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Outcomes following minimally invasive dorsal cheilectomy for hallux rigidus:A systematic review

World Journal of Orthopedics 2024年第6期15卷 585-592页

作者： Katherine Esser James J Butler Mackenzie Roof Nathaniel P Mercer Michael C Harrington Alan P Samsonov Andrew J Rosenbaum john g kennedy Department of Orthopaedic Surgery University of Toledo Medical Center University of Toledo College of Medicine and Life SciencesToledoOH 43614United States Department of Orthopedic Surgery NYU Langone HealthNew YorkNY 10002United States Department of Orthopedic Surgery Albany Medical CenterAlbanyNY 12208United States

BACKgROUND Cheilectomy of the 1^(st)metatarsophalangeal joint(MTPJ)is one of the most common procedures for the management of hallux ***,there is no consensus regarding outcomes following minimally invasive dorsal cheilectomy(MIDC)for the management of hallux *** To evaluate outcomes following MIDC for the management of hallux *** During November 2023,the PubMed,EMBASE and Cochrane Library databases were systematically reviewed to identify clinical studies examining outcomes following MIDC for the management of hallux *** Six studies were *** total,348 patients(370 feet)underwent MIDC for hallux rigidus at a weighted mean follow-up of 37.9±16.5 *** distribution of patients by Coughlin and Shurna's classification was recorded in 4 studies as follows:Ⅰ(58 patients,27.1%),Ⅱ(112 patients,52.3%),Ⅲ(44 patients,20.6%).Three studies performed an additional 1^(st)MTPJ arthroscopy and debridement following *** intra-articular bone debris was observed in 100%of patients in 1 *** weighted mean American orthopedic foot and ankle society score improved from a preoperative score of 68.9±3.2 to a postoperative score of *** complication rate was 8.4%,the most common of which was persistent joint pain and ***-two failures(8.7%)were ***-three secondary procedures(8.9%)were performed at a weighted mean time of 8.6±3.2 months following the index *** This systematic review demonstrated improvements in subjective clinical outcomes together with a moderate complication rate following MIDC for the management of hallux rigidus at short-term follow-up.A moderate reoperation rate at short-term follow-up was *** marked heterogeneity between included studies and paucity of high quality comparative studies limits the generation of any robust conclusions.

关键词： Minimally invasive dorsal cheilectomy Hallux rigidus The first metatarsophalangeal joint Cheilectomy Minimally invasive surgery

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Ankle arthrodesis:A systematic approach and review of the literature

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World Journal of Orthopedics 2016年第11期7卷 700-708页

作者： Youichi Yasui Charles P Hannon Dexter Seow john g kennedy Hospital for Special Surgery Department of Orthopaedic Surgery 2~(nd) Teikyo University School of Medicine

Ankle arthrodesis is a common treatment used for patients with end-stage ankle arthritis(ESAA). The surgical goal of ankle arthrodesis is to obtain bony union between the tibia and talus with adequate alignment [slight valgus(0°-5°)], neutral dorsiflexion, and slight external rotation positions) in order to provide a pain-free plantigrade foot for weightbearing activities. There are many variations in operative technique including deferring approaches(open or arthroscopic) and differing fixation methods(internal or external fixation). Each technique has its advantage and disadvantages. Success of ankle arthrodesis can be dependent on several factors, including patient selection, surgeons' skills, patient comorbidities, operative care, etc. However, from our experience, the majority of ESAA patients obtain successful clinical outcomes. This review aims to outline the indications and goals of arthrodesis for treatment of ESAA and discuss both open and arthroscopic ankle arthrodesis. A systematic step by step operative technique guide is presented for both the arthroscopic and open approaches including a postoperative protocol. We review the current evidence supporting each approach. The review finishes with a report of the most recent evidence of outcomes after both approaches and concerns regarding the development of hindfoot arthritis.

关键词： Ankle Osteoarthritis Arthrodesis Review Ankle fusion

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Current management of talar osteochondral lesions

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World Journal of Orthopedics 2017年第1期8卷 12-20页

作者： Arianna L gianakos Youichi Yasui Charles P Hannon john g kennedy Department of Orthopedic Surgery 2~(nd) Jersey City Medical Center Department of Foot and Ankle Hospital for Special Surgery Department of Orthopaedic Surgery 2~(nd) Teikyo University School of Medicine 2~(nd) Department of Orthopaedic Surgery Rush University Medical Center (C.P.H.)

Osteochondral lesions of the talus(OLT) occur in up to 70% of acute ankle sprains and fractures. OLT have become increasingly recognized with the advancements in cartilage-sensitive diagnostic imaging modalities. Although OLT may be treated nonoperatively, a number of surgical techniques have been described for patients whom surgery is indicated. Traditionally, treatment of symptomatic OLT have included either reparative procedures, such as bone marrow stimulation(BMS), or replacement procedures, such as autologous osteochondral transplantation(AOT). Reparative procedures are generally indicated for OLT gies are used for large lesions or after failed primary repair procedures. Although shortand medium-term results have been reported, longterm studies on OLT treatment strategies are lacking. Biological augmentation including platelet-rich plasma and concentrated bone marrow aspirate is becoming increasingly popular for the treatment of OLT to enhance the biological environment during healing. In this review, we describe the most up-to-date clinical evidence of surgical outcomes, as well as both the mechanical and biological concerns associated with BMS and AOT. In addition, we will review the recent evidence for biological adjunct therapies that aim to improve outcomes and longevity of both BMS and AOT procedures.

关键词： Osteochondral lesions of talus Comprehensive review Diagnosis Bone marrow stimulation Autologous autograft transfer Biologics

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Scaffolds based therapy for osteochondral lesions of the talus:A systematic review

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World Journal of Orthopedics 2017年第10期8卷 798-808页

作者： Yoshiharu Shimozono Youichi Yasui Andrew W Ross Wataru Miyamoto john g kennedy Hospital for Special Surgery New York Department of Orthopaedic Surgery Teikyo University School of Medicine Department of Orthopaedic Surgery Kyoto University Graduate School of Medicine

AIM To clarify the effectiveness of scaffold-based therapy for osteochondral lesions of the talus(OLT). METHODS A systematic search of MEDLINE and EMBASE databases was performed during August 2016 and updated in January 2017. Included studies were evaluated with regard to the level of evidence(LOE) and quality of evidence(QOE) using the Modified Coleman Methodology Score. Variable reporting outcome data, clinical outcomes, and the percentage of patients who returned to sport at previous level were also evaluated. RESULTS Twenty-eight studies for a total of 897 ankles were included; 96% were either LOE Ⅲ or Ⅳ. Studies were designated as either of poor or fair quality. There were 30 treatment groups reporting six different scaffold repair techniques: 13 matrix-induced autologous chondrocyte transplantation(MACT), nine bone marrow derived cell transplantation(BMDCT), four autologous matrixinduced chondrogeneis(AMIC), and four studies of other techniques. The categories of general demographics(93%) and patient-reported outcome data(85%) were well reported. Study design(73%), imaging data(73%), clinical variables(49%), and patient history(30%) were also included. The weighted mean American Orthopaedic Foot and Ankle Society(AOFAS) score at final follow-up was: 86.7 in MACT, 88.2 in BMDCT, and 82.3 in AMIC. Eight studies reported that a weighted mean of 68.3% ofpatients returned to a previous level of sport activity. CONCLUSION Scaffold-based therapy for OLT may produce favorable clinical outcomes, but low LOE, poor QOE, and variability of the data have confounded the effectiveness of this treatment.

关键词： Scaffold Ankle Talar osteochondral lesion Systematic review Cartilage

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Alignment of the hindfoot following total knee arthroplasty: A systematic review

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World Journal of Orthopedics 2021年第10期12卷 791-801页

作者： James J Butler Nathaniel P Mercer Eoghan T Hurley Mohammad T Azam john g kennedy Department of Orthopedic Surgery Royal College Surgeons in IrelandDublin 18Ireland Department of Orthopedic Surgery NYU Langone HealthNew YorkNY 10002United States

BACKgROUND There appears to be a close relationship between deformities at the knee joint and at the hindfoot in patients with knee osteoarthritis(OA).Despite this intrinsic link,there is a dearth of studies investigating alterations in hindfoot alignment following total knee arthroplasty(TKA)in patients with knee *** To evaluate changes in alignment of the hindfoot following TKA,foot and ankle clinical outcomes in terms of subjective clinical scoring tools following surgical intervention,and to analyse the level of evidence(LOE)and quality of evidence(QOE)of the included *** MEDLINE,EMBASE and Cochrane Library databases were systematically reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses *** reporting changes in the postoperative alignment of the hindfoot following TKA were *** level and QOE were recorded and *** Eleven studies with a total of 1142 patients(1358 knees)met the inclusion/exclusion *** studies were of LOE II and 5 studies were of LOE *** with preoperative varus knee deformity and valgus hindfoot deformity demonstrated improvement in hindfoot alignment post *** with preoperative varus knee deformity and varus hindfoot deformity demonstrated no improvement in hindfoot alignment following *** different radiographic parameters were used to measure the alignment of the hindfoot across the included studies,with the tibio-calcaneal angle most frequently utilised(27.3%).CONCLUSION This systematic review demonstrated that the hindfoot may display compensatory changes in alignment following TKA in patients with knee ***,the marked heterogeneity between the included studies and poor QOE limits any meaningful cross sectional comparisons between ***,well designed studies are necessary to determine the changes and outcomes of hindfoot alignment following TKA.

关键词： Total knee arthroplasty Hindfoot alignment Hindfoot Knee osteoarthritis Varus knee deformity Valgus hindfoot deformity

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Can bedside needle arthroscopy of the ankle be an accurate option for intra-articular delivery of injectable agents?

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World Journal of Orthopedics 2022年第1期13卷 78-86页

作者： Tobias Stornebrink Sjoerd A S Stufkens Nathaniel P Mercer john g kennedy gino M M J Kerkhoffs Department of Orthopedic Surgery Amsterdam UMCUniversity of AmsterdamAmsterdam Movement SciencesAmsterdam 1105AZNetherlands Academic Center for Evidence based Sports Medicine Amsterdam 1105AZNetherlands Amsterdam Collaboration for Health and Safety in Sports International Olympic Committee Research Center Amsterdam UMCAmsterdam 1105AZNetherlands Department of Orthopedic Surgery NYU Langone HealthNew YorkNY 10010United States

BACKgROUND Bedside needle arthroscopy of the ankle under local anesthesia has been proposed for intra-articular delivery of injectable *** and tolerability of this approach in the clinical setting–including patients with end-stage ankle pathology and/or a history of prior surgery–is not *** To assess clinical accuracy and tolerability of bedside needle arthroscopy as a delivery system for injectable agents into the tibiotalar *** This was a prospective study that included adult patients who were scheduled for an injection with hyaluronic acid to the tibiotalar *** our center,these injections are used as a last resort prior to extensive *** primary outcome was injection accuracy,which was defined as injecting through the arthroscopic cannula with intra-articular positioning confirmed by a clear arthroscopic view of the joint *** outcome measures included a patientreported numeric rating scale(NRS,0-10)of pain during the procedure and willingness of patients to return for the same *** of ankle pain at rest and during walking was collected at baseline and at 2-wk *** were monitored from inclusion up to a 2-wk control *** We performed 24 ***(46%)participants were male,and mean age was 46.8±14.5 *** was the indication for injection in 20(83%)cases,of which 8(33%)patients suffered from osteoarthritis Kellgren-Lawrence grade IV,and 10(42%)patients from Kellgren-Lawrence grade *** osteochondral defect was the indication for injection in 4(17%)cases.A history of ankle surgery was present in 14(58%)participants and a history of multiple ankle surgeries in 11(46%)*** was possible to confirm accuracy in 21(88%)*** 3(12%)participants where needle arthroscopy did not reach a clear view of the joint space all suffered from Kellgren-Lawrence grade IV *** during the procedure was reported with a median of 1[i

关键词： Ankle arthroscopy NanoScope Needle arthroscopy Injections Proof of concept Patient experience

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Systematic review of bone marrow stimulation for osteochondral lesion of talus-evaluation for level and quality of clinical studies

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World Journal of Orthopedics 2017年第12期8卷 956-963页

作者： Youichi Yasui Laura Ramponi Dexter Seow Eoghan T Hurley Wataru Miyamoto Yoshiharu Shimozono john g kennedy 2~(nd) Department of Orthopaedic Surgery Teikyo University School of Medicine Hospital for Special Surgery New York 2~(nd) Rizzoli Orthopaedic Institute 2~(nd) Royal College of Surgeons in Ireland Department of Orthopaedic Surgery Teikyo University School of Medicine

AIM To clarify the quality of the studies indicating lesion size and/or containment as prognostic indicators of bone marrow stimulation(BMS) for osteochondral lesions of the talus(OLT). METHODS Two reviewers searched the Pub Med/MEDLINE and EMBASE databases using specific terms on March 2015 in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. Predetermined variables were extracted for all the included studies. Level of evidence(LOE) was determined using previously published criteria by the Journal of Bone and Joint Surgery and methodological quality of evidence (MQOE) was evaluated using the Modified Coleman Methodology Score. RESULTS This review included 22 studies. Overall, 21 of the 22(95.5%) included studies were level Ⅳ or level Ⅲ evidences. The remaining study was a level Ⅱ evidence. MQOE analysis revealed 14 of the 22(63.6%) included studies having fair quality, 7(31.8%) studies having poor quality and only 1 study having excellent quality. CONCLUSION The evidence supporting the use of lesion size and containment as prognostic indicators of BMS for OLTs has been shown to be of low quality.

关键词： Osteochondral lesion of talus Arthroscopy Bone marrow stimulation Systematic review

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Football injuries of the ankle: A review of injury mechanisms, diagnosis and management

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World Journal of Orthopedics 2016年第1期7卷 8-19页

作者： Raymond J Walls Keir A Ross Ethan J Fraser Christopher W Hodgkins Niall A Smyth Christopher J Egan James Calder john g kennedy Department of Foot and Ankle Surgery Hospital for Special Surgery New York University of Miami/Jackson Memorial Hospital Department of Trauma and Orthopaedic Surgery Chelsea and Westminster Hospital

Football is the most popular sport worldwide and is associated with a high injury rate, most of which are the result of trauma from player contact. Ankle injuries are among the most commonly diagnosed injuries in the game. The result is reduced physical activity and endurance levels, lost game time, and considerable medical cost. Sports medicine professionals must employ the correct diagnostic tools and effective treatments and rehabilitation protocols to minimize the impact of these injuries on the player. This review examines the diagnosis, treatment, and postoperative rehabilitation for common football injuries of the ankle based on the clinical evidence provided in the current literature.

关键词： Management Soccer Football Ankle Injury

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Posterior ankle impingement syndrome: A systematic fourstage approach

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世界骨科杂志：英文版 2016年第10期7卷 657-663页

作者： Youichi Yasui Charles P Hannon Eoghan Hurley john g kennedy Department of Orthopaedic Surgery 2nd Teikyo University School of Medicine Hospital for Special Surgery 2nd Department of Orthopaedic Surgery Rush University Medical Center (C.P.H.) 2nd Royal College of Surgeons in Ireland

Posterior ankle impingement syndrome(PAIS) is a common injury in athletes engaging in repetitive plantarflexion, particularly ballet dancers and soccer players. Despite the increase in popularity of the posterior twoportal hindfoot approach, concerns with the technique remain, including; the technical difficulty, relatively steep learning curve, and difficulty performing simultaneous anterior ankle arthroscopy. The purpose of the current literature review is to provide comprehensive knowledge about PAIS, and to describe a systematic four-stage approach of the posterior two-portal arthroscopy. The etiology, clinical presentation, diagnostic strategies are first introduced followed by options in conservative and surgical management. A detailed systematic approach to posterior hindfoot arthroscopy is then described. This technique allows for systematic review of the anatomic structures and treatment of the bony and/or soft tissue lesions in four regions of interest in the hindfoot(superolateral, superomedial, inferomedial, and inferolateral). The review then discusses biological adjuncts and postoperative rehabilitation and ends with a discussion on the most recent clinical outcomes after posterior hindfoot arthroscopy for PAIS. Although clinical evidence suggests high success rates following posterior hindfoot arthroscopy in the short- and mid-term it may be limited in the pathology that can be addressed due to the technical skills required, but the systematic four-stage approach of the posterior two-portal arthroscopy may improve upon this problem.

关键词： Posterior ankle impingement syndrome Arthroscopy Endoscopy Review Os trigonum

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Platelet-rich plasma increases transforming growth factor-beta1 expression at graft-host interface following autologous osteochondral transplantation in a rabbit model

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World Journal of Orthopedics 2015年第11期6卷 961-969页

作者： Lorraine A Boakye Keir A Ross john M Pinski Niall A Smyth Amgad M Haleem Charles P Hannon Lisa A Fortier john g kennedy Department of Orthopaedic Surgery Hospital for Special Surgery Department of Orthopaedic Surgery Rush University Medical Center Department of Clinical Sciences Cornell University College of Veterinary Medicine

AIM: To explore the effect of platelet-rich plasma on protein expression patterns of transforming growth factor-beta1(TgF-β1) in cartilage following autologous osteochondral transplantation(AOT) in a rabbit knee cartilage defect ***: Twelve New Zealand white rabbits received bilateral AOT. In each rabbit, one knee was randomized to receive an autologous platelet rich plasma(PRP) injection and the contralateral knee received saline injection. Rabbits were euthanized at 3, 6 and 12 wk post-operatively. Articular cartilage sections were stained with TgF-β1 antibody. Histological regions of interest(ROI)(left, right and center of the autologous grafts interfaces) were evaluated using Meta Morph. Percentage of chondrocytes positive for TgF-β1 was then ***: Percentage of chondrocytes positive for TgF-β1 was higher in PRP treated knees for selected ROIs(left; P = 0.03, center; P = 0.05) compared to control and was also higher in the PRP group at each post-operative time point(P = 6.6 × 10^(-4), 3.1 × 10^(-4) and 7.3 × 10^(-3) for 3, 6 and 12 wk, respectively). TgF-β1 expression was higher in chondrocytes of PRP-treated knees(36% ± 29% vs 15% ± 18%)(P = 1.8 × 10^(-6)) overall for each post-operative time point and ROI. CONCLUSION: Articular cartilage of rabbits treated with AOT and PRP exhibit increased TgF-β1 expression compared to those treated with AOT and saline. Our findings suggest that adjunctive PRP may increase TgF-β1 expression, which may play a role in the chondrogenic effect of PRP in vivo.

关键词： Platelet rich plasma Transforming growth factor-beta Autologous osteochondral transplantation

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