Robert B Anderson

Stanford University, Palo Alto, California, United States

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Publications (50)50.36 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: The optimal method for treating intra-articular fractures of the calcaneus remains controversial. Extensile approaches allow excellent fracture exposure, but high rates of wound complications are seen. Newer minimally invasive techniques for calcaneus fracture fixation offer a potentially lower wound complication rate, but long-term clinical results are not available. The aim of this study was to compare the outcomes of intra-articular calcaneus fractures treated with open reduction and internal fixation via an extensile approach versus those with a minimally invasive sinus tarsi approach. METHODS: We performed a retrospective review of all intra-articular calcaneal fractures treated operatively between October 2005 and December 2008. A total of 112 fractures were found that met our inclusion criteria; 79 were treated with an extensile lateral approach and 33 via a minimally invasive approach based on surgeon preference. Chart and radiographic results were thoroughly reviewed on all 112 fractures, specifically for wound healing complications and the need for further surgeries within the study period. Additionally, all patients were contacted and asked to return for a research visit that included radiography, clinical examination, and quality of life questionnaires (Short Form 36 [SF-36], foot function index [FFI], visual analog scale [VAS] pain). A total of 47 of 112 (42%) patients returned for a research visit (31 extensile, 16 minimally invasive). RESULTS: The 2 groups were comparable with regard to demographics (age, follow-up, male to female ratio, tobacco use, diabetes, workers' compensation status). In the extensile group, 53% of fractures were Sanders II and 47% were Sanders III, whereas in the minimally invasive group 61% were Sanders II and 39% were Sanders III. The overall wound complication rate was 29% in the extensile group (9% required operative intervention) versus 6% in the minimally invasive group (P = .005) (none required operative intervention). Overall, 20% of the extensile group required a secondary surgery within the study period versus 2% in the minimally invasive group (P = .007). In the group of patients who returned for research visits, the average FFI total score was 31 in the extensile group versus 22 in the minimally invasive group (P = .21). The average VAS pain score with activity was 36 in the extensile group versus 31 in the minimally invasive group (P = .48). Overall, 84% of patients in the extensile group were satisfied with their result versus 94% in the minimally invasive group (P = .32). Both groups had 100% union rates, and no differences were noted in the final postoperative Bohler's angle and angle of Gissane. CONCLUSION: Clinical results were similar between calcaneal fractures treated with an extensile approach and those treated with a minimally invasive approach. However, the minimally invasive approach had a significantly lower incidence of wound complications and secondary surgeries. The minimally invasive approach was a valuable method for the treatment of intra-articular calcaneal fractures, with low complication rates and results comparable to those treated with an extensile approach. LEVEL OF EVIDENCE: Level III, retrospective comparative case series.
    Foot & Ankle International 03/2013; · 1.47 Impact Factor
  • Kenneth John Hunt, Robert B Anderson
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    ABSTRACT: Many procedures have been described for surgical treatment of symptomatic hallux rigidus. Dorsal cheilectomy of the metatarsophalangeal joint combined with a dorsal-based closing wedge osteotomy of the proximal phalanx (i.e., Moberg procedure) has been described as an effective procedure. For patients with hallux rigidus and clinically significant hallux valgus interphalangeus, the authors previously described a dorsal cheilectomy combined with a biplanar closing wedge osteotomy of the proximal phalanx, combining a Moberg osteotomy with an Akin osteotomy. The purpose of this study was to describe the clinical results of this procedure. This article is a retrospective review of prospectively gathered data that reports the clinical and radiographic results of dorsal cheilectomy combined with a biplanar oblique closing wedge proximal phalanx osteotomy (i.e., Moberg-Akin procedure) for patients with symptomatic hallux rigidus and hallux valgus interphalangeus. Consecutive patients were followed and evaluated for clinical and radiographic healing, satisfaction, and ultimate need for additional procedure(s). Thirty-five feet in 34 patients underwent the procedure. All osteotomies healed. At an average of 22.5 months of follow-up, 90% of patients reported good or excellent results, with pain relief, improved function, and fewer shoe wear limitations following this procedure. Hallux valgus and hallux interphalangeal angles were radiographically improved. Other than one patient who requested hardware removal, no patients required additional surgical procedures. Dorsal cheilectomy combined with a Moberg-Akin procedure was an effective and durable procedure with minimal morbidity in patients with hallux rigidus combined with hallux valgus interphalangeus.
    Foot & Ankle International 12/2012; 33(12):1043-50. · 1.47 Impact Factor
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    ABSTRACT: Sprains of the first metatarsophalangeal (MTP) joint, referred to colloquially as "turf toe," are a debilitating sports injury because the hallux is pivotal to an athletes' ability to accelerate and cut. Severe sprains may require weeks to full recovery, and injuries requiring surgery may prevent an athlete from full athletic participation for months. Whereas the diagnosis and treatment of turf toe are well documented in the literature, less is known about the biomechanics of this joint and the mechanical properties of the structures that compose it. Nevertheless, this information is vital to those, such as equipment designers, who attempt to develop athletic footwear and surfaces intended to reduce the likelihood of injury. To that end, this review summarizes the literature on the anatomy of the first MTP joint, on biomechanical studies of the first MTP joint, and on the incidence, mechanisms, and treatment of turf toe. Furthermore, gaps in the literature are identified and opportunities for future research are discussed. Only through a thorough synthesis of the anatomic, biomechanical, and clinical knowledge regarding first MTP joint sprains can appropriate countermeasures be designed to reduce the prevalence and severity of these injuries.
    Critical Reviews in Biomedical Engineering 01/2012; 40(1):43-61.
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    ABSTRACT: Dorsal plate fixation is used commonly for arthrodesis of the hallux first metatarsophalangeal (MTP) joint. Custom dorsal plates incorporating locking technology have been developed recently for applications in the foot to provide relative ease of application and theoretically superior mechanical properties. The purpose of this study is to compare the radiographic and clinical outcomes of patients undergoing hallux MTP joint arthrodesis using a locked plate, or a nonlocked plate. We compared consecutive patients who underwent hallux MTP arthrodesis for a variety of diagnoses with either a precontoured locked titanium dorsal plate (Group 1) or a precontoured, nonlocked stainless steel plate (Group 2). All patients were evaluated with radiographs, visual analog pain scale, American Orthopaedic Foot and Ankle Society (AOFAS) hallux score, and a detailed patient satisfaction survey. There were 73 feet in Group 1 and 107 feet in Group 2. There was a trend toward a higher nonunion rate in Group 1 compared to Group 2. When considering only patients without rheumatoid arthritis (RA), the union rate was significantly higher in Group 2 compared to Group 1. Hardware failure and the overall complication rate was equivalent between the two Groups. As locked plate technology continues to gain popularity for procedures in the foot, it is important that clinical outcomes are reported. Locked titanium plates were associated with higher nonunion rates. Improved plate design, patient selection, and an understanding of plate biomechanics in this unique loading environment may optimize future outcomes for hallux MTP arthrodesis.
    Foot & Ankle International 07/2011; 32(7):704-9. · 1.47 Impact Factor
  • Kenneth J Hunt, Robert B Anderson
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    ABSTRACT: Fractures of the proximal fifth metatarsal metaphysis (ie, the Jones fracture) can be problematic in the elite athlete because of a high incidence of nonunion and refracture with nonoperative treatment. Although these fractures are not common, athletes can suffer refracture or nonunion of a Jones fracture despite operative stabilization. This is often attributable to hardware of insufficient strength, aggressive postoperative rehabilitation, or biologic insufficiency at the fracture site. The authors review the results of revision intramedullary screw fixation with cancellous autologous bone grafting or bone-marrow aspirate combined with demineralized bone matrix after refracture or nonunion of Jones fractures in elite athletes. Study Case series; Level of evidence, 4. The authors retrospectively reviewed the clinical and radiographic outcomes and return to sport in 21 elite athletes undergoing treatment of Jones fracture refractures or nonunions. All patients underwent intramedullary screw fixation with autologous bone graft (12 patients), bone-marrow aspirate (BMA) + demineralized bone matrix (DBM) (8 patients), or no bone graft (1 patient). All athletes were able to return to their previous level of athletic competition at an average of 12.3 weeks. All fractures showed clinical and radiographic evidence of compete cortical healing. Only 1 patient subsequently suffered a refracture. The authors recommend revision fixation with a large, solid screw (5.5 mm or larger) and autologous bone grafting for symptomatic refractures and nonunions of the proximal fifth metatarsal in elite athletes. Additional investigation is needed to determine whether BMA combined with DBM is an effective substitute for cancellous autograft.
    The American journal of sports medicine 06/2011; 39(9):1948-54. · 3.61 Impact Factor
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    ABSTRACT: As clinical suspicion increases and radiographic evaluation improves, navicular stress fractures are becoming a more recognized injury. To date, there is a small volume of literature examining these stress fractures, particularly as it pertains to outcomes of surgical management. To evaluate the clinical and computed tomography (CT) outcomes of surgically treated navicular stress fractures. Case series; Level of evidence, 4. Ten navicular stress fractures in 10 patients were available for follow-up at an average of 42.4 months postoperatively (range, 16.8-79.9). These patients underwent a clinical examination and a CT scan of their operatively treated foot. The American Orthopaedic Foot & Ankle Society (AOFAS) and SF-36 scores were completed for each fracture at the time of examination. The CT scans were blindly evaluated for bony union. According to the CT scan evaluation, 8 of 10 navicula (80%) had gone on to union. Clinical outcome scores on all patients were an average AOFAS hindfoot score of 88.5 and an average SF-36 score of 88.3. The feet with united fractures had an average AOFAS score of 92.1 (range, 83-100) and an average SF-36 score of 91.9 (range, 79-98). The 2 patients with nonunions had AOFAS scores of 74 and 74 and SF-36 scores of 70 and 78, respectively. Both nonunions were complete, displaced fractures on preoperative imaging. In our series of operatively treated navicular stress fractures, 80% went on to union, as verified by CT scan. Patients with united fractures had a clinically significant improvement in outcome, with higher AOFAS and SF-36 scores as compared with the 2 patients with nonunions. Patients with complete, displaced navicular stress fractures may be more likely to develop nonunions.
    The American journal of sports medicine 04/2011; 39(8):1741-8. · 3.61 Impact Factor
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    ABSTRACT: The Twenty-fifth Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society (AOFAS) was held 16-18 July 2009 at the Westin Bayshore Hotel in Vancouver, British Columbia, Canada. There were 521 registered attendees, including 339 (65%) individuals from 42 of the United States and 182 (35%) attendees from 32 countries outside the United States.
    Foot and Ankle Surgery 03/2011; 17(1):44-9.
  • Foot & Ankle Specialist 02/2011; 4(1):46-53.
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    ABSTRACT: The potential for disabling malunion following calcaneal fracture is high, regardless whether a patient is treated nonsurgically or surgically. Fracture displacement typically results in loss of hindfoot height, varus heel position, and widening of the hindfoot, with possible subfibular impingement and irritation of the peroneal tendon and/or sural nerve. Frequently, the subtalar joint develops posttraumatic arthritis. In symptomatic patients with calcaneal malunion, systematic evaluation is required to determine the source of pain. Nonsurgical treatment, such as activity modification, bracing, orthoses, and injection, is effective in many patients. Surgical treatment may involve simple ostectomy, subtalar arthrodesis with or without distraction, or corrective calcaneal osteotomy. A high rate of successful arthrodesis and of patient satisfaction has been reported with surgical management.
    The Journal of the American Academy of Orthopaedic Surgeons 01/2011; 19(1):27-36. · 2.46 Impact Factor
  • Foot & Ankle International 01/2011; 32(1):95-111. · 1.47 Impact Factor
  • Source
    Jeremy J McCormick, Robert B Anderson
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    ABSTRACT: Despite an increasing awareness of turf toe injury, confusion still exists regarding the anatomy, mechanism, diagnosis, and treatment of this hyperextension injury to the hallux metatarsophalangeal (MTP) joint. This article reviews the anatomy, diagnosis, and treatment algorithm for turf toe injury by reviewing relevant studies and presenting information useful to clinicians, therapists, and athletic trainers. A literature search was performed by a review of PubMed and OVID articles published from 1976 to July 2010. Grade I injury is a sprain or attenuation of the plantar capsular ligamentous complex of the hallux MTP joint; athletes are typically able to return to play as tolerated. Grade II injury is a partial rupture of the plantar soft tissue structures of the hallux MTP joint, typically requiring about 2 weeks to recover. Grade III injury is a complete rupture of the plantar structures of the hallux MTP joint, requiring at least 10 to 16 weeks to recover. Some complete ruptures require surgical repair. With accurate diagnosis, athletes can have an appropriate treatment plan, and their expectations can be tempered to the degree of injury. Careful management may allow successful return to play at a preinjury level of participation.
    Sports health. 11/2010; 2(6):487-94.
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    ABSTRACT: Patients with idiopathic cavovarus deformity and lateral ankle ligament instability often present with varying degrees of ankle arthritis. The purpose of this study was to determine whether the severity of degenerative change would impact the clinical outcome in patients treated operatively for both cavovarus deformity and lateral ankle ligament instability. Twenty-two patients were treated with lateral ankle ligament reconstruction and realignment foot osteotomy. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Karlsson and Peterson (KP) scoring scale, Visual Analog Scale (VAS) for pain, and level of satisfaction were obtained. Preoperative and postoperative ankle radiographs were reviewed and graded using the van Dijk score. Patients with Grade 0 and I arthritis preoperatively were grouped together as ``no to minimal arthritis'' (Group 1) and those with Grade II and III arthritis preoperatively as ``moderate to severe arthritis'' (Group 2). There were 14 ankles in Group 1 and eight ankles in Group 2. Mean followup was 60.4 months. Mean AOFAS and KP scores were significantly improved in Group 1 compared to Group 2 at latest followup, while VAS pain scale trended lower in Group 1. There were 12 excellent/good results, one fair result, and one poor result in Group 1. Patients in Group 2 had three excellent/good results, two fair results, and three poor results. One of 14 patients in Group 1 had progression of arthritis, while five of eight patients in Group 2 either had progression of arthritis or required an ankle fusion. Patients treated with lateral ankle ligament reconstruction and cavovarus realignment osteotomy with no to minimal preoperative tibiotalar arthritis have higher clinical scores and increased satisfaction compared to patients with more advanced preoperative tibiotalar arthritis. A cautious and realistic approach should be followed when recommending surgical treatment for this patient population.
    Foot & Ankle International 11/2010; 31(11):941-8. · 1.47 Impact Factor
  • Robert B Anderson, Kenneth J Hunt, Jeremy J McCormick
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    ABSTRACT: Foot and ankle injuries are commonplace in competitive sports. Improvements in injury surveillance programs and injury reporting have enabled physicians to better recognize and manage specific foot and ankle injuries, with a primary goal of efficient and safe return to play. Athletes are becoming stronger, faster, and better conditioned, and higher-energy injuries are becoming increasingly common. Close attention is required during examination to accurately identify such injuries as turf toe, ankle injuries, tarsometatarsal (ie, Lisfranc) injuries, and stress fractures. Early diagnosis and management of these injuries are critical. Ultimately, however, pressure to return to play must not compromise appropriate care and long-term outcomes.
    The Journal of the American Academy of Orthopaedic Surgeons 09/2010; 18(9):546-56. · 2.46 Impact Factor
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    ABSTRACT: Lesser toe deformities are frequent and bothersome conditions. Many options exist for the treatment of hammertoes and clawtoes. The purpose of this study was to review our experience with the use of an intramedullary fusion device. An IRB approved retrospective review was performed to identify 38 toes in 27 patients treated with the StayFuse (Nexa Orthopaedics) device with a mean followup of 31 months. The indications for surgery were primary deformity in 12 toes and recurrent deformities in 26 toes. Union occurred in 23 of 38 (60.5%). The union rate was nine of 12 for primary procedures and 53.8% (14/26) for revisions. Coronal PIP alignment demonstrated no change in 33 of 38 cases (86.8%) and changed in five of 38 (13.2%). Sagittal PIP alignment demonstrated no change in 36 of 38 cases (94.7%), and changed in 2/38 (5.3%). Including nonunion, the overall complication rate was 55.3% (21/38) (15 nonunions; three hardware failures (two (bent) not requiring intervention and one (broke) leading to a rotational deformity requiring revision), one intraoperative fracture (without sequelae), one requiring MP surgery, and one requiring a larger implant. The index surgery for all three of the patients that required a second surgery was for a recurrent deformity. All three patients requiring a second surgery occurred in the nonunion group. The StayFuse intramedullary fusion device was efficacious in maintaining PIP alignment in the treatment of lesser toe deformities with a relatively low reoperation rate at mid-term followup.
    Foot & Ankle International 05/2010; 31(5):372-6. · 1.47 Impact Factor
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    ABSTRACT: The purpose of this study was to retrospectively review the results of patients treated with hallux MTP joint arthrodesis using dome-shaped reamers for joint preparation and a precontoured dorsal stainless steel plate for internal fixation. A series of 145 patients (155 feet) were identified. Postoperative evaluation included weightbearing radiographs, physical examination, and chart review. Outcomes were assessed with a pain visual analog scale, AOFAS hallux score, as well as a detailed questionnaire and a subjective satisfaction survey. Ninety-eight patients (107 feet) met the criteria for the study. The mean followup was 61 weeks. Revision cases accounted for 18.7% (20/107). Rheumatoid arthritis (RA) was present in 32.7% (35/107). The average postoperative AOFAS hallux score was 79.7 and pain VAS was 19. The average pre- and postoperative hallux valgus angle was 26.5 and 12.3 degrees, respectively (p < 0.05). Eighty-nine of 107 patients (83.1%) reported good to excellent results at final followup. Discomfort related to prominence of the plate occurred in 14.9% (16/107). The nonunion rate was 12.1% (13/107). The nonunion rate for patients with/without RA was 22.9% (8/35) and 6.9% (5/72), respectively (p < 0.05). Patients with a nonunion noted more hardware related pain than those with a union (p < 0.05). First MTP joint arthrodesis using this technique achieves a high union rate. RA patients have a lower union and higher complication rate.
    Foot & Ankle International 05/2010; 31(5):385-90. · 1.47 Impact Factor
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    ABSTRACT: Tibialis anterior tendon rupture is an uncommon injury that can cause significant functional deficit. Recent series have supported surgical reconstruction in younger, more active patients. We investigated our clinical outcomes of patients having undergone surgical management of tibialis anterior tendon ruptures. Fifteen tibialis anterior tendon ruptures in 14 patients were retrospectively reviewed after surgical management. Five had primary repair, while 10 had tendon transfers. Average age at time of surgery was 70.6 years with an average followup of 27.2 months. Patients were evaluated with American Orthopaedic Foot and Ankle Society (AOFAS) and SF-36 clinical outcome scores. Strength measurements utilizing a dynamometer and range of motion (ROM) were documented on the operative and non-operative ankles. Patient satisfaction surveys were performed. Average postoperative AOFAS hindfoot score was 88.8 and SF-36 score was 76.4. There was a statistically significant difference in average dorsiflexion strength of 21.8 lbs/in(2) on the operative side and 28.8 lbs/in(2) on the non-operative limb, and in dorsiflexion ROM of patients that received a gastrocnemius recession. There was no statistically significant difference between primary tendon repair versus tendon transfer groups nor plantarflexion strength or ROM among any group. Patient surveys revealed that seven patients were completely satisfied, six had minor reservations, and one had major reservations. There were no complications. This study supports the surgical repair or reconstruction of the tibialis anterior tendon ruptures to restore functional strength and ROM.
    Foot & Ankle International 05/2010; 31(5):412-7. · 1.47 Impact Factor
  • Jeremy J McCormick, Robert B Anderson
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    ABSTRACT: The evaluation and diagnosis of turf toe injuries is improving as it becomes a more recognized pattern of injury to the hallux metatarsophalangeal joint. With an understanding of the anatomy of the injury and the ability to focus on important diagnostic and radiographic clues, turf toe can be diagnosed, assessed, and treated accurately, with surgical repair when indicated. Regardless of the grade of injury, rehabilitation of the athlete under the guidance of a physical therapist or athletic trainer is critical to complete recovery. With appropriate care, athletes can successfully return to play and efficiently reach their preinjury level of participation.
    Clinics in sports medicine 04/2010; 29(2):313-23, ix. · 1.33 Impact Factor
  • Foot & Ankle International 02/2010; 31(2):182-9. · 1.47 Impact Factor
  • Kenneth J. Hunt, Jeremy J. McCormick, Robert B. Anderson
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    ABSTRACT: Athletes who participate in high-impact sports are at higher risk for acute and chronic forefoot injuries. We review the diagnosis and treatment techniques for the most common conditions that produce forefoot pain in the athlete: metatarsal stress fracture, hallux valgus, hallux rigidus, second metatarsophalangeal synovitis and instability, turf toe, and sesamoid pathologies. These conditions and their treatments are discussed in the context of forefoot anatomy and biomechanics. Both nonoperative and operative techniques are highlighted.
    Operative Techniques in Sports Medicine - OPERAT TECHNIQ SPORTS MED. 01/2010; 18(1):34-45.
  • Source
    Kenneth John Hunt, Robert B Anderson
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    ABSTRACT: Heel pain, a relatively common problem in the athlete, can present a diagnostic and therapeutic dilemma. The purpose of this article is to review treatment techniques for common causes of heel pain in the athlete. Articles in the English literature through August 2008 were selected and reviewed in the context of the management of heel pain in the athlete. Clinical and surgical photographs are presented as an illustration of preferred techniques and pertinent pathologic findings. Although nonoperative treatment remains the mainstay for most painful heel pathologies, a number of surgical interventions have shown encouraging results in carefully selected patients. The management of heel pain in the athlete requires diagnostic skill, appropriate imaging evaluation, and a careful, initially conservative approach to treatment. Surgical treatment can be successful in carefully selected patients.
    Sports Health A Multidisciplinary Approach 09/2009; 1(5):427-34.

Publication Stats

234 Citations
50.36 Total Impact Points

Institutions

  • 2011–2012
    • Stanford University
      • Department of Orthopaedic Surgery
      Palo Alto, California, United States
  • 2010–2011
    • Washington University in St. Louis
      • Department of Orthopaedic Surgery
      San Luis, Missouri, United States
    • University of Michigan
      • Department of Orthopaedic Surgery
      Ann Arbor, MI, United States
  • 2009–2011
    • Weil Foot and Ankle Institute
      Chicago, Illinois, United States
    • University of Tennessee
      Knoxville, Tennessee, United States
  • 2004–2011
    • Carolinas Medical Center University
      Charlotte, North Carolina, United States
  • 2002–2009
    • University of North Carolina at Charlotte
      Charlotte, North Carolina, United States
  • 2007
    • Walter Reed National Military Medical Center
      • Division of Orthopaedic Surgery
      Washington, Washington, D.C., United States
  • 2004–2005
    • Rush University Medical Center
      • Department of Orthopaedic Surgery
      Chicago, Illinois, United States
  • 2003–2004
    • Marshfield Clinic
      Marshfield, Wisconsin, United States