Faculty Bibliography

Platelet-rich plasma (PRP) has emerged as a regenerative treatment option for various foot and ankle pathologies, containing growth factors and anti-inflammatory proteins to promote tissue healing. The most consistent clinical evidence supports PRP use for plantar fasciitis and osteochondral lesions of the talus, with significant improvements in pain and function observed. In contrast, outcomes for Achilles tendon pathologies and ankle osteoarthritis are mixed, demonstrating heterogeneity in PRP preparation and implementation. Future high-quality, standardized studies are necessary to determine the efficacy, optimal protocols, and long-term outcomes of PRP in foot and ankle pathologies.

Concentrated bone marrow aspirate (cBMA) is an autologous biologic increasingly used in orthopaedic surgery for its regenerative potential. It contains mesenchymal stem cells (MSCs), growth factors, and cytokines that contribute to tissue repair and immunomodulation. Mesenchymal stem cells primarily exert their effects through paracrine signaling and macrophage reprogramming, promoting a shift from a pro-inflammatory (M1) to a reparative (M2) phenotype. Emerging evidence also suggests a role for mitochondrial transfer in this process. In foot and ankle surgery, cBMA has been investigated in the management of osteochondral lesions of the talus, fracture healing, and tendon disorders. Early clinical studies suggest potential improvements in functional outcomes, healing rates, and revision rates; however, the available evidence remains heterogeneous and is largely limited to small, non-randomized studies. Variability in cBMA preparation and reporting further limits comparability across studies. As such, while cBMA represents a promising adjunct in foot and ankle surgery, its clinical role is not yet fully defined. Future research should focus on prospective, controlled studies with standardized methodologies and explore emerging cell-free approaches, including MSC-derived extracellular vesicles, to optimize regenerative strategies.

BackgroundBone grafting is a commonly used adjunct in foot and ankle surgery to enhance osseous healing in fracture fixation and arthrodesis. Although autologous corticocancellous bone is commonly used, donor site morbidity and limited graft availability have driven the development of allogenic alternatives such as demineralized bone matrix (DBM).FormulationsDemineralized bone matrix is produced through decalcification of donor bone, preserving a collagen-rich scaffold and biologically active proteins that support osteoconduction and osteoinduction. Commercial formulations vary in carrier systems, structural properties, and quality control processes. Products such as DBX (DePuy Synthes/MTF Biologics) and AlloSync (Arthrex) incorporate lot-specific osteoinductivity testing, whereas others including AlloMatrix (Stryker), OrthoBlast II (SeaSpine/Orthofix), and Grafton (Medtronic) use carriers to improve handling. Carrier-free and structural grafts, as well as injectable systems, further expand available options.Clinical ApplicationsThe strongest clinical evidence for DBM exists in fracture fixation, where high union rates have been consistently reported. In arthrodesis procedures, DBM demonstrates union rates comparable to autograft, though without evidence of superiority. Applications in osteochondral lesions of the talus and hallux valgus correction remain less clearly defined, with variable outcomes reported in predominantly small case series. Limited evidence also suggests a potential role in calcaneal bone cysts.ConclusionDemineralized bone matrix is a safe and versatile adjunct that avoids donor site morbidity and provides favorable handling characteristics. However, the current literature is dominated by level III-IV evidence, with no high-quality comparative studies demonstrating superiority over autograft. Demineralized bone matrix is best used in fracture fixation and selective arthrodesis, while further studies are required to define its role in cartilage-related and forefoot procedures.

BACKGROUND:The purpose of this systematic review is to evaluate the clinical outcomes, complication rates, and failure rates following platelet-rich plasma (PRP) injections for lateral ankle ligament injuries. METHODS:During June 2025, a systematic review of the PubMed, EMBASE, and Cochrane Library databases was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines to identify comparative clinical studies evaluating PRP for lateral ankle ligament injuries. Data extracted included patient demographics, clinical outcomes, complications, failures, and secondary procedure rates. RESULTS:Five studies were included involving a total of 126 patients (126 ankles) who received PRP injections and 48 patients (48 ankles) who were in the control cohort, with a mean follow-up of 7.1 ± 4.3 months. Across studies, no consistent differences were found in clinical outcome scores between PRP and control cohorts at short-term follow-up. Significant heterogeneity in PRP preparation and administration protocols precluded a pooled meta-analysis from being performed. Platelet-rich plasma injections were associated with low complication (3.4%) and failure (5.1%) rates, and no secondary procedures were reported. Overall, the certainty of the available evidence was low, representing a limited and heterogeneous evidence base. CONCLUSION/CONCLUSIONS:Based on limited short-term data, the available studies do not demonstrate a clear or consistent difference in clinical outcomes between PRP-treated patients and controls. However, the evidence base is scarce, highly heterogeneous, and of low certainty. Substantial variability in PRP preparation and administration, small sample sizes, and short follow-up preclude reliable quantitative synthesis and comparative conclusions. Consequently, the current literature is insufficient to determine whether PRP provides any clinical advantage over standard care for lateral ankle ligament injuries. Further well-designed, adequately powered prospective studies with standardized PRP protocols and longer follow-up are warranted. LEVEL OF EVIDENCE/METHODS:

BACKGROUND/UNASSIGNED:Hallux varus is an uncommon pathology with no consensus regarding outcomes following the various surgical techniques available for its management. The purpose of this systematic review was to evaluate clinical outcomes, radiographic parameters, and complications following surgical management of hallux varus. METHODS/UNASSIGNED:During August 2025, the PubMed, Embase, and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following surgical management of hallux varus. RESULTS/UNASSIGNED:Eleven studies comprising 152 patients (159 feet) were included. Among patients treated with soft-tissue procedures, the weighted mean age was 53.5 ± 5.1 years with a weighted mean follow-up time of 35.3 ± 11.1 months. The weighted mean American Orthopedic Foot and Ankle Society (AOFAS) score improved 25.6 points, with corresponding improvements in hallux valgus angle (HVA) of 17.5°. The complication and failure rates were 18.9% and 11.3%, respectively. In the osteotomy cohort, the weighted mean age was 52.4 ± 6.0 years and the weighted mean follow-up time was 44.3 ± 15.6 months. The weighted mean AOFAS score improved 23.7 points, with improvements in of 24.5°. The complication and failure rates were 1.7% and 3.3%, respectively. In the arthrodesis cohort, the weighted mean age was 63.3 ± 0.7 years and the weighted mean follow-up time was 44.2 ± 30.1 months. The mean AOFAS improved 51 points, with improvements in HVA of 25.2°. The overall complication and failure rates were 10.7% and 3.6%, respectively. CONCLUSIONS/UNASSIGNED:Surgical management of hallux varus is associated with meaningful improvements in clinical outcomes and radiographic alignment across a range of operative techniques. No technique could be definitively identified as superior given the absence of comparative studies and variability in reported outcomes. Future studies should prioritize prospective, comparative designs with standardized outcome measures and long-term follow-up to better establish optimal management strategies for hallux varus. REGISTRATION/UNASSIGNED:CRD420261280842 (Prospero identifier). LEVEL OF EVIDENCE/UNASSIGNED:IV, systematic review.

Minimally invasive surgery (MIS) has revolutionized foot and ankle care by emphasizing delicate tissue handling, reduced postoperative pain, and faster recovery through small incisions and precise instrumentation. The evolution of MIS spans 4 distinct historical "seasons," from its early development in the mid-20th century to its global resurgence in the 2010s, driven by improved techniques, education, and international collaboration. Today, MIS extends beyond hallux valgus correction to include complex procedures such as first metatarsophalangeal joint, subtalar joint, tibiotalar joint, and tibiotalocalcaneal arthrodesis, with evidence demonstrating comparable or superior outcomes to open approaches. This review details the history of MIS in foot and ankle orthopedics and how this paradigm shift continues to redefine standards and improves outcomes in foot and ankle surgery.

CONTEXT/BACKGROUND:Although ankle sprains are among the most common musculoskeletal injuries, prior studies have not systematically reviewed the educational quality of related YouTube videos. We aimed to evaluate the characteristics, sources, and educational quality of YouTube videos addressing ankle sprains. DESIGN/METHODS:Cross-sectional analysis of online material. METHODS:We performed 4 independent YouTube searches on ankle sprains and recorded the top 25 results for each search. After screening 100 videos, we included 73 total videos for final analysis. We evaluated video content using 3 validated tools: Global Quality Scale (GQS), the Patient-Friendliness Scale, and the Journal of the American Medical Association criteria. RESULTS:A total of 73 YouTube videos accumulated over 20.7 million views (mean: 283,546). Videos received 14.8 likes and 1.04 comments per 1000 views. Among included videos, the mean GQS score measured 3.75, Patient-Friendliness Scale score measured 3.48, and Journal of the American Medical Association score measured 1.19, indicating good accessibility, moderate educational quality, and poor transparency. Physicians produced the highest overall quality and transparency (GQS: 3.89, Journal of the American Medical Association: 1.50). Rehabilitation-focused content emerged as the most common theme (36%), maintaining good quality and accessibility (GQS: 3.77, Patient-Friendliness Scale: 4.23). CONCLUSION/CONCLUSIONS:YouTube offers wide access to ankle sprain information, yet video quality, accessibility, and transparency remain low. Physician-created and rehabilitation-focused videos demonstrated superior educational value, although highly viewed videos did not correspond with higher quality. These findings highlight the need for more reliable, high-quality ankle sprain content on online platforms.

BACKGROUND:Acute Achilles tendon ruptures (AATRs) are devastating injuries for athletes, yet outcomes in elite rugby union players remain poorly characterized. HYPOTHESIS/OBJECTIVE:Elite rugby union players who sustain AATRs will demonstrate significantly reduced performance metrics postinjury compared with preinjury levels. STUDY DESIGN/METHODS:Retrospective case series. LEVEL OF EVIDENCE/METHODS:Level 4. METHODS: value <0.05 was determined as statistically significant. RESULTS: = -0.47 to -0.72). CONCLUSION/CONCLUSIONS:AATRs in elite rugby union players were associated with significant declines in performance metrics in both the immediate postinjury season and across subsequent seasons. These findings highlight the substantial performance impact of AATRs and support the need for improved position-specific prevention strategies and targeted postinjury rehabilitation protocols. CLINICAL RELEVANCE/CONCLUSIONS:Clinicians can use these findings to counsel rugby athletes and teams on prognosis, treatment decisions, and realistic performance expectations after AATRs.

BackgroundThe purpose of this systematic review is to evaluate the mid-term to long-term clinical outcomes, physical exam findings, radiographic findings, implant survivorship, and complications between the Salto and Salto-Talaris total ankle replacement (TAR) implant designs for the treatment of end-stage arthritis.MethodsDuring September 2025, the PubMed, EMBASE, and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes and survivorship following TAR with Salto or Salto-Talaris implants. Of note, most included studies were non-comparative case series.ResultsFifteen studies comprising 1196 patients (1221 ankles) who underwent TAR with Salto or Salto-Talaris implants were included. The weighed mean follow-up time for Salto and Salto-Talaris implant patients was 86.4 ± 24.9 and 73.6 ± 23.5 months, respectively. The weighted mean American Orthopaedic Foot and Ankle Society score increased 42.6 ± 16.8 points for the Salto implant cohort and 28.1 ± 15.1 points for the Salto-Talaris implant cohort. For patients who received the Salto implant, 33 (6.8%) ankles required revisions at a weighted mean time of 4.8 ± 1.4 years. Survivorship of the Salto implant at 5- and 10-year follow-up was 92% and 89%, respectively. For patients who underwent the Salto-Talaris implant, 27 (3.7%) ankles required revisions at a weighted mean time of 3.6 ± 2.5 years. Survivorship of the Salto-Talaris implant at 5- and 10-year follow-up was 97% and 92%, respectively.ConclusionsMid-term and long-term follow-ups for patients who received either Salto or Salto-Talaris implants demonstrated improvements in clinical outcomes, radiographic findings, range of motion, and implant survivorship. Overall, both implants provided favorable and largely comparable performance profiles, with low rates of clinical complications and revisions. The absence of formal comparative statistical analyses and head-to-head studies prevents definitive conclusions regarding implant superiority. Further prospective, comparative studies are warranted to establish which implant offers superior longevity for the treatment of end-stage ankle arthritis.Levels of EvidenceIV, systematic review.

BACKGROUND:Posterior malleolus (PM) fractures compromise overall ankle stability, lending to poorer long-term prognosis without adequate fixation. There remains inconsistency in the preferred surgical approach to fixation of the posterior malleolus, however arthroscopic approaches can reduce trauma to the soft tissue envelope and may improve clinical and radiographic outcomes. This study reviews the technical considerations of arthroscopic-assisted reduction and fixation of PM fractures and the associated clinical outcomes. METHODS:A systematic review of Pubmed, EMBASE, and UNE Library Services databases included studies evaluating arthroscopic assisted treatment of ankle fractures with associated posterior malleolus fragment. RESULTS:Seven studies evaluating 101 patients who underwent fixation of ankle fractures with posterior malleolus involvement met inclusion criteria. Twenty-seven patients underwent open reduction internal fixation (ORIF) alone and 74 patients underwent various arthroscopic-assisted reductions of PM fractures. The studies reported no significant difference in VAS and AOFAS scores in ORIF vs arthroscopic approach, and favorable VAS, AOFAS, OMAS, and FADI scores in arthroscopically treated patients. Acceptable radiographic differences were reported in each case. Complication rates in arthroscopic groups were minimal (mean 12 %). Reported benefits of arthroscopic assistance include improved visualization, debridement, and manipulation of the posterior malleolar fragment. CONCLUSION/CONCLUSIONS:Fixation of ankle fractures involving the posterior malleolus consistently report favorable clinical outcomes in patients treated with arthroscopy, with many patients achieving desirable AOFAS, OMAS, FADI, and VAS scores with a very low complication rate. LEVEL OF EVIDENCE/METHODS:Level I, systematic review.