion cases were bone grafted. The 157 patients (excluding nonunion cases) were allocated to either a refracture group or a union group. Clinical features, such as age, weight, fracture classification, time to union, and reinjury history, were compared. Radiological parameters representing cavus deformity and fifth metatarsal head protrusion were compared to evaluate the influence of structural abnormalities. Results: Mean group weights were significantly different (P = .041), but mean ages (P = .879), fracture grades (P = .216, P = .962), and time from surgery to rehabilitation (P = .539) were similar. No significant intergroup differences were found for talocalcaneal (TC) angle (P = .470), calcaneal pitch (CP) angle (P = .847), or talo–first metatarsal (T-MT1) angle (P = .407) on lateral radiographs; for fifth metatarsal lateral deviation (MT5-LD) angle (P = .623) on anteroposterior (AP) radiographs; or for MT5-LD angle (P = .065) on the 30-degree medial oblique radiographs. However, the mean fourth-fifth intermetatarsal (IMA4-5) angle on AP radiographs was significantly greater in the refracture group, and for Torg II cases, mean weight (P = .042), IMA4-5 angle on AP radiographs (P = .014), and MT5-LD angle (P = .043) on 30-degree medial oblique radiographs were significantly greater in the refracture group. For B2 cases (incomplete fracture and a plantar gap of 1 mm or larger), mean weight (P = .046), IMA4-5 angle on AP radiographs (P = .019), and MT5-LD angle (P = .045) on 30-degree medial oblique radiographs were significantly greater in the refracture group. All cases of refracture had a traumatic history after bone union. Refracture developed within 6 months of starting rehabilitation in 13 cases and within 3 months in 8 cases. Conclusion: The development of refracture after the surgical treatment of fifth metatarsal stress fractures was found to be associated with higher body mass index (BMI) and with radiological parameters (IMA4-5 on AP radiographs, MT5-LD on oblique radiographs) associated with protrusion of the fifth metatarsal head. The study indicates that patients with a protruding fifth metatarsal head and a high BMI should approach rehabilitation with care before considering a return to previous sporting activity levels. Level of Evidence: Level III, retrospective comparative series.

Sagittal and axial mobility of 1st ray in hallux valgus

Hypermobility of the first ray is one causative factor in development and recurrence of Hallux valgus[1],[2],[3]. so treated as an important factor in hallux valgus. While most discussions of 1st ray instability refer to sagittal motion [4],[5], [6],[7]. Increased motion may also be present in the axial plan. However, there is no known way of measuring motion of axial plan. In this study, we assessed the axial plan mobility by means of measuring the difference between weight bearing IMA and non-weight bearing IMA from foot AP radiograph. This study investigated the difference between the axial motion of the first ray of the symptomatic hallux valgus patients group and that of the normal group.