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Article: Tranexamic Acid in Foot and Ankle Surgery: A Systematic Review and Meta-Analysis.

Dombrowski, Nicholas / Enos, Jake / Henkelman, Erik / Mar, Damon / Tarakemeh, Armin / Vopat, Bryan

Kansas journal of medicine

2023 Volume 16, Page(s) 302–308

Abstract: Introduction: Tranexamic acid (TXA) use has become common in orthopedic surgeries. Despite the growing number of publications related to its use, no recent systematic reviews have been published examining TXA use in foot and ankle surgery. The purpose ... ...

Abstract	Introduction: Tranexamic acid (TXA) use has become common in orthopedic surgeries. Despite the growing number of publications related to its use, no recent systematic reviews have been published examining TXA use in foot and ankle surgery. The purpose of this review article is to provide a summary of the current available literature regarding TXA use in foot and ankle surgery and to further the understanding of its safety and efficacy. Methods: This systematic review utilized PubMed, Ovid, CINAHL, Clinical Key, Medline, and Embase, and the search was conducted through December 22, 2022. Key words used in the search included: "tranexamic acid," "TXA," "foot," "ankle," "calcaneal," and "surgery." The outcomes within the studies analyzed included measures of perioperative blood loss (intra-operative blood loss, 24-hour post-operative blood loss, blood loss from hour 24 to hour 48, post-operative hemoglobin (Hgb), and post-operative hematocrit [Hct]), as well as wound complications and vascular events. Meta-regression was included to assess the impact of age on between-study variation. Results: Ten studies met preliminary inclusion criteria. Upon further inspection, eight met full inclusion criteria for the meta-analysis. Despite a growing amount of literature on the topic, there is still a paucity of literature published on TXA use in foot and ankle surgery. Current literature suggests that foot and ankle surgery patients treated with TXA may have reduced 24-hour post-operative blood loss (MD=-183.41 mL, 95% CI=-247.49 to -119.34 mL, p<0.001), increased post-operative hemoglobin (MD=0.71 g/dL, 95% CI=0.11 to 1.31 g/dL, p=0.020) and hematocrit (MD=2.66%, 95% CI=0.07 to 5.24%, p=0.040) when compared to similar patients not receiving TXA. The use of TXA in foot and ankle surgery did not lead to increased thromboembolic complications. Meta-regression indicated no clinically relevant association of age to between-study variation. Conclusions: TXA was found to be a safe treatment that did affect wound healing or infection rates while decreasing perioperative blood loss. Further research should be performed to evaluate the long-term effects of TXA administration on patient outcomes after foot and ankle surgery.
Language	English
Publishing date	2023-11-30
Publishing country	United States
Document type	Journal Article ; Review
ISSN	1948-2035
ISSN	1948-2035
DOI	10.17161/kjm.vol16.21262
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Article ; Online: Manipulation Under Anesthesia and Lysis of Adhesions Are the Most Commonly Reported Treatments for Arthrofibrosis of the Knee After Arthroscopy or Anterior Cruciate Ligament Reconstruction in Both Pediatric and Adult Patients.

Reddy, Ravali / Bernard, Christopher / Tarakemeh, Armin / Morey, Tucker / Mulcahey, Mary K / Vopat, Bryan G / Vopat, Matthew L

Arthroscopy, sports medicine, and rehabilitation

2024 Volume 6, Issue 2, Page(s) 100896

Abstract: Purpose: To systematically review the literature and provide a detailed summary of the current treatments and outcomes for arthrofibrosis following knee arthroscopy and anterior cruciate ligament reconstruction (ACLR) and to compare the treatment ... ...

Abstract	Purpose: To systematically review the literature and provide a detailed summary of the current treatments and outcomes for arthrofibrosis following knee arthroscopy and anterior cruciate ligament reconstruction (ACLR) and to compare the treatment strategies in pediatric and adult populations. Methods: A systematic review was performed in March 2022 using PubMed, EMBASE, and Cochrane Library Databases per Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Search terms consisted of variations of the following: ("arthrofibrosis" OR "stiffness" OR "stiff" OR "complications") AND ("arthroscopy" OR "arthroscop" OR "ACL" OR "anterior cruciate") AND ("treat" OR "care" OR "management" AND "knee"). The inclusion criteria were studies that were written in English, were published since 2000, and that reported outcomes of knee arthroscopy or ACLR for treatment of arthrofibrosis of the knee. The study quality was assessed, and data about the patients and treatments were recorded. Treatments were compared between pediatric and adult patients. Results: A total of 1,208 articles were identified in the initial search, 42 (3.48%) of which met eligibility criteria, involving treatment regimens for arthrofibrosis following knee arthroscopy or ACLR. Of the 42 studies included, 29 (69.0%) were reported data for adults and 13 (31.0%) reported data for pediatric patients. Thirty-nine studies (92.8%) discussed manipulation under anesthesia and/or lysis of adhesions (LOA) as treatment for arthrofibrosis of the knee, whereas 2 (4.8%) described the use of medications. Conclusions: Within orthopaedic sports medicine literature, there is variability in the reported treatment options for arthrofibrosis of the knee. Most studies identified manipulation under anesthesia and/or LOA as the treatment among both adult and pediatric patients. Other variants include notchplasty, open posterior arthrolysis, total graft resection, removal of hardware with LOA, dynamic splinting, casting in extension, bracing, and medications. Level of evidence: Level IV, systematic review of Level I-IV studies.
Language	English
Publishing date	2024-02-02
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2666-061X
ISSN (online)	2666-061X
DOI	10.1016/j.asmr.2024.100896
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Article ; Online: Epidemiology of Ankle Sprain in the Active-Duty Military Population.

Goodrich, Ezra / Morris, Brandon / Hermanns, Christina / Herda, Ashley / Tarakemeh, Armin / Vopat, Bryan

JBJS reviews

2022 Volume 10, Issue 6

Abstract: Ankle sprain is one of the most prevalent injuries within the military population, resulting in health-care costs, time away from active duty, and negative impacts on overall readiness.: »: Female service members appear to be more likely to ... ...

Abstract	»: Ankle sprain is one of the most prevalent injuries within the military population, resulting in health-care costs, time away from active duty, and negative impacts on overall readiness. »: Female service members appear to be more likely to sustain ankle sprains than male service members. »: There is a need for additional research on prevention methods and rehabilitation programs for ankle sprains in the military population because the rate of ankle sprain in this population exceeds that in populations with less physically demanding lifestyles. Consequently, low-cost prevention strategies could yield substantial benefits.
MeSH term(s)	Ankle Injuries/epidemiology ; Female ; Health Care Costs ; Humans ; Male ; Military Personnel ; Sprains and Strains/epidemiology
Language	English
Publishing date	2022-06-09
Publishing country	United States
Document type	Journal Article
ISSN	2329-9185
ISSN (online)	2329-9185
DOI	e21.00232
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Article ; Online: Traumatic Peroneal Nerve Injuries: A Systematic Review.

Mackay, Matthew J / Ayres, Jack M / Harmon, Ian P / Tarakemeh, Armin / Brubacher, Jacob / Vopat, Bryan G

JBJS reviews

2022 Volume 10, Issue 1

Abstract: Background: The common peroneal nerve (CPN) is the most commonly injured peripheral nerve of the lower extremity in patients with trauma. Traumatic CPN injuries have historically been associated with relatively poor outcomes and patient satisfaction, ... ...

Abstract	Background: The common peroneal nerve (CPN) is the most commonly injured peripheral nerve of the lower extremity in patients with trauma. Traumatic CPN injuries have historically been associated with relatively poor outcomes and patient satisfaction, although improved surgical technique and novel procedures appear to improve outcomes. Given the variety of underlying injury modalities, treatment options, and prognostic variables, we sought to evaluate and summarize the current literature on traumatic CPN injuries and to provide recommendations from an analysis of the included studies for treatment and future research. Methods: A systematic review was performed using PubMed, Embase, and Cochrane databases per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms consisted of variations of "peroneal nerve" or "fibular nerve" combined with "injury," "laceration," "entrapment," "repair," or "neurolysis." Information with regard to treatment modality, outcomes, and patient demographic characteristics was recorded and analyzed. Results: The initial search yielded 2,301 articles; 42 met eligibility criteria. Factors associated with better outcomes included a shorter preoperative interval, shorter graft length when an interposed graft was used, nerve continuity, and younger patient age. Gender or sex was not mentioned as a factor affecting outcomes in any study. Motor grades of ≥M3 on the British Medical Research Council (MRC) scale are typically considered successful outcomes. This was achieved in 81.4% of patients who underwent neurolysis, 78.8% of patients who underwent end-to-end suturing, 49.0% of patients who underwent nerve grafting, 62.9% of patients who underwent nerve transfer, 81.5% of patients who underwent isolated posterior tibial tendon transfer (PTTT), and 84.2% of patients who underwent a surgical procedure with concurrent PTTT. Conclusions: Studies included in this review were heterogenous, complicating our ability to perform further analysis. It is not possible to uniformly advocate for the best treatment option, given diverse injury modalities and patient presentations and a variety of prognostic factors. Many studies do not show outcomes with respect to injury modality. Future studies should show preoperative muscle strengths and should clearly define outcomes based on the injury modality and surgical treatment option. This would allow for greater analysis of the most appropriate treatment option for a given mechanism of injury. Newer surgical techniques are promising and should be further explored. Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
MeSH term(s)	Humans ; Nerve Transfer ; Peripheral Nerve Injuries ; Peroneal Nerve/injuries ; Peroneal Nerve/surgery ; Peroneal Neuropathies/etiology ; Peroneal Neuropathies/surgery ; Tendon Transfer
Language	English
Publishing date	2022-01-12
Publishing country	United States
Document type	Journal Article ; Systematic Review
ISSN	2329-9185
ISSN (online)	2329-9185
DOI	e20.00256
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Article ; Online: Augmented stress weightbearing CT for evaluation of subtle tibiofibular syndesmotic injuries in the elite athlete.

Campbell, Tanner / Mok, Anthony / Wolf, Megan R / Tarakemeh, Armin / Everist, Brian / Vopat, Bryan G

Skeletal radiology

2022 Volume 52, Issue 6, Page(s) 1221–1227

Abstract: Objective: We aim to present a novel imaging technique utilizing weight-bearing CT with syndesmotic stress to identify subtle, unstable syndesmotic injuries. We illustrate this with a case presentation of such an injury in an elite athlete that ... ...

Abstract	Objective: We aim to present a novel imaging technique utilizing weight-bearing CT with syndesmotic stress to identify subtle, unstable syndesmotic injuries. We illustrate this with a case presentation of such an injury in an elite athlete that ultimately required operative fixation. Materials and methods: In order to perform an augmented stress weightbearing CT, the patient is in the standing position, feet facing forward, and with weight distributed equally. The patient is then coached to internally rotate the shin and knee. This places an external rotational moment on the TFS due to the planted foot and ankle. The augmented stress images undergo 3D reconstruction and post-processing to render coronal and sagittal images. These are subsequently compared to standard, conventional weightbearing CT images performed without the external rotation stress. Results: We illustrate this technique by presenting a case in which a 21-year-old collegiate athlete sustained a Grade II syndesmotic injury, diagnosed by MRI and clinical exam without evidence of instability by standard weightbearing CT or weightbearing radiographs. After undergoing the augmented stress weightbearing CT, the instability was noted. This prompted subsequent operative fixation and ultimately return to sport. Conclusion: We propose this technique for diagnosing unrecognized, subtle dynamically unstable syndesmosis injuries where clinical suspicion persists despite negative imaging, particularly in the elite athlete.
MeSH term(s)	Humans ; Young Adult ; Adult ; Ankle Joint ; Ankle Injuries/surgery ; Weight-Bearing ; Tomography, X-Ray Computed ; Athletes ; Joint Instability
Language	English
Publishing date	2022-11-14
Publishing country	Germany
Document type	Journal Article
ZDB-ID	527592-1
ISSN	1432-2161 ; 0364-2348
ISSN (online)	1432-2161
ISSN	0364-2348
DOI	10.1007/s00256-022-04229-9
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Article: Return to Sport After Primary Anterior Cruciate Ligament (ACL) Reconstruction: A Survey of The American Orthopaedic Society for Sports Medicine.

Xu, Shin / Cheema, Sana G / Tarakemeh, Armin / Randall, Jeffrey / Bechtold, Megan / Mullen, Scott / Schroeppel, Paul / Mulcahey, Mary K / Vopat, Bryan G

Kansas journal of medicine

2023 Volume 16, Page(s) 105–109

Abstract: Introduction: Anterior cruciate ligament (ACL) tears are a common sports injury, and typically require a prolonged post-operative rehabilitation. The purpose of this study was to survey members of the American Orthopaedic Society for Sports Medicine ( ... ...

Abstract	Introduction: Anterior cruciate ligament (ACL) tears are a common sports injury, and typically require a prolonged post-operative rehabilitation. The purpose of this study was to survey members of the American Orthopaedic Society for Sports Medicine (AOSSM) to determine their return to sport (RTS) criteria after primary ACL reconstruction (ACLR). Methods: A 23-question, anonymous survey hosted through Google Results: A total of 863 surgeons responded over four months. The most popular graft choice was bone patellar tendon bone autograft (63%). For non-pivoting sports, 43% of respondents allowed RTS at five to six months, while 31% allowed RTS at seven to eight months. For pivoting sports, 34% of respondents allowed RTS at seven to eight months, while 36% allowed RTS at nine to ten months. The most common criteria for return to non-pivoting sports include full knee motion (89%) and time after ACLR (76%). The most common criteria for return to pivoting sports include full knee motion (87%) and passing a hop test (80%). Only 21% of respondents assessed for psychological readiness to RTS. Conclusions: RTS occurred sooner in non-pivoting than pivoting sports, with similar RTS criteria in both groups. Most respondents did not assess for psychological readiness to RTS.
Language	English
Publishing date	2023-04-24
Publishing country	United States
Document type	Journal Article
ISSN	1948-2035
ISSN	1948-2035
DOI	10.17161/kjm.vol16.18617
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Article: A Scoping Review to Assess Risk of Fracture Associated with Anxiolytic Medications.

Dallman, Johnathan / Aldag, Levi / Klass, Amanda / Hadley, Morgan / Clary, Steven / Tarakemeh, Armin / Zackula, Rosey / Morey, Tucker / Vopat, Bryan

Kansas journal of medicine

2023 Volume 16, Page(s) 222–227

Abstract: Introduction: Recent research has focused on evaluating the impact of pharmalogical sources on fracture risk. The purpose of this study was to review the literature on anxiolytic medications that may be associated with an increased risk of fracture.: ... ...

Abstract	Introduction: Recent research has focused on evaluating the impact of pharmalogical sources on fracture risk. The purpose of this study was to review the literature on anxiolytic medications that may be associated with an increased risk of fracture. Methods: A search was conducted in MEDLINE and Embase databases to identify primary clinical studies of patients who sustained a fracture while prescribed anxiolytic medications and were published prior to July 2021. Anxiolytics defined by ATC Class N05B, beta blockers, and zolpidem were included. The search terms consisted of variations of the following: ("Psychotropic Drugs" or MeSH terms) AND ("Fracture" or MeSH terms). Results: Of 3,213 studies, 13 (0.4%) met inclusion criteria and were evaluated. Fractures associated with benzodiazepine were reported in 12 of 13 studies; the highest risk occurred in patients aged 60 years and older (RR=2.29, 95% CI (1.48-4.40)). The ATC Class N05B showed an increased fracture risk for those ≤ 55 years of age that differed by sex: for men (RR=5.42, 95% CI(4.86-6.05)) and for women (RR=3.33, 95% CI (3.03-3.66)). Zolpidem also showed an increase fracture risk (RR=2.29, 95% CI(1.48-3.56)), but only during the first four weeks of treatment. A relative risk of 0.77, 95% CI(0.72-0.83) was observed for beta blockers. Conclusions: Fractures are a mainstay of traumatic injuries and are accompanied by economical, physiological, and psychological hardship. With proper assessment and prophylactic measures, fracture risk can be reduced dramatically. Anxiolytic medications have been described widely to increase fracture risk, such as benzodiazepines in 60+ year old patients, and ATC Class N05B anxiolytics increased fracture risk in 55+ year old men and in 55+ year old women. Yet, some studies showed that at low doses, nitrazepam lowered fracture risk. Other anxiolytic medications, such as zolpidem and beta blockers, also showed a decrease in fracture risk. Ultimately, this scoping review helped to illuminate the inconsistency of anxiolytic fracture risk assessment while simultaneously illustrating the necessary steps to guide future research.
Language	English
Publishing date	2023-08-24
Publishing country	United States
Document type	Journal Article ; Review
ISSN	1948-2035
ISSN	1948-2035
DOI	10.17161/kjm.vol16.20091
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Article ; Online: Rib Stress Fractures and a Novel Muscle-Sparing Rib Fixation Plating in an Elite Tennis Player: A Systematic Review of the Literature and Case Report.

Fearing, Marcus / Behzadpour, Vafa / House, Richard D / Tarakemeh, Armin / Morey, Tucker / Randall, Jeffrey / Vopat, Bryan / Darche, Jean-Philippe

Sports health

2023 , Page(s) 19417381231195271

Abstract: A nationally ranked Division One female collegiate tennis player presented with pain in the chest and right posterior rib region after feeling a popping sensation during a routine overhead movement. The patient was eventually diagnosed with 2 lower rib ... ...

Abstract	A nationally ranked Division One female collegiate tennis player presented with pain in the chest and right posterior rib region after feeling a popping sensation during a routine overhead movement. The patient was eventually diagnosed with 2 lower rib stress fractures. After unsuccessful conservative management, the player underwent an open reduction and internal fixation and autologous bone grafting of the sixth and seventh ribs with a muscle-sparing approach and was able to return to full competition. We present this case along with a systematic review of the literature regarding rib stress fractures, which included 6 separate online data sources (PubMed, EMBASE, Cochrane, CINAHL, SportDiscus, and Medline). The successful surgical intervention demonstrates a significant option for elite athletes who wish to return to competition but have been unable to with standard of care conservative management of rib stress fractures.
Language	English
Publishing date	2023-09-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2508802-6
ISSN	1941-0921 ; 1941-7381
ISSN (online)	1941-0921
ISSN	1941-7381
DOI	10.1177/19417381231195271
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Article ; Online: Various Definitions of Failure Are Used in Studies of Patients Who Underwent Anterior Cruciate Ligament Reconstruction.

Aldag, Levi / Dallman, Johnathan / Henkelman, Erik / Herda, Ashley / Randall, Jeffrey / Tarakemeh, Armin / Morey, Tucker / Vopat, Bryan G

Arthroscopy, sports medicine, and rehabilitation

2023 Volume 5, Issue 6, Page(s) 100801

Abstract: Purpose: To conduct a literature review to assess the definitions of anterior cruciate ligament reconstruction (ACLR) failure used throughout the orthopaedic literature.: Methods: A systematic search of Embase, Ovid Medline, SPORTDiscus, and Web of ... ...

Abstract	Purpose: To conduct a literature review to assess the definitions of anterior cruciate ligament reconstruction (ACLR) failure used throughout the orthopaedic literature. Methods: A systematic search of Embase, Ovid Medline, SPORTDiscus, and Web of Science was conducted by a university librarian to identity level I-IV clinical studies on ACLR failure. Inclusion criteria consisted of patients who underwent ACLR and included a definition of failure of ACLR. Patients who underwent anterior cruciate ligament (ACL) repairs, animal/cadaver studies, review studies, non-English language articles, and non-full text articles were excluded. Failure data were extracted from each study and categorized. Other data that were extracted included follow-up time after ACLR, failure reoperation rate, and failure reoperation procedure. Descriptive statistics was used to analyze the data. Results: Out of 2,775 studies, 104 (3.75%) met inclusion criteria and were analyzed in this review. The most common definition of ACLR failure included the use of a physical examination, specifically Lachman's test (21/104 [20.2%]), anterior laxity assessment, or a Pivot-Shift test (24/104 [35.2%]) or undergoing or requiring revision ACLR (39/104 [37.5%]). Although some studies used quantitative tests or imaging to help define "failure," others simply defined it as graft rerupture that was otherwise not defined (22/104 [22.5%]). Other common definitions included: the use of imaging (magnetic resonance imaging/radiographs) to confirm graft re-rupture (37/104 [35.6%]), patient-reported outcomes (recurrent instability)/patient reported outcomes measures (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Tegner) (18/104 [17.3%]), and the use of an arthrometer (KT-1000/2000, Rollimeter, or Kneelax) (17/104 [16.3%]). The least common definitions included graft failure or rerupture confirmed by arthroscopy (13/104 [12.5%]) and nonrevision surgery (2/104 [1.0%]). The failure rate of this procedure ranged from 0% to 100% depending on the definition of "failure." Conclusion: In this study, we found that a variety of definitions of failure are used among studies published in the orthopaedic literature. The most common criteria for failure of ACLR were the results of physical examination tests (35%), the need for undergoing a revision ACLR (36%), and the use of imaging to diagnose the failure (34%). About 17% of studies included in this review used patient-reported outcomes, specifically recurrent instability, or PROMs (IKDC, KOOS, Tegner) in their assessment of failure of ACLR. The least used definitions of "failure" of ACLR included nonrevision ACLR surgery (2%). Although some studies used similar tests or categories in their definition of failure, there were a variety of score and grade cutoff points between them. Level of evidence: Level IV, systematic review of Level II-IV studies.
Language	English
Publishing date	2023-09-22
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2666-061X
ISSN (online)	2666-061X
DOI	10.1016/j.asmr.2023.100801
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Article ; Online: Current Definitions of Failure in Lateral Ankle Instability Surgery: A Systematic Review.

Dallman, Johnathan / Wolf, Megan R / Campbell, Tanner / Herda, Trent / White, Jacob / Tarakemeh, Armin / Vopat, Bryan G

The American journal of sports medicine

2023 Volume 51, Issue 10, Page(s) 2748–2757

Abstract: Background: "Failure" is a term that is frequently used to describe an unfavorable outcome for patients who undergo surgical treatment for lateral ankle instability (LAI). A standard definition of failure for the surgical treatment of ankle instability ... ...

Abstract	Background: "Failure" is a term that is frequently used to describe an unfavorable outcome for patients who undergo surgical treatment for lateral ankle instability (LAI). A standard definition of failure for the surgical treatment of ankle instability has not been established by clinicians and researchers. Purpose: To identify the definitions of ankle instability treatment failure that are currently in the literature and to work toward the standardization of the definition. Study design: Systematic review; Level of evidence, 4. Methods: A systematic search of MEDLINE, SPORTDiscus, CINAHL, Embase, and Web of Science was conducted to identify clinical studies that included patients who underwent surgical treatment for LAI and included information about surgical failure. Studies with level of evidence 1 to 4 were included in this review. Animal studies, biomechanical studies, cadaveric studies, review articles, and expert opinions were excluded. The included studies were then reviewed for definitions of failure of any surgical procedure that was performed to correct LAI. Results: Of the 1200 studies found, 3.5% (42/1200) published between 1984 and 2021 met the inclusion criteria and were analyzed. After reviewing the data, we found numerous definitions were reported in the literature for LAI surgical failure. The most common was recurrent instability (40% [17/42]), followed by rerupture (19% [8/42]). For the original surgical procedure, the anatomic Broström-Gould technique was used most frequently (57% [24/42]). The failure rate of the Broström-Gould technique ranged from 1.1% to 45.2% depending on the definition of failure. Conclusion: There were multiple definitions of failure for the surgical treatment of LAI, which is one of the reasons why the rate of failure can vary greatly. The literature would benefit greatly from the standardization of the definition of ankle instability treatment failure. This definition should include specific, objective physical examination findings that eliminate the ambiguity surrounding failure.
MeSH term(s)	Humans ; Ankle Joint/surgery ; Lateral Ligament, Ankle/surgery ; Ankle/surgery ; Orthopedic Procedures/methods ; Joint Instability/diagnosis ; Joint Instability/surgery ; Joint Instability/etiology
Language	English
Publishing date	2023-03-14
Publishing country	United States
Document type	Systematic Review ; Journal Article
ZDB-ID	197482-8
ISSN	1552-3365 ; 0363-5465
ISSN (online)	1552-3365
ISSN	0363-5465
DOI	10.1177/03635465231153165
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