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Negative spillovers due to firms’ product-harm crises have attracted the attention of marketing researchers owing to the devastating and irrecoverable damage they can cause. Despite the extensive research undertaken on this topic, studies concerning spillovers across competing brands from different companies are relatively scant. Drawing upon self-construal theory, we propose that spillover effects across competing brands from different companies may vary depending on consumers’ self-construal and on the perceived similarity between the brands. The results of two studies show that, when the brands’ perceived similarity is high, the spillover effect of a product-harm crisis on a competing brand from a different company is greater for consumers with interdependent self-construal than for those with independent self-construal. Our findings extend the theoretical knowledge of spillover effects and provide meaningful managerial implications for global corporations.

Background: The mobile-bearing Salto total ankle prosthesis has been reported to have promising outcomes. However, clinical reports on this prosthesis are few, and most have been published by the inventors and disclosed consultants. Methods: We retrospectively reviewed 59 patients who received Salto prosthesis unilaterally. The average follow-up was 35.9 (range, 6-56) months. Clinical and radiologic results were evaluated. Clinical results were evaluated according to visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Ankle Osteoarthritis Scale (AOS) pain and disability score, and ankle range of motion (ROM) in dorsiflexion/plantarflexion. In the radiographic evaluation, we measured the tibial angle (TA), talar angle (TAL), tibial slope, and talocalcaneal angle (TCA) on weightbearing radiographs. Results: By the last follow-up, 7 of 59 patients (11.9%) had undergone reoperation, and 3 of 59 implants (5.1%) had been removed. The prosthesis survival was 94.9% (95% CI, 89.1%-100%). With any reoperation as the endpoint of follow-up, the clinical success rate was 88.1% (95% CI, 79.4%-96.9%). The mean postoperative visual analog scale score, AOFAS ankle-hindfoot score, and Ankle Osteoarthritis Scale pain and disability score improved significantly ( P < .001). The ankle range of motion also improved from preoperative 33.4 ± 16.6 to 40.3 ± 15.5 postoperatively ( P < .001); however, there was no statistically significant change in plantarflexion ( P = .243). Radiolucent areas and osteolysis were found in 28 (47.5%) and 27 (45.8%) patients, respectively. Heterotopic ossification was observed in 13 patients (22.0%). Conclusions: In this series, early clinical and radiographic outcomes of this prosthesis were promising. We believe the early radiolucent lines were probably due to the gap at the implant and bone interface, and they disappeared at the time of osseous integration. However, longer follow-up is necessary to determine the long-term durability and survivorship of this implant, particularly given the high incidence of postoperative osteolysis. Level of Evidence: Level IV, case series.

Background:The modified Broström procedure for chronic lateral ankle instability (CLAI) has presented outstanding clinical results. However, after the procedure, some patients with generalized ligamentous laxity have experienced a recurrence of ankle instability.Purpose:To understand the effect of generalized ligamentous laxity on prognosis and risk of recurrence in a cohort of patients with CLAI after the modified Broström procedure.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 199 ankles from 188 patients underwent the modified Broström procedure for CLAI with a mean follow-up of 60.1 months (range, 48-108 months). Generalized ligamentous laxity was assessed in all patients. The Karlsson-Peterson ankle score (Karlsson score), talar tilt angle, and anterior displacement of the talus were used to evaluate clinical and radiological outcomes. Risk factors associated with clinical outcomes were evaluated using bivariate analysis and logistic regression analysis. Survival outcomes were compared using Kaplan-Meier analysis.Results:Generalized ligamentous laxity was evident in 42 cases (21.1%). The average Karlsson score improved from 54.6 ± 7.1 preoperatively to 87.9 ± 7.2 at last follow-up ( P < .001). The presence of generalized ligamentous laxity was significantly associated with poor clinical and radiological outcomes. The rates of clinical failure were 10.8% and 45.2% in the nonlaxity group and the laxity group, respectively ( P < .001). According to bivariate analysis, generalized ligamentous laxity, syndesmosis widening, osteochondral lesion of the talus, high preoperative talar tilt angle (>15°), and high preoperative anterior displacement of the talus (>10 mm) were significantly associated with clinical failure. Multivariate logistic regression analysis revealed that generalized ligamentous laxity was the most important independent predictor of clinical failure after the modified Broström procedure. The cumulative success rates for the nonlaxity group were significantly superior to those for the laxity group in Kaplan-Meier curves ( P < .001).Conclusion:Generalized ligamentous laxity is an independent predictor of poor outcomes and a risk factor of recurrent instability following the modified Broström procedure for CLAI.

Despite the prevalence of celebrity endorsers for brands that feature sustainable products, there are few empirical studies on what factors should be considered in utilizing endorsers in marketing sustainable products. In this study, we explored the relationships between celebrity endorsers’ characteristics and consumers’ perceptions, attitudes, and purchase intentions toward a brand that markets sustainable products. The data were collected via an online survey with a total of 1,220 responses, and structural equation modeling was used to test the hypotheses. In the results, endorser trustworthiness and endorser-brand congruity positively predicted brand credibility while endorser ethicality and endorser-brand congruity positively predicted brand ethicality. Brand ethicality positively predicted brand credibility. Brand credibility positively predicted brand attitude as well as brand purchase intention. Although brand ethicality positively predicted brand attitude, it did not predict brand purchase intention. Lastly, brand attitude positively predicted brand purchase intention. Theoretical and practical implications were discussed.

Background: Tendinopathy is a clinical problem for which treatment shows mixed results and treatment options are limited. Gene expression signatures early in the mechanotransduction pathway can accurately predict risk and correlate with different clinical outcomes. Studies aimed at elucidating the molecular mechanisms of tendinopathy have focused on small cohorts of genes that show an incomplete picture of the degeneration process. This study compared the effect of cyclic strain on gene expression in tendon cells from normal tendon and chronically painful areas of tendinopathy in 3 patients. Methods: We measured a panel of mechanotransduction genes and cytoskeletal tensional balance with and without cyclic strain, which disrupts connective tissue synthetic-degradative equilibrium. Normal and degenerative tendons were obtained from patients undergoing surgery to treat chronic painful tendinopathy. A cyclic strain model was established to measure cytoskeletal tensional homeostasis. Results: Prior to cyclic strain, the normal tendon cells exhibited varying patterns of elevated expression of 7 genes compared with degenerative tendon cells. In response to cyclic strain, gene expression of COL1A1, ITGA6, CTNNA1, and CLEC3B was up-regulated in normal tendon cells. Cyclic strain had no effect on degenerative tendon cells. Cyclic strain exacerbated the inhibition of protein synthesis in both cell types, especially in the degenerative tendon cells. Conclusion: Alterations in the pattern of gene expression are suggestive of a dynamic equilibrium between synthesis and degradation, whereby cell adhesion molecules are predominantly up-regulated to facilitate cellular reorientation in response to their altered functional environment. Clinical Relevance: These data might have future applications, including the identification of markers for early diagnosis, targets for drug design, and indicators for treatment responsiveness and prognosis.

Background: Several studies have reported on the outcome of arthroscopic treatment or osteochondral autologous transplantation (OAT) for osteochondral lesions of the talus (OLT), with mixed results. None of these studies has compared the results of repeat arthroscopy and OAT after failed primary arthroscopic treatment. Purpose: To compare the outcomes of OAT and repeat arthroscopy for the treatment of OLT after primary arthroscopy Study Design: Cohort study; Level of evidence, 3. Methods: This study included 22 patients who underwent OAT (group A) and 22 patients who underwent repeat arthroscopy (group B) after failed treatment of OLT among 399 patients who received primary arthroscopic marrow stimulation at single institution between 2001 and 2009. All patients were evaluated clinically using the visual analog scale (VAS) for pain and American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale. The cumulative success rates were compared by use of Kaplan-Meier life table analysis. Results: The patients’ demographic and clinical characteristics and indications for surgery were comparable between the groups. Both groups showed significantly improved ( P < .001) VAS and AOFAS scores 6 months after surgery. However, group B showed significant deterioration over a mean follow-up period of 50 months. Overall, 18 of 22 (81.8%) patients in group A and 7 of 22 (31.8%) patients in group B achieved an excellent or good (≥80) AOFAS score ( P < .001). No patient in group A and 14 of 22 (63.6%) in group B required further revisions. Conclusion: Osteochondral autologous transplantation was significantly superior to repeat arthroscopic treatment of OLT after a mean follow-up period of 48 months. Therefore, repeat arthroscopy should be used judiciously for the treatment of OLT after failed arthroscopic treatment.

Background: Periprosthetic osteolysis in total ankle arthroplasty (TAA) is a substantial problem. We report the incidence and characteristics of periprosthetic osteolysis and its association with clinical outcomes after TAA using the HINTEGRA ankle system. Methods: Between May 2004 and April 2010, 126 primary TAA were performed on 115 patients. We excluded 27 ankles with a follow-up of less than 24 months; thus, 99 ankles in 90 patients with a mean follow-up of 40.8 (range, 24–89) months were included in the study. Pain and clinical outcomes were assessed using the visual analog scale and the American Orthopaedic Foot and Ankle Society score. Fluoroscopy was used for optimum visualization of the bone-implant interfaces on radiographs. Computed tomography (CT) was conducted on 25 ankles that exhibited progression of osteolysis. Results: Radiographs revealed that 37 of the 99 ankles showed radiologic evidence of osteolysis; of these, 10 demonstrated continuous progression over the study period. Helical CT scans were more accurate than radiographs for identifying and measuring periprosthetic osteolysis in TAA. None of the demographic parameters were substantially different between the 2 groups of subjects (with or without osteolysis). No major association was found between the presence of osteolysis and clinical and radiologic outcomes. Conclusion: Osteolysis associated with TAA may indeed be common in the postoperative period. Although most of the osteolytic lesions observed here were relatively quiescent, these lesions raise concerns in contemporary TAA because of their incidence rate and the potential for later mechanical failure as compared to arthrodesis. Early diagnosis and careful evaluation of osteolysis may provide a clinical opportunity for limited revision surgery in ankles of impending prosthesis failure. Level of Evidence: Level IV, case series.

Consumers tend to have more favorable attitudes for their in-group brands than their out-group brands. However, little is known regarding how brand managers can overcome consumers’ negative attitudes toward out-group brands. Drawing on the moral identity literature, the authors theorize that moral identity may enhance out-group (but not in-group) brand attitudes through decreased psychological distance. Four studies demonstrate that moral identity increases out-group brand attitudes. The authors also identify two important boundary conditions of this moral identity effect. These findings suggest that brand managers who want to overcome the less-than-favorable perceptions associated with out-group brands may benefit from drawing on consumers’ moral identity in marketing communications. Theoretically, this research establishes that moral identity extends beyond prosocial behaviors to influence marketplace judgments (i.e., brand attitudes and categorization).

Background: Among the types of osteochondral lesions of the talus (OLTs), the osteochondral and chondral types make up the majority of OLTs. There is a possibility that between these two types of lesions, the clinical outcomes and characteristics may differ. Purpose: This study was designed to compare the clinical outcomes, demographics, and characteristics of osteochondral- and chondral-type lesions of OLTs. Study Design: Cohort study; Level of evidence, 3. Methods: The authors retrospectively analyzed 298 ankles that underwent arthroscopic marrow-stimulating procedures for OLTs between 2001 and 2009 that had been arthroscopically determined as either chondral type (210 ankles) or osteochondral type (88 ankles). Clinical outcomes, demographics, and characteristics of the lesions were compared. Results: The age distribution showed that the chondral type reached its peak in patients in their 50s, whereas the osteochondral type had a peak distribution for those in their 20s. The average duration of symptoms was greater in the chondral type (28.3 months; range, 7-240 months) than in the osteochondral type (14.4 months; range, 8-120 months) ( P < .001). With regard to the characteristics of the lesions, differences only existed in the combined intra-articular lesions between the two types. Subchondral cysts (odds ratio [OR], 3.71; 95% CI, 1.61-8.55; P = .001) and soft tissue impingement (OR, 1.82; 95% CI, 1.10-3.03; P = .021) were more frequently present in the chondral type. The American Orthopaedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) for pain showed significant improvement from preoperative to postoperative scores in both groups. However, the preoperative and postoperative VAS and AOFAS scores did not differ significantly between the groups. Conclusion: Differences were found with age distribution, duration of symptoms, and combined intra-articular lesions between the osteochondral- and chondral-type lesions of OLTs. We achieved similar successful clinical outcomes in both types of lesions using arthroscopic marrow stimulating procedures, such as microfracture or abrasion arthroplasty.

Ligament balancing during total ankle arthroplasty is an important step in optimizing the mechanical balance of the ankle joint. Soft-tissue contractures that result from varus or valgus coronal plane deformity can pose a difficult problem, and the surgeon should have a standard procedure for managing such situations in the operating room. Balance may be assessed intraoperatively with the use of spacer blocks, laminar spreaders, and tensioning devices as well as by placement of trial components. Techniques used to balance the varus or valgus ankle during primary total ankle arthroplasty include osteophyte resection, soft-tissue release, and bone resection. Mediolateral ligament balancing is crucial for long-term success and patient satisfaction.

Background: The majority of lateral ankle instability can be treated successfully with conservative method. However, if such treatments fail, surgical treatment should be considered. A wide variety of procedures have been introduced to treat chronic lateral ankle instability. The percutaneous method avoids dissection which is associated with open surgery and can lead to excessive morbidity. The purpose of this study was to evaluate the clinical and radiological outcomes of percutaneous lateral ligament reconstruction with an allograft in the treatment of chronic lateral ankle instability. Methods: Between October 2006 and April 2009, percutaneous lateral ligament reconstruction using an allograft was performed on 15 ankles in 13 patients for chronic lateral ankle instability. The patients included in this study satisfied at least one of the following criteria: a previously failed reconstruction of the ligament, severe ankle instability (more than 15 degrees of talar tilt, more than 10 mm of anterior drawer), general laxity of ligaments, body mass index (BMI) higher than 25. The mean followup period was 18.1 (range, 12 to 40) months. The grafted tendon was secured by double tenodeses at both the talus and calcaneus or triple tenodeses which included a fibular tenodesis. The clinical outcomes were evaluated with Visual Analogue Scale (VAS) for pain, Karlsson-Peterson ankle score, and patients' subjective satisfaction. The radiological results were evaluated using the varus tilting angle and the anterior displacement distance. Results: The VAS improved from preoperative 3.7 ± 2.2 to 1.6 ± 1.3 at the last followup ( p = 0.002). The Karlsson-Peterson ankle score increased from 54.2 ± 8.8 to 80.9 ± 7.2 ( p = 0.001). Patients were satisfied in 13 cases (86.7%) with excellent or good results. Radiologically, the mean varus tilting angle was 15.5 ± 4.4 degrees preoperatively and 7.3 ± 3.6 at the last followup ( p = 0.001). The anterior drawer distance was 10.1 ± 3.3 mm preoperatively and 7.2 ± 2.7 mm at last followup ( p = 0.001). Conclusion: We believe percutaneous lateral ligament reconstruction with allograft to be a useful method as a salvage procedure for the treatment of severe and complicated types of chronic lateral ankle instability. Furthermore, the minimal invasiveness of this technique provides a good cosmetic outcome and we found it to be a technically easy and fast procedure. Level of Evidence: Comparative Case Series

Background: Several studies have addressed the issue of the feasibility of arthroscopic surgery in older patients, usually by choosing an arbitrary age limit. Hypothesis: Patient age is not associated with poor clinical outcome after arthroscopic surgery for osteochondral lesion of the talus (OLT), and other patient variables are the major determinants of clinical success/failure. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2001 and 2008, 173 ankles underwent arthroscopic marrow stimulation treatment for OLT and were stratified into 6 age groups ( Results: There were no significant differences among the 6 age groups in the preoperative and postoperative visual analog scale (VAS) for pain or the American Orthopaedic Foot and Ankle Society (AOFAS) score. There was a significant increase in the duration of symptoms ( P < .001) and a significant decrease in the incidence of trauma ( P = .01) in the older group. Both the size of the osteochondral defect and the number of associated intra-articular lesions independently predicted a poor clinical outcome ( P < .001). Conclusion: In contrast to some of the previous studies on this topic, we found that increased age was not an independent risk factor for poor clinical outcome after arthroscopic treatment for OLT. We did find that older patients were less likely to have a history of trauma and had a longer duration of symptoms, had smaller osteochondral defects, and had more associated intra-articular lesions.

Background: The purpose of our study was to determine the efficacy of a management algorithm that includes negative pressure wound therapy (NPWT) in diabetic feet with limb-threatening infection. Materials and Methods: Forty-five septic diabetic feet were treated with NPWT between 2006 and 2008. After emergent abscess evacuation, early vascular intervention was performed if necessary. Debridement, with or without partial foot amputation, was followed by NPWT. Wound progress was measured using a digital scanner. A limb was considered salvaged if complete healing was achieved without any or with minor amputation through or below the ankle. The mean followup after complete wound healing was 17 (range, 6 to 35) months. Results: Thirty-two cases (71%) were infected with two or more organisms. Negative pressure wound therapy was applied for 26.2 ± 14.3 days. The median time to achieve more than 75% wound area granulation was 23 (range, 4 to 55) days and 104 (range, 38 to 255) days to complete wound healing. Successful limb salvage was achieved in 44 cases (98%); 14 (31%) without any amputation and 30 (67%) with partial foot amputations. Total number of operations per limb was 2.4 ± 1.3. One case of repeated infection and necrosis was managed with a transtibial amputation. There were no complications associated with NPWT. Conclusion: This study provides the outcome of a management algorithm which includes NPWT in salvaging severely infected diabetic feet. With emergent evacuation of abscess, early vascular intervention and appropriate debridement, NPWT can be a useful adjunct to the management of limb-threatening diabetic foot infections. Level of Evidence: IV, Retrospective Case Series

Background: Ossicles at the tip of the lateral malleolus are frequently found in patients with chronic lateral ankle instability (CLAI). However, the relationship between the presence or the size of an ossicle and the outcome of ligament reconstruction is poorly understood. Therefore, this study aimed to evaluate the effect of an ossicle at the tip of the lateral malleolus on ligament reconstruction in CLAI. Materials and Methods: Seventy-four ankles with chronic lateral instability that received lateral ligament reconstruction using a modified Broström technique between January 2001 and March 2007 were included. The mean followup was 47 (range, 25 to 89) months. Ankles were divided into 2 groups: the ossicle group (26 ankles, 35.1%) and the non-ossicle group (48 ankles, 64.9%). Then, depending on the size, the ossicle group was subdivided into small (less than 10 mm, 14 ankles) and large ossicles (greater than 10 mm, 12 ankles). Pre- and postoperative Karlsson-Peterson ankle scores and findings on stress radiographs were compared between the groups. Results: Both the ossicle and non-ossicle groups improved significantly on stress radiographs without difference between the groups. Karlsson-Peterson ankle scores showed functional improvement in each group, however, the mean score at last followup was significantly lower in the ossicle group ( p = 0.01). The prevalence of an osteochondral lesion of the talus was significantly higher in the ossicle group ( p = 0.046). In ankles with large ossicles, varus stability was achieved but anterior displacement of the talus was not improved after ligament reconstruction. Conclusion: The surgeon should be aware of the inferior functional outcome in ankles with ossicles. Also, when the ossicle is large, excision and modified Broström technique may not be suitable to achieve mechanical anteroposterior stability. Therefore, fusing the ossicle to the fibular tip or using other methods of ligament reconstruction can be considered when performing ligament reconstruction in CLAI with associated large ossicles. Level of Evidence: III, Retrospective Comparative Study

Background: Although several studies have described good results of proximal chevron and Ludloff osteotomies, there have been no studies comparing the results of these two techniques at a single institution. Materials and Methods: We consecutively evaluated 46 patients who underwent proximal chevron osteotomies and 52 patients who underwent Ludloff osteotomies. Patients were evaluated by preoperative and postoperative weight bearing radiographs and the American Orthopaedic Foot and Ankle Society (AOFAS) hallux MP score. Results: Both groups had similarly high AOFAS scores and good correction by radiographic parameters. No statistically significant differences were found with respect to correction of hallux valgus angle (HVA) and intermetatarsal angle (IMA) between the two groups. Significant shortening of the first metatarsal was found after Ludloff osteotomy ( p < 0.05). At 6 weeks after surgery, the pain subscore was significantly lower in the proximal chevron group than in the Ludloff group ( p < 0.05). Conclusions: The proximal chevron and Ludloff osteotomies yielded equivalent clinical and radiological results. The Ludloff osteotomy with lag screw fixation is more stable and does not require postoperative hardware removal, although it is technically demanding and has a tendency toward greater shortening of the first metatarsal. Level of Evidence: III, Retrospective Comparative Study

Background: Isolated involvement of bone in tuberculous infection is uncommon, and the variable clinical and radiological features may mimic pyogenic osteomyelitis, bone tumor or other inflammatory and neoplastic processes of the synovium. We have reported our experiences with the diagnosis of tuberculosis infection in the ankle and foot with the hope of providing sufficient information about these cases to lead to early diagnosis. Materials and Methods: We treated 15 patients with tuberculosis involving the foot and ankle between 1995 and 2005. They were followed for a minimum of 24 months, and the average duration of symptoms was 23 months. All patients underwent a physical examination, routine laboratory tests, plain radiographs, and a biopsy of the infection site. MRI studies were performed in 10 patients and a CT scan was done in one patient. Results: The lesions were located in the forefoot (2), midfoot (3) and ankle (10). From the imaging studies, the presumptive preoperative diagnoses were tuberculous osteomyelitis (7), pyogenic osteomyelitis (4), pigmented villonodular synovitis (2), amyloidosis (1), and avascular necrosis of the talus (1). These diagnoses were verified by granulomatous inflammation with or without caseous necrosis on histology and tubercle bacilli were cultured in four cases. In three cases the diagnosis was made by polymerase chain reaction (PCR). Conclusion: When a patient presents with a localized, painful swelling and a persistent draining sinus of the foot and ankle, tuberculosis should be considered in the differential diagnosis. Additionally, we highly recommend taking a biopsy of the site of suspected infection because an early diagnosis is the key to successful treatment.

Category: Diabetes Introduction/Purpose: Fast and complete healing of a diabetic foot ulcer (DFU) is challenging due to the hostile wound healing environment of the diabetic patients. As a part of a multimodal treatment approach, advanced dressing material using hyaluronic acid (HA) has been found to be effective. However, previous studies have used HA with additional biologics, which interferes in determining the true clinical effect of HA in DFU. The purpose of this study is to examine the effectiveness and safety of a new HA dressing material in the treatment of DFU. Methods: This study was a prospective, randomized, placebo-controlled, single-center study conducted between September 2012 and January 2014. The inclusion criteria were type 1 or 2 diabetes, a ulcer size ≥ 1.0 cm2 that did not exhibit signs of healing for 6 weeks, Wagner grade 1 or 2, and palpable pulses at the ankle. The assessments of DFU included size, microbial culture study, detailed description of the DFU, and clinical photos. Patients in the study group were treated with an HA dressing material (hyaluronic acid 80 ± 5% and poloxamer 10 ± 5%), while patients in the control group were treated with a conventional moisture- retentive dressing (petrolatum gauze). Weekly follow-up was conducted with the dressing change up to maximum 12 weeks. Complete ulcer healing rate was evaluated as a primary endpoint. Additionally, healing velocity and the mean duration for achieving a 50% ulcer size reduction was compared between the two groups as a secondary endpoint. Results: Twenty-five patients were included in the final analysis (study group: 13, control group: 12). There were no significant differences between two groups regarding demographic factors and baseline DFU characteristics. The study group presented a significantly higher complete healing rate as compared to that in the control group [84.6% (11/13), 41.6% (5/12), respectively, P = 0.041]. Faster ulcer healing velocity and shorter mean duration for achieving a 50% ulcer size reduction were observed in the study group (P = 0.022, P = 0.004, respectively). The Kaplan-Meier analysis for the median time for 50% ulcer healing rate also showed a significantly shorter duration in the study group (21 days vs 39 days, P = 0.012). There were no adverse events related to the dressing materials. Conclusion: This study supports that a HA dressing without additional substances may offer a safe and effective treatment for DFU.

Category: Diabetes Introduction/Purpose: Ulcer healing in the diabetic patients is challenging due to a prolonged inflammatory response, extracellular matrix degradation irregularities, and increased bacteria presence. Collagen components are fundamental to the process of wound healing and skin formation. Recently, collagen-containing wound dressings, which create a biological scaffold matrix, have been used in the treatment of diabetic foot ulcer (DFU). However, there is not enough evidence to support that 100% collagen dressing can replace the diabetic wound management. In this study, we examined the effectiveness and safety of a new collagen dressing material in the treatment of DFU. Methods: This study was a prospective, randomized, placebo-controlled, single-center study conducted between November 2011 and September 2014. The inclusion criteria were type 1 or 2 diabetes, a ulcer size ≥ 1.0 cm2 that did not exhibit signs of healing for 6 weeks, Wagner grade 1 or 2, and palpable pulses at the ankle. The assessments of DFU included size, microbial culture study, detailed description of DFU, and clinical photos. Patients in the study group were treated with a collagen dressing material (100% porcine type I collagen) and foam dressing, while patients in the control group were treated with only foam dressing. Dressing changes had been performed two or three times per week. Complete ulcer healing rate was evaluated as a primary endpoint and ulcer size were compared between the two groups as a secondary endpoint. Results: Thirty patients were included in the final analysis (study group: 17 patients, control group: 13 patients). There were no significant differences between two groups regarding demographic factors and baseline DFU characteristics. The study group presented a higher rate of complete healing as compared to that in the control group [82.4% (14/17), 38.5% (5/13), respectively, P = 0.022]. At the last follow-up, ulcer sizes of the study group were smaller than those of the control group (P = 0.048). The Kaplan-Meier analysis for the complete ulcer healing also showed a significantly higher rate of complete healing in the study group (Hazard ratio = 3.0, log-rank P = 0.025). There were no adverse events related to the dressing materials. Conclusion: This study supports that the wound dressing using 100% collagen materials may offer a safe and effective treatment for DFU.

Category: Ankle Introduction/Purpose: The optimal treatment for symptomatic osteochondral lesion of the talus (OLT) after failed arthroscopic microfracture has been a controversial issue. The use of viscosupplementation for treatment of OLT has been gradually increasing. The hyaluronic acid (HA) injection is believed to play an important role in reducing pain and inflammation, and promoting tissue repair. The purpose of this study is to evaluate the clinical outcomes of intra-articular HA injection for the patients with failed arthroscopic microfracture in OLT. Methods: This study included 12 patients who received three weekly injections of intra-articular HA after arthroscopic microfracture for OLT between October 2014 and October 2015. Five men and seven women were included in this study. The average age at the time of injection was 41 years (range, 19-63 years). All patients had recurrent pain for at least 6 months after the index surgery. The patients were followed for 6.1 months (range: 5.0-7.0). At each visit, the efficacy of HA injection was evaluated by a Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and Foot and Ankle Outcome Score (FAOS) pain subscale. In addition, subjective satisfactions were assessed by the Alexander scale. Results: The mean period from the arthroscopic microfracture to the intra-articular HA injection was 26.5 months (range: 6.0- 87.0). Mean VAS decreased from 6.7 ± 1.1 at pre-injection to 2.4 ± 1.6 at post-injection six weeks (p < 0.001), 3.1 ± 1.5 at three months (p = 0.002) and 3.8 ± 2.3 at six months (p = 0.02). Mean AOFAS score improved from 61.0 ± 9.1 at pre-injection to 85.3 ± 11.3 at post-injection six weeks (p < 0.001), 82.9 ± 10.4 at three months (p < 0.001) and 80.4 ± 13.8 at six months (p = 0.001). Mean FAOS pain subscale also improved from 53.2 ± 4.2 at pre-injection to 71.1 ± 9.4 at post-injection six weeks (p < 0.001), 66.7 ± 7.2 at three months (p = 0.001) and 64.4 ± 9.5 at six months (p = 0.036). According to the Alexander scale, there were 58.3% (7/12) good, 25.0% (3/12) fair, and 16.7% (2/12) poor results at post-injection six months. There was no adverse effect. Conclusion: In this study, we found that the main improvement in clinical outcomes occurred during the first six weeks and significantly maintained until at least three or six months. We believe that the HA injection could be a useful treatment option after failed arthroscopic microfracture in OLT.