Mark S Myerson

Mercy Hospital Miami, Miami, Florida, United States

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Publications (197)274.49 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: First metatarsophalangeal (MP) arthrodesis in the setting of bone loss is a difficult problem. Bone loss may compromise stability of implant fixation. Union rates may be adversely affected by these circumstances. The primary goals of this cadaveric, biomechanical study were to (1) investigate stiffness of a dual mini-plate construct versus a standard MP arthrodesis plate in the setting of severe bone loss and (2) evaluate arthrodesis interface motion when an interpositional graft is used. Twelve matched cadaveric samples were used in this study. In a given pair, both dual mini-plate fixation and standard MP arthrodesis plate were used. Interpositional graft was used in 6 of the specimen pairs. After implantation, soft tissues were dissected away and specimens were placed into a cantilever bending setup. A cantilever load was applied at a rate of 6 mm/min until catastrophic failure of the test construct or 5-mm plantar gapping of either bone block interface. Based on load to failure data, there were no differences between the various constructs in terms of stiffness. There was a high degree of calculated plantar gapping with the placement of a bone block, irrespective of the fixation type. Although no construct differences were observed in terms of stiffness, the dual mini-plate is an alternative option for fixation when asymmetric bone loss is either seen on the phalangeal or metatarsal head side. The high degree of plantar gapping of the proximal interface with the placement of the bone block may have implications for healing potential across the arthrodesis site. This is the first biomechanical study investigating the stiffness of multiple constructs for MP arthrodesis in the setting of severe bone loss. Furthermore, this is the first study to introduce a biomechanical rationale for difficulties in healing for this particular clinical scenario. Level V, Bench testing. © 2015 The Author(s).
    Foot & Ankle Specialist 04/2015; DOI:10.1177/1938640015583512
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    Ettore Vulcano, J. Kent Ellington, Mark S. Myerson
    Foot and Ankle Clinics of North America 04/2015; DOI:10.1016/j.fcl.2015.02.002 · 0.84 Impact Factor
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    Andrew R Hsu, Steven L Haddad, Mark S Myerson
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    ABSTRACT: Total ankle arthroplasty (TAA) is an increasingly popular treatment option for patients with end-stage ankle arthritis. Although improved short- and long-term clinical and radiographic outcomes have been achieved with TAA, revision surgery may be necessary in the setting of aseptic loosening, subsidence, impingement, arthrofibrosis, or infection. Factors such as patient selection, implant design, and surgical technique can all contribute to TAA failure. Treatment of patients with a painful TAA is complex and requires careful consideration of symptom history, workup, and nonsurgical and surgical treatment options. Surgical management of failed TAA includes arthrodesis, revision surgery, or below-knee amputation. Copyright 2015 by the American Academy of Orthopaedic Surgeons.
    The Journal of the American Academy of Orthopaedic Surgeons 03/2015; 23(5). DOI:10.5435/JAAOS-D-14-00017 · 2.40 Impact Factor
  • Mark S. Myerson, Amiethab A. Aiyer, Dawid Burger
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    ABSTRACT: Rupture of the tibialis anterior tendon is often not clinically recognized. It typically occurs in the atraumatic setting and leads to a steppage gait. For sedentary individuals, nonoperative management may be considered. In more active individuals with stable soft-tissue envelope and a stable neurovascular status, reconstruction of the tendon is a viable option. This technique paper introduces a novel technique that bypasses the need to open the extensor retinaculum and avoids potential wound complications. Levels of Evidence: Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence.
    Techniques in Foot & Ankle Surgery 02/2015; DOI:10.1097/BTF.0000000000000077
  • Lauren E Geaney, Mark S Myerson
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    ABSTRACT: Hallux metatarsophalangeal (MP) joint arthrodesis for hallux varus is generally reserved for severe deformity, failed surgery or the development of osteoarthritis. The purpose of this study was to determine the radiologic results of arthrodesis of the hallux MP joint following treatment for hallux varus. Our hypothesis was that in the process of correcting the hallux valgus angle, the 1-2 intermetatarsal angle (1-2 IMA) and hallux valgus angle (HVA) will be improved due to correction of the deforming forces. A retrospective review was performed on 26 patients with 29 feet that had symptomatic hallux varus deformities treated with arthrodesis of the hallux MP joint between September 1, 2002, and December 31, 2012. The 1-2 IMA and HVA were measured on the preoperative and most recent postoperative films and compared. Twenty-nine patients were followed with postoperative weight-bearing radiographs. Two were men and 24 were women. Twelve were performed on the right foot, 17 on the left, including 3 bilateral cases. Fourteen patients had concomitant procedures on the ipsilateral forefoot. The average 1-2 IMA changed from 4.8 degrees to 8.4 degrees, a difference of 3.6 degrees (P < .05), and the average HVA changed from -20.7 degrees to 8.1 degrees (P < .05). Our study showed that a hallux MP joint arthrodesis in patients with hallux varus resulted in a predictable increase in the 1-2 IMA. Level IV, case series. © The Author(s) 2014.
    Foot & Ankle International 12/2014; 36(4). DOI:10.1177/1071100714560400 · 1.63 Impact Factor
  • Mark S. Myerson
    Foot and Ankle Clinics of North America 11/2014; DOI:10.1016/j.fcl.2014.09.004 · 0.84 Impact Factor
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    ABSTRACT: Metatarsus adductus (MA) is a congenital condition in which there is adduction of the metatarsals in conjunction with supination of the hindfoot through the subtalar joint. It is generally believed that MA precedes the development of hallux valgus. Historically, studies have demonstrated that patients with a history of MA were ~3.5 times more likely to develop hallux valgus. The purpose of this study was to identify the relative prevalence of MA in patients undergoing surgery for symptomatic hallux valgus.
    Foot & Ankle International 09/2014; DOI:10.1177/1071100714551022 · 1.63 Impact Factor
  • Casey Jo Humbyrd, Mark S Myerson
    Foot & Ankle International 09/2014; 36(2). DOI:10.1177/1071100714553468 · 1.63 Impact Factor
  • Mark S Myerson, Raheel Shariff, Alan J Zonno
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    ABSTRACT: Little has been published on the management of infected total ankle replacements. This study reviewed our experience with this difficult clinical problem.
    Foot & Ankle International 07/2014; DOI:10.1177/1071100714543643 · 1.63 Impact Factor
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    ABSTRACT: Although plain radiographs have been historically used to evaluate the status of arthrodesis in the foot and ankle, computed tomography (CT) has gained popularity for evaluation of fusion status. The degree of fusion identified on CT scan has been correlated with functional outcome, with an arthrodesis area of 25-50% necessary for clinical success. In the clinical setting, orthopaedic surgeons often evaluate CT scans independently. The purpose of this study was to evaluate the interrater reliability of CT scans to assess the status of hindfoot or ankle fusions among orthopaedic foot and ankle surgeons.
    Foot & Ankle International 07/2014; DOI:10.1177/1071100714544521 · 1.63 Impact Factor
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    ABSTRACT: Cavovarus deformity associated with neuromuscular imbalance is a challenging pathology. Most of these deformities lead to pressure symptoms at the lateral border of the foot. This leads to pain, callosity, and commonly fracture of the fifth metatarsal base. This study reports the outcome of a cohort of patients who underwent an adjunctive procedure of resection of the fifth metatarsal, either partial or complete, in conjunction with cavovarus foot reconstruction to offload the lateral border of the foot. This was a retrospective study looking at the clinical and radiographic outcome of patients with an underlying neuromuscular problem with a cavovarus foot who underwent a resection of the fifth metatarsal. This was used as an adjunctive procedure during reconstruction for lateral foot pressure overload symptoms. Case notes and radiographs were reviewed. The distance on weight-bearing radiographs from the inferior most part of the bony prominence on the lateral border of the foot to the floor was measured and compared between pre- and postoperatively. Eighteen patients met the inclusion criteria. Mean age was 55 years. Mean follow-up was 32 months. Fourteen patients had a partial base of fifth metatarsal resection, and 4 had a complete fifth ray resection. Radiographic measurements showed a statistically significant improvement in the distance from the inferior most part of the bony prominence on the lateral border of the foot to the floor between pre- and postoperative radiographs. Sixteen patients reported a significant improvement in their symptoms, 2 had some persistent lateral overload symptoms. The technique described in this study has not been reported previously for this indication. We believe it is a good adjunctive procedure in cavovarus foot reconstruction for patients suffering from lateral pressure overload. We describe strict guidelines and indications for this procedure. Level IV, case series.
    04/2014; 35(6). DOI:10.1177/1071100714531225
  • Shariff R, Myerson MS, Palmanovich E
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    ABSTRACT: Abstract BACKGROUND: Cavovarus deformity associated with neuromuscular imbalance is a challenging pathology. Most of these deformities lead to pressure symptoms at the lateral border of the foot. This leads to pain, callosity, and commonly fracture of the fifth metatarsal base. This study reports the outcome of a cohort of patients who underwent an adjunctive procedure of resection of the fifth metatarsal, either partial or complete, in conjunction with cavovarus foot reconstruction to offload the lateral border of the foot. METHODS: This was a retrospective study looking at the clinical and radiographic outcome of patients with an underlying neuromuscular problem with a cavovarus foot who underwent a resection of the fifth metatarsal. This was used as an adjunctive procedure during reconstruction for lateral foot pressure overload symptoms. Case notes and radiographs were reviewed. The distance on weight-bearing radiographs from the inferior most part of the bony prominence on the lateral border of the foot to the floor was measured and compared between pre- and postoperatively. Eighteen patients met the inclusion criteria. Mean age was 55 years. Mean follow-up was 32 months. RESULTS: Fourteen patients had a partial base of fifth metatarsal resection, and 4 had a complete fifth ray resection. Radiographic measurements showed a statistically significant improvement in the distance from the inferior most part of the bony prominence on the lateral border of the foot to the floor between pre- and postoperative radiographs. Sixteen patients reported a significant improvement in their symptoms, 2 had some persistent lateral overload symptoms. CONCLUSION: The technique described in this study has not been reported previously for this indication. We believe it is a good adjunctive procedure in cavovarus foot reconstruction for patients suffering from lateral pressure overload. We describe strict guidelines and indications for this procedure. LEVEL OF EVIDENCE: Level IV, case series. KEYWORDS: Charcot–Marie–Tooth, cavovarus foot, fifth metatarsal resection, lateral pressure overload
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    Ezequiel Palmanovich, Mark S. Myerson
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    ABSTRACT: KEYWORD � Severe hallux valgus � Distal metatarsal osteotomy � Chevron � Correction power � Intramedullar plate � Novel technique KEY POINTS Q6 � The concept of minor and moderate deformities being treated by distal osteotomies and the severe deformities treated best by proximal metatarsal osteotomies is changing. � High, powerful correction for aggressive distal chevron osteotomy can be fixed by a stable intramedullar plate. � A new technique of fixation is based on the Murawski and Beskin concept, because a powerful correction can be performed with a minimally invasive approach. � A low rate of complications is due to minimal invasive technique.
    Foot and ankle clinics 04/2014; Volume 19,Issue 2(2). DOI:10.1016/j.fcl.2014.02.003 · 0.84 Impact Factor
  • Jeffrey D. Seybold, Jacob R. Zide, Mark S. Myerson
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    ABSTRACT: Classically, the patient presenting with a stage II posterior tibial tendon rupture is distinguished from the stage III patient by the presence of hindfoot stiffness. As with all deformities, there are certainly shades of gray between the 2 stages and a “one-size-fits-all” approach is inappropriate. Typically, the more longstanding the deformity, the greater the likelihood of progression of arthritis and hindfoot rigidity, but this is not always the case. Some patients may have only partial loss of hindfoot motion and the surgeon may be tempted to “push the limits” for joint-sparing procedures, or conversely, to perform a triple arthrodesis in a patient who does not have a completely rigid deformity. In the following pages we will discuss the evaluation of the “late” stage II and stage III posterior tibial tendon rupture and present a variety of arthrodesis techniques that successfully address these conditions.
    Techniques in Foot & Ankle Surgery 01/2014; 13(1):29-38. DOI:10.1097/BTF.0000000000000034
  • J Kent Ellington, Sanjeev Gupta, Mark S Myerson
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    ABSTRACT: Few studies have focused on treatment following failed total ankle replacement. The purpose of this study was to report the outcomes of patients undergoing revision total ankle replacement and to propose a talar component subsidence grading system that may be helpful in making decisions regarding how to revise failed total ankle replacements in the future. A retrospective review was performed of fifty-three patients who underwent revision total ankle replacement and had been followed for a minimum of two years. Patients were assessed radiographically and with outcome scores. The rates of conversion to amputation or fusion were also assessed. The mean follow-up period was 49.1 months after the revision arthroplasty. The average time from primary total ankle replacement to revision was fifty-one months. Forty-one of the fifty-three patients (77%) were available for follow-up. The revision arthroplasty had been converted to an arthrodesis in five of the forty-one patients, and two additional patients had undergone amputation. The most common indication for revision total ankle replacement was talar subsidence (63%; twenty-six of forty-one). Twenty-two patients (54%) had a subtalar arthrodesis performed at the time of the revision arthroplasty, with nineteen of those having a custom-designed long-stem talar component placed simultaneously. The mean radiographic measurements of component position did not change significantly postoperatively. The mean postoperative scores for the thirty-four patients with a retained total ankle replacement were: 4.4 of 10 possible points on a visual analog pain scale (VAS), 65 of 100 possible points on the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale, 93.5 of 100 possible points on the Short-Form 12 (SF-12), 137.9 of 204 possible points on the Revised Foot Function Index (FFI-R), and 64 of 180 possible points on the Ankle Osteoarthritis Scale (AOS). The mean arc of motion radiographically was 18° preoperatively and 23° postoperatively, with all improvement occurring in plantar flexion. A lesser amount of preoperative talar subsidence was a significant predictor of a good outcome based on the AOFAS hindfoot score (p < 0.03) and the AOS (p < 0.01) score. Revision arthroplasty may be considered as an alternative to arthrodesis when treating patients with a failed Agility total ankle implant. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    The Journal of Bone and Joint Surgery 12/2013; 95(23):2112-8. DOI:10.2106/JBJS.K.00920 · 4.31 Impact Factor
  • Jacob R Zide, Mark S Myerson
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    ABSTRACT: When the cavus foot has become rigid, midfoot and triple arthrodesis may be the only reasonable surgical options left. The apex of the deformity is multiplanar and some deformities may have more than one apex. The best outcomes are achieved with minimal shortening of the foot, so correction should be by rotation and translation and with minimal wedge resection wherever possible. Posterior tibial tendon transfer and peroneus longus transfer are nearly always required for correction. If the principles of soft tissue balancing are followed, arthrodesis is an excellent procedure despite the literature that states to the contrary.
    Foot and ankle clinics 12/2013; 18(4):755-67. DOI:10.1016/j.fcl.2013.08.012 · 0.84 Impact Factor
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    ABSTRACT: Lateral transfers of the flexor hallucis longus (FHL) or flexor digitorum longus (FDL) tendons have been described for treatment of concomitant, irreparable peroneal tears. This study evaluated the anatomic benefits and constraints of lateral FHL and FDL tendon transfers with regard to available tendon length, diameter, and proximity to the posterior neurovascular bundle. In 9 cadaveric specimens, the FHL and FDL tendons were transected through a medial approach distal to the knot of Henry. Each tendon was transferred into a lateral incision, passing the FDL tendon both posterior and anterior to the tibial neurovascular bundle. The tendons were individually secured to the base of the fifth metatarsal with the foot in maximal eversion and dorsiflexion. The length of donor tendon available for fixation at the fifth metatarsal was measured. After the FDL tendon transfer was secured, the posterior neurovascular bundle was examined for signs of compression. Average FHL tendon diameter measured 5.1 mm; the FDL measured 4.5 mm. After passage through a bone tunnel, an additional 4.9 cm of FHL tendon remained to suture to itself; only 0.5 cm remained for the posterior and anterior FDL transfers. Transfer of the FHL did not increase muscle bulk within the retrofibular groove. Every FDL transfer posterior to the neurovascular bundle produced obvious visual compression of the tibial nerve with plantar flexion and inversion of the foot. Use of the FHL tendon for lateral transfer consistently provided sufficient length of tendon for multiple fixation options and a stronger muscle for transfer. Fixation options for the FDL were limited due to its shorter length. Lateral transfer of the FDL tendon posterior to the neurovascular bundle caused visible compression on the tibial nerve with ankle and hindfoot range of motion. This anatomic study confirmed several advantages for the use of the FHL tendon transfer in cases of concomitant peroneal tears.
    Foot & Ankle International 09/2013; 34(12). DOI:10.1177/1071100713503817 · 1.63 Impact Factor
  • Mark S Myerson, Jacob R Zide
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    ABSTRACT: The goal of osteotomy in the treatment of varus ankle arthritis is to shift the forces imparted to the ankle to a portion of the joint that is not involved in the degenerative process. The redistribution of loads and stresses seen by the tibiotalar joint can be approached either above or below the ankle with an osteotomy of the tibia or calcaneus. Evaluation of the deformity as being subtalar, supramalleolar, or a combination allows the surgeon to best address the increased joint stresses, thereby reducing the risk of failure of the osteotomy.
    Foot and ankle clinics 09/2013; 18(3):471-80. DOI:10.1016/j.fcl.2013.06.006 · 0.84 Impact Factor
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    ABSTRACT: The Ludloff osteotomy is a technique option to address hallux valgus in patients with a moderately to significantly increased first-second intermetatarsal angle. The Ludloff osteotomy is an oblique osteotomy of the first metatarsal extending dorsal-proximal to plantar-distal when viewed in the sagittal plane. The dorsal-proximal portion of the metatarsal is cut with the saw while maintaining the plantar-distal surface intact. A screw is inserted across the proximal aspect of the osteotomy, then the osteotomy is extended across the plantar surface distally. The metatarsal is rotated around the axis of the screw to the desired correction. In order to perform the osteotomy correctly, the surgeon must not only effectively complete the nuances of the technique, but also understand the limitations and contraindications of the Ludloff osteotomy. This review of current concepts for the Ludloff osteotomy reviews recent literature as well as technique pearls and pitfalls in the application of this powerful osteotomy.
    International Orthopaedics 08/2013; DOI:10.1007/s00264-013-2027-x · 2.02 Impact Factor
  • Jacob R Zide, Mark Myerson
    Foot & Ankle International 07/2013; 34(9). DOI:10.1177/1071100713497934 · 1.63 Impact Factor

Publication Stats

3k Citations
274.49 Total Impact Points

Institutions

  • 2011–2014
    • Mercy Hospital Miami
      Miami, Florida, United States
    • Massachusetts General Hospital
      • Department of Orthopaedic Surgery
      Boston, MA, United States
  • 2002–2014
    • Weil Foot and Ankle Institute
      Chicago, Illinois, United States
  • 2002–2013
    • Mercy Medical Center
      • Institute for Foot and Ankle Reconstruction
      Baltimore, Maryland, United States
  • 2012
    • St Joseph Medical Center (MD, USA)
      تاوسن، مریلند, Maryland, United States
  • 2008
    • University of Zurich
      • Department of Pediatric Orthopaedics
      Zürich, ZH, Switzerland
    • University of Michigan
      • Department of Orthopaedic Surgery
      Ann Arbor, MI, United States
  • 2007
    • Madigan Army Medical Center
      Tacoma, Washington, United States
    • Mercy Medical Center
      Мейсон-Сити, Iowa, United States
  • 1992–2007
    • Union Memorial Hospital
      Baltimore, Maryland, United States
  • 2000
    • Orthopädisches Spital Speising Wien
      Wien, Vienna, Austria
  • 1997
    • Geisel School of Medicine at Dartmouth
      Hanover, New Hampshire, United States
  • 1996
    • Mount Sinai School of Medicine
      • Department of Orthopaedics
      Manhattan, NY, United States
  • 1995
    • William Beaumont Army Medical Center
      El Paso, Texas, United States
  • 1994
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States