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Background: Ankle syndesmotic ligament injury is an important factor affecting clinical outcome after lower extremity injury with as little as 2 mm of syndesmotic displacement leading to worse clinical outcome. One important factor is the appropriate placement of clamps and fixation across the syndesmosis. When not ideally aligned, these can result in malalignment of the fibula in the incisura. This study sought to provide computer validation of using the center-center technique to identify an ideal centroid axis for placement of syndesmotic implants. Methods: Thirty computed tomography (CT) scans of patients from July 1, 2016, to June 30, 2018, with normal syndesmoses were evaluated. Center-center and centroid measurements were drawn and compared on the axial CT images at 10, 20, and 30 mm superior to the tibial plafond. Three observers recorded measurements for the same 50 patients in order to compare interobserver reliability. Results: The difference between the centroid and center-center axis at each height level was a mean 0.4 degrees (range, 0.3-0.5 degrees). The center-center and centroid axis change by externally rotating as the height increases away from the tibial plafond with mean, 3 degrees (range, 0-6.1 degrees). Intraclass correlation coefficients (ICCs) were measured at 0.98, thus demonstrating excellent intraobserver and interobserver reliability on these measurements. Conclusion: The center-center technique can be used to identify the centroid axis within an acceptable degree of rotation at heights above the tibial plafond that are relevant to an operating surgeon placing syndesmotic fixation. Clinical Relevance: Theoretically, this aligns the centroids of the fibula and tibia, which achieves the same ideal patient-specific alignment and raises the question as to the extent to which the centroid and center-center axes correlate in the general population. If present, a strong correlation has potentially high clinical importance when planning syndesmotic fixation.

Background: The deep peroneal nerve (DPN) plays a role in afferent nociceptive dorsal midfoot joint pain perception. DPN neurectomy for treatment of symptomatic dorsal midfoot osteoarthritis allows early mobilization and weightbearing. The purpose of our study was to evaluate the patient satisfaction and pain relief after DPN neurectomy for treatment of chronic dorsal midfoot pain due to osteoarthritis. Methods: In this retrospective, IRB-approved, questionnaire-based study, we evaluated 48 patients (55 feet) with an average follow-up of 35.1 (range, 16-51) months who underwent DPN neurectomy at our institution between September 2017 and February 2021. There were 38 women and 10 men, 41 unilateral (22 right, 19 left) and 7 bilateral procedures, with an average age of 67.8 (range, 35-88) years at the time of surgery. A questionnaire that included questions regarding postsurgical dorsal midfoot pain relief, surgical result satisfaction, and current functional limitations was administered via telephone. Demographic information, patient responses, and complications were recorded. Results: Of the 48 patients, 80.8% were satisfied with the result of the surgery in relieving their dorsal midfoot pain, 84.6% would repeat the surgery under the same circumstances, 83.8% would recommend the surgery to a friend, 10.4% reported they wish they had undergone arthrodesis, 91.7% reported pain relief in the first 6 months, and 55.6% reported current activity limitations. Six feet (10.9%) underwent a second procedure with an average postoperative time of 20.5 (range, 1-36) months. Complications included 1 hematoma and deep wound infection, 1 DPN neuroma and superficial peroneal nerve entrapment, and 4 patients with inadequate pain relief. Conclusion: In this cohort, DPN neurectomy appeared to be a reasonable surgical alternative to arthrodesis for the management of chronic dorsal midfoot pain due to midfoot osteoarthritis after failed nonoperative management. Level of Evidence: Level IV, retrospective case series.

Knee scooters are commonly used for mobility instead of other devices. However, passive popliteal venous flow impedance has been observed with knee scooter usage ostensibly as a result of deep knee flexion. This study aimed to characterize the magnitude of impact knee flexion has on popliteal venous flow in relation to the degree of knee flexion when walking boot immobilized. Furthermore, the countervailing effect of standardized pedal musculovenous pump (PMP) activation was observed. Popliteal venous diameter and flow metrics were assessed with venous ultrasonography in 24 healthy individuals. Straight leg, crutch, and knee scooter positioning while wearing a walking boot and non–weight-bearing were compared. Flow was assessed with muscles at rest and with PMP activation. Of 24 participants, 16 (67%) were female. Twelve limbs (50%) were right sided. The mean age was 21.9 (SD = 3.0) years, and the mean body mass index was 21.9 (SD 1.9) kg/m2. Observer consistencies were excellent (intraclass correlation range = 0.93 to 0.99). No significant differences in mean vessel diameter, time-averaged mean velocity, and total volume flow occurred (all P > .01). Corresponding knee flexion effect sizes were small (range = −0.04 to −0.26). A significant decrease (−24%) in active median time-averaged peak velocity occurred between upright and crutch positions (20.89 vs 15.92 cm/s; P < .001) with a medium effect size (−0.51). PMP activation increased all flow parameters (all P < .001), and effect sizes were comparatively larger (>0.6) across all knee flexion positions. Clinical Significance: Knee flexion has a small to medium impact on popliteal venous return in healthy patients. Active toe motion effectively counters the negative effects of gravity and knee flexion when the ankle is immobilized. Levels of Evidence: Therapeutic, Level IV

Background Batter's shoulder has been defined as an acute posterior subluxation of the lead shoulder during a baseball swing causing a traumatic tear of the posterior labrum. There are limited data correlating repair techniques with return-to-play information but none utilizing standardized outcome measures. The purpose of this study is to examine a case series of patients for postoperative return-to-play and obtain follow-up using standardized outcome measures. Methods We retrospectively identified 10 patients with a batter's shoulder injury. Patients were included if they met the criteria for batter's shoulder injury. We attempted contact via telephone to complete Western Ontario Shoulder Instability (WOSI) and Disability of Arm Shoulder and Hand (QuickDASH) evaluations. We successfully reached five of the patients. The minimum follow-up was one year and the maximum was 11 years. Results All five patients in our cohort were able to return to play at the previous level without limitation. Patients reported a very low percentage limitation on the WOSI and QuickDASH questionnaires and results are detailed further on. Range of motion (ROM) and strength were not affected. Conclusion Batter's shoulder is an infrequent cause of posterior labral tearing, leading to a painful swing that can limit sports activity. In our limited series, all patients treated with arthroscopic repair were able to return to play at the previous level, confirming a significantly improved prognosis for a batter's shoulder injury in contrast to return to play after other causes of posterior labral tears.

Background: Although long suspected, it has yet to be shown whether the foot and ankle deformities of Charcot-Marie-Tooth disease (CMT) are generally associated with abnormalities in osseous shape. Computed tomography (CT) was used to quantify morphologic differences of the calcaneus, talus, and navicular in CMT compared with healthy controls. Methods: Weightbearing CT scans of 21 patients (27 feet) with CMT were compared to those of 20 healthy controls. Calcaneal measurements included radius of curvature, sagittal posterior tuberosity-posterior facet angle, and tuberosity coronal rotation. Talar measurements included axial and sagittal body-neck declination angle, and coronal talar head rotation. Surface-mesh model analysis of the hindfoot was performed comparing the average of the CMT cohort to the controls using a CT analysis software (Disior Bonelogic 2.0). Means were compared with a t test ( P < .05). Results: CMT patients had significantly less talar sagittal declination vs controls (17.8 vs 25.1 degrees; P < .05). Similarly, CMT patients had less talar head coronal rotation vs controls (30.8 vs 42.5 degrees; P < .001). The calcaneal radius of curvature in CMT patients was significantly smaller than controls (822.8 vs 2143.5 mm; P < .05). CMT sagittal posterior tuberosity–posterior facet angle was also significantly different from that of controls (60.3 vs 67.9 degrees respectively; P < .001). Surface-mesh model analysis demonstrated the largest differences in morphology at the navicular tuberosity, medial talar head, sustentaculum tali, and anterior process of the calcaneus. Conclusion: This is the first study to quantify the morphologic differences in hindfoot osteology seen in CMT patients. Patients identified with osseous changes of the calcaneus, especially a smaller axial radius of curvature, may benefit from a 3-dimensional osteotomy for correction.

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