Published 8/1/2015
Mary Ann Porucznik

Trauma, Toe, and TAR Papers Take Awards

Scientific papers on inflammatory mediators after ankle fracture, treatment of advanced hallux rigidus, and functional outcomes after total ankle replacement (TAR) were recognized during the 2015 annual meeting of the American Orthopaedic Foot & Ankle Society (AOFAS), held in Long Beach, Calif., July 15–18, 2015.

J. Leonard Goldner Award
A paper on “Inflammatory Cytokines and Matrix Metalloproteinases (MMPs) in the Synovial Fluid after Intra-articular Ankle Fracture” received the 2015 J. Leonard Goldner Award, recognizing outstanding basic science research. Noting that synovial fluid exhibits a degraded environment of largely pro-inflammatory mediators similar to that described in idiopathic osteoarthritis (OA), researchers hoped to characterize the inflammatory cytokine and MMP composition by comparing synovial fluid from an injured ankle with that from the contralateral joint.

The 21 patients in the study had no history of trauma, but had sustained a unilateral intra-articular ankle fracture in one leg. The contralateral joint was pain free and had no radiographic evidence of arthritis, so it served as the matched control. Surgery was performed at a mean of 17 days after the injury (range, 8 to 40 days). Synovial fluid was obtained from both ankles and analyzed for the presence of several different cytokines and MMPs, including tissue necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), IL-2, IL-6, IL-8, IL-10, MMP-1, MMP-2, MMP-3, MMP-9, MMP-10, and sulfated glycosaminoglycans, among others.

Synovial fluid from the injured ankle had significantly higher concentrations of IL-6, IL-8, IL-10, MMP-1, MMP-2, MMP-3, MMP-9, and MMP-10 compared to the uninjured contralateral ankle. However, TNF-α levels were significantly higher in the uninjured ankle’s synovial fluid. No significant differences were found in the levels of the other mediators tested.

“These data lend credence to reducing acute intra-articular inflammation through the development of antagonists to these pro-inflammatory and degradatory mediators,” concluded the authors. “Likewise, early synovial fluid aspiration and lavage might reduce the intra-articular pro-arthritic burden.”

Roger A. Mann Award
The Roger A. Mann award for outstanding clinical paper was presented to the authors of “A Prospective, Randomized, Multicenter Clinical Trial Assessing Efficacy of a Synthetic Cartilage Implant to First Metatarsophalangeal (MTP) Arthrodesis in Advanced Hallux Rigidus.”

Although great toe arthrodesis is the “gold standard” for treating advanced hallux rigidus, researchers sought to maintain toe motion by using a small (8 mm–10 mm) hydrogel implant instead. The prospective study involved 202 patients randomized (2:1) to a synthetic cartilage implant or first MTP fusion. The primary endpoint consisted of a composite of pain, function, and safety measures.

Based on the results of this study, the authors concluded, “The synthetic implant is an excellent alternative to arthrodesis in patients who wish to maintain first MTP motion. The need for secondary surgical procedures was similar between groups. Less than 10 percent of implant patients required revision to arthrodesis at 2 years, and outcomes from the revision surgery were comparable to primary fusion.”

IFFAS Award for Excellence
The International Federation of Foot and Ankle Societies (IFFAS) Award for Excellence was presented to “Radiographic Severity of Arthritis Predicts Functional Outcomes in Total Ankle Replacement.” This was a retrospective review of 124 TARs performed by a single surgeon; all patients were part of a hospital joint registry and had a minimum of 1 year follow-up.

Preoperative weight-bearing radiographs were reviewed and graded for OA severity. Pain, function, stiffness, general health, and patient satisfaction scores were collected prior to surgery and at 1 and 2 years postoperative. Although demographic data and preoperative pain, function, and stiffness scores were similar across all grades of OA, patients whose OA was more pronounced were significantly more satisfied (P = 0.001) than those with less severe radiographic disease.

Patients with the most severe OA also saw the greatest improvement in pain, function, and stiffness and were more likely to say they would have the surgery again. Although the researchers noted that their study does not explain all of the dissatisfaction in TAR, “radiological severity is an important factor that the surgeon must consider. Patients with less severe arthritis on X-ray are at risk of being dissatisfied postoperatively. The surgeon should be cautious when offering arthroplasty to these patients.”

For more information on the AOFAS annual meeting, visit www.aofas.org

Mary Ann Porucznik is managing editor, AAOS Now. She can be reached at porucznik@aaos.org

Congratulations to the Award-Winning Authors

J. Leonard Goldner Award
Inflammatory Cytokines and Matrix Metalloproteinases (MMPs) in the Synovial Fluid after Intra-articular Ankle Fracture:
Samuel B. Adams Jr, MD;
Lori Setton, PhD; Richard Bell, BS; Mark Easley, MD; Janet Huebner, MS; Thomas Stabler, MS; Virginia Kraus, MD, PhD; Elizabeth Leimer, BS; Steven Olson, MD; Dana Nettles, PhD

Roger A. Mann Award
A Prospective, Randomized, Multicenter Clinical Trial Assessing Efficacy of a Synthetic Cartilage Implant to First Metatarsophalangeal (MTP) Arthrodesis in Advanced Hallux Rigidus:
Judith Baumhauer, MD, MPH;
Dishan Singh, FRCS; Mark Glazebrook, MSc, PhD, MD, FRCSC; Chris Blundell, BMedSci (Hons), MB, ChB, MD, FRCS (Tr&Orth); Guy Wansbrough, MBBS, FRCS (Tr&Orth), BEng; Gwyneth Devries, MD, FRCSC; Ian L.D. Le, MD; Dominic Nielsen, MD; Elizabeth Petersen, MD; Anthony Sakellariou, FRCS (Tr&Orth); Matthew Solan, MD; Alastair S.E. Younger, MD, FRCSC; Timothy R. Daniels, MD, FRCSC; MOTION Study Investigators from the United Kingdom and Canada

IFFAS Award for Excellence
Radiographic Severity of Arthritis Predicts Functional Outcomes in Total Ankle Replacement:
Simon Chambers, FRCS (Tr&Orth); Jayasree Ramaskandhan, MSc, MPTh; Malik Siddique, FRCS (Tr&Orth)

One or more of the authors reported potential conflicts of interest. For more information, visit www.aofas.org or search www.aaos.org/disclosure