Faculty Bibliography

BACKGROUND/UNASSIGNED:Peroneal tendon disorders span tendinopathy, tenosynovitis, intrasheath subluxation, stenosis, and tears, and may be challenging to diagnose accurately with clinical examination and MRI alone. Peroneal tendoscopy offers a minimally invasive, diagnostic-therapeutic option. We systematically reviewed clinical indications, intraoperative findings, procedures, imaging accuracy, complications, and patient-reported outcomes following peroneal tendoscopy. METHODS/UNASSIGNED:Eight studies (190 patients; 195 ankles) were reviewed. Data on demographics, indications, procedures, PROMs, return to sport (RTS), complications/failures, and imaging-tendoscopy agreement were extracted and pooled when constructs aligned. Random-effects meta-analyses generated pooled means or proportions with 95 % CIs (Hartung-Knapp adjustment). Where applicable, diagnostic performance of preoperative assessment was compared with tendoscopy as reference. RESULTS/UNASSIGNED:Across 190 patients (195 ankles), pooled mean age was 32 years (95 % CI 25.0-39.0), follow-up 30.3 months (95 % CI 20.8-39.8); 71 % of ankles had traumatic aetiologies. Indications were broad, with recurrent subluxation/dislocation, intrasheath subluxation, and refractory lateral ankle pain common. Frequently performed procedures included synovectomy/debridement (94 ankles), groove deepening (34 ankles), excision of space occupying lesions (65 ankles; predominantly low-lying muscle bellies [LLMB] and peroneus quartus), tendon repair/tubularization (23 ankles), and tendoscopic retinacular repair (14 ankles). Six studies reported validated PROMS with four reporting AOFAS suitable for pooling. Postoperative AOFAS averaged 96.6 (95 % CI 94.3-99.0) with a pooled mean gain of +19.8 (95 % CI 18.5-21.2); JSSF, FAOS and SF-12 improved significantly. RTS occurred at a pooled 13.3 weeks (95 % CI 10.6-16.0), with RTS of 12.2 ± 0.6 weeks after tendoscopic retinacular stabilization and 14.8 ± 2.0 weeks after groove deepening. Overall complications were 7.6 % (13 events) and mainly consisted of persistent ankle pain and minor wound issues. Failure rate was 1.5 % and two revision surgeries (1.0 %) were reported. Diagnostic agreement was high at the aggregate level (MRI overall sensitivity 0.90, specificity 0.72), but lesion-level performance varied: MRI was strong for tears and tenosynovitis, weaker for stenosis. Composite preoperative diagnosis in a large series showed high specificity (0.97) but only moderate sensitivity (0.76), with LLMB frequently under-recognized preoperatively. CONCLUSIONS/UNASSIGNED:Peroneal tendoscopy provides meaningful functional gains, timely RTS, and a low adverse-event burden across a wide indication spectrum, and it complements imaging by clarifying dynamic/space-conflict pathology. Longer, prospective comparative studies are warranted.

Freiberg's disease is a condition characterized by progressive flattening and eventual collapse of a metatarsal head. Core decompression, metatarsophalangeal joint (MTPJ) debridement, metatarsal osteotomies, autologous osteochondral transplantation (AOT), interpositional arthroplasties, and synthetic implant hemiarthroplasties comprise the surgical management options for patients with Freiberg's disease. Although autografts harvested from the iliac crest have been utilized for the treatment of various osteochondral pathologies of the lower extremity, their use for Freiberg's disease has not been reported to date. We present the case of a novel technique of metatarsal osteoperiostic grafting from the iliac crest (MetOPIC) to the second metatarsal head with injection of concentrated bone marrow aspirate (cBMA) in a 28-year-old former collegiate cheerleader with a longstanding history of chronic pain due to Freiberg's disease. The patient was able to return to her normal activities and participate in sporting activity 8 weeks following the operation. To the authors' knowledge, this is the first report of the use of the MetOPIC procedure to surgically correct Freiberg's disease.Levels of Evidence: V, Case report.

BACKGROUND:Freiberg's disease is a rare osteochondrosis of the metatarsal head that can cause progressive pain, deformity, and loss of function. The two most widely used joint-preserving surgical options for advanced disease are dorsiflexion closing wedge metatarsal osteotomy (DCWMO) and autologous osteochondral transplantation (AOT). To date, no meta-analysis has directly compared these procedures. This systematic review and meta-analysis aimed to evaluate functional, radiographic, and complication outcomes of AOT versus DCWMO in Freiberg's disease. METHODS:A systematic search of PubMed, Embase, and Cochrane Library was conducted in August 2025 according to PRISMA guidelines. Inclusion criteria were clinical studies comparing or reporting outcomes of AOT or DCWMO in Freiberg's disease. Risk of bias was assessed using JBI Critical Appraisal Tools. Pairwise meta-analyses were performed for comparative studies evaluating American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual analogue scale (VAS) pain, range of motion (ROM), and complications. Single-arm pooled analyses were conducted for AOT and DCWMO separately to provide context for within-group improvements and complication rates. Random-effects models were applied throughout. RESULTS:Sixteen studies involving 259 toes were included: 62 treated with AOT and 197 with DCWMO. Three comparative studies (n = 70) demonstrated significantly greater functional gain with AOT (AOFAS mean difference [MD] 7.15, 95 % CI 4.29-10.02; I²=0 %) and superior dorsiflexion both postoperatively (MD 7.85°, 95 % CI 4.40-11.29; I²=0 %) and in terms of gain from baseline (MD 7.46°, 95 % CI 3.77-11.14; I²=0 %). Absolute postoperative AOFAS and VAS pain scores were similar between groups, as were improvements in plantarflexion. DCWMO consistently shortened the metatarsal head (pooled mean 1.76 mm), whereas AOT preserved or slightly increased length (-0.20 mm). Complications were significantly lower with AOT (risk difference -0.20, 95 % CI -0.35 to -0.04; risk ratio 0.23, 95 % CI 0.05-0.96). Single-arm pooled analyses confirmed large improvements in AOFAS (∼25 points) and VAS (∼5 points) for both groups, with pooled complication rates of 1 % for AOT and 6 % for DCWMO. CONCLUSION/CONCLUSIONS:Both AOT and DCWMO provide meaningful pain relief and functional improvement in advanced Freiberg's disease. However, AOT demonstrated superior functional gains, greater preservation of motion and metatarsal length, and fewer complications, suggesting it may represent the preferred joint-preserving option, particularly for Smillie stage III-IV disease. Future prospective comparative trials with standardized outcome reporting and exploration of lower-morbidity donor graft sources are warranted to refine surgical decision-making. LEVEL OF EVIDENCE/METHODS:Level II, systematic review and meta-analysis.

Needle arthroscopy has transitioned from a limited diagnostic adjunct to a versatile tool in ankle surgery. Enabled by advancements in optics, fluid systems, and nano-instruments, this technique allows for effective diagnosis and treatment under local anesthesia. This review explores the evolution, technology, indications, outcomes, and cost-effectiveness of needle arthroscopy in the ankle and discusses its implications for future orthopedic practice.

Osteochondral lesions (OCL) are common among young patients and often require surgical interventions since cartilage has a poor capacity for self-repair. Bone marrow stimulation (BMS) has been used clinically for decades to treat OCLs, however a persisting challenge with BMS and other cartilage repair strategies is the inferior quality of the resulting fibrocartilaginous repair tissue. Lubrication-based therapies have the potential to improve the quality of cartilage repair tissue as joint lubrication is linked to local cartilage tissue strains and subsequent cellular responses including death and apoptosis. Recently, a full length recombinant human lubricin (rhLubricin) was developed and has been shown to lower friction in cartilage. This study investigated the effect of a single delayed injection of rhLubricin on cartilage repair in an in vivo rabbit OCL model using gross macroscopic evaluation, surface profilometry, histology, and tribology. Moderate improvement in macroscopic scores for cartilage repair were observed. Notably, quantitative analysis of Safranin-O histology showed that rhLubricin treated joints had significantly higher glycosaminoglycan content compared to saline treated joints, and there were no differences in repair integration between groups. Furthermore, rhLubricin treated joints had significantly lower friction coefficients tested across three sliding speeds compared to saline treated joints (rhLubricin: 0.15 ± 0.03 at 0.1 mm/s to 0.12 ± 0.03 at 10 mm/s, Saline: 0.22 ± 0.06 at 0.1 mm/s to 0.19 ± 0.05 at 10 mm/s). Overall, a single delayed injection of rhLubricin improved the quality and lubricating ability of the repair cartilage tissue without inhibiting repair tissue integration.

Chronic exertional compartment syndrome is a leading source of lower-leg pain in young athletic populations, attributable to increased pressure within the musculofascial compartments. In-office needle endoscopic procedures are of growing interest for the diagnosis and treatment of various musculoskeletal pathologies. The benefits of such procedures include lower morbidity, faster postoperative recovery, improved patient satisfaction, and decreased cost compared with traditional endoscopy in the operating room setting. The purpose of this Technical Note is to demonstrate a technique for in-office needle endoscopic 4-compartment fasciotomy for lower-extremity chronic exertional compartment syndrome, including a discussion on the advantages of performing this procedure in the office setting, compared with a traditional operating room.

BACKGROUND:Minimally invasive surgery (MIS) chevron osteotomy has emerged as an alternative to the traditional open chevron (OC) osteotomy for hallux valgus correction, aiming to achieve similar deformity correction with reduced soft-tissue trauma and faster recovery. However, the relative clinical and radiographic outcomes of these techniques remain debated. METHODS:A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. PubMed, EMBASE, and Cochrane databases were searched through June 2025 for randomized controlled trials (RCTs) and cohort studies comparing MIS and OC osteotomies in patients with hallux valgus. Only studies explicitly describing a percutaneous, burr-based V-shaped Chevron osteotomy were included. Primary outcomes included American Orthopaedic Foot & Ankle Society (AOFAS) scores, Visual Analog Scale (VAS) pain scores, radiographic parameters: hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) and complication rates. Random-effects meta-analyses were performed, with subgroup analyses at early (≤6 months), mid-term (6-12 months), and long-term (>12 months) follow-ups. RESULTS:=23 %). CONCLUSION/CONCLUSIONS:This systematic review and meta-analysis demonstrate that MIS Chevron osteotomy provides clinical and radiological outcomes comparable to those of open Chevron osteotomy. Differences in pain scores, angular correction, and complication rates were small and not clinically meaningful. These findings suggest that MIS Chevron is a safe and effective alternative to open Chevron osteotomy.

BACKGROUND:Lumbar disc pathologies, some of the leading causes of lower back pain, have spurred interest in platelet-rich plasma (PRP) treatments; however, for these discopathies, there are multiple factors that can influence treatment efficacy. The Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) guidelines were published in 2017 as a framework to improve data reporting. Adherence to these guidelines would help eliminate inadequate reporting on important findings, such as the benefits and harm associated with this treatment. QUESTIONS/PURPOSES/OBJECTIVE:In this systematic review, we therefore asked: How well do studies reporting on the outcomes of PRP injections for lumbar discopathies adhere to MIBO guidelines? METHODS:A systematic review of the PubMed, Embase, and Cochrane Library databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Clinical studies that assessed the outcomes of PRP injections for lumbar disc pathologies published in English in peer-reviewed journals from January 2016 to June 2024 were included. Included studies were those that reported outcomes after PRP for the treatment of lumbar disc pathologies, had at least 3 months of follow-up, had a minimum of 5 patients per cohort, were written in English, and were published in the PubMed, Embase, or Cochrane databases. The following were excluded: systematic reviews, cadaveric studies, biomechanical studies, and in vivo studies. Adherence to MIBO guidelines was evaluated by determining the total percentage of items reported out of a checklist of 46 items modified from the original MIBO items. In total, 15 studies (583 patients) were included in this systematic review, with a median (range) age of 44 years (20 to 56) and a median follow-up time of 18 months (6 to 78). There is a possibility for publication bias with these studies, which was evaluated as part of the Risk of Bias in Non-randomized studies - of Interventions (ROBINS I) and Risk of Bias 2 (RoB2) criteria. RESULTS:The mean adherence percentage across all studies was 39% ± 9% of items reported. Only 1 of 15 studies had an adherence percentage greater than 50%, 5 of 15 studies had an adherence percentage between 40% and 49.9%, and 9 of 15 studies had an adherence rate less than 40%. Only 1 of 12 MIBO categories had an adherence percentage ≥ 80%. There was no qualitative difference in adherence percentages of the studies before publication of the MIBO guidelines in May 2017 (38% ± 7%) and after publication (40% ± 10%). CONCLUSION/CONCLUSIONS:Considering these discoveries, stricter reporting and adherence to these guidelines are needed to attain greater transparency and reproducibility of studies evaluating the treatment of lumbar disc pathologies with PRP injections. Furthermore, not adhering to these guidelines may introduce bias, potentially leading to inaccurate reporting of the efficacy or harm in PRP use for lumbar disc pathologies. Given the relative novelty of biologics such as PRP, studies should abide more closely to these guidelines to provide accurate insight in their effect. LEVEL OF EVIDENCE/METHODS:Level III, therapeutic study.

Patients with cartilage defects often experience increased meniscal degeneration. It remains unclear whether meniscal damage occurs concurrently with cartilage injury or due to later joint pathology. Limited data exists on how isolated cartilage injuries affect meniscal structure and degeneration. In osteoarthritis models, alterations to the structure and composition of meniscal ECM components have been observed, including meniscus hypertrophy characterized by excessive glycosaminoglycan deposition and fibrochondrocyte rounding. Although proteoglycan deposition increases in early OA, the timing of GAG changes relative to collagen disruption remains unclear. This study examined the correlation between changes in local proteoglycan deposition, cell morphology, and the collagen network in the meniscus following cartilage damage using an in vivo rabbit model. A medial osteochondral defect was created on the femoral condyle of New Zealand white male rabbits, and menisci were harvested 12 weeks later. Our results indicate that a medial osteochondral defect drives pathology in the underlying meniscus, likely due to altered loading conditions. The medial menisci of defect joints exhibited increased proteoglycan deposition and hypertrophy, with increased cell roundness and area in regions of elevated GAGs. Local collagen architecture showed increased fiber diameter in the medial menisci of defect joints, which positively correlated with increased GAG coverage. Abnormal collagen structures were observed, including wider variations in fiber diameters and areas of small fibers with low second harmonic generation signals, indicating poorly organized collagen. A deeper understanding of GAG regulation and fibrochondrocyte pathology in injured meniscus tissue could aid in the development of therapeutics and inform disease progression.

OBJECTIVE:To evaluate whether artificial intelligence (AI)-based software was associated with enhanced identification of eight second-trimester fetal ultrasound findings suspicious for congenital heart defects (CHDs) among obstetrician-gynecologists (ob-gyns) and maternal-fetal medicine specialists. METHODS:A dataset of 200 fetal ultrasound examinations from 11 centers, including 100 with at least one suspicious finding, was retrospectively constituted (singleton pregnancy, 18-24 weeks of gestation, patients aged 18 years or older). Only examinations containing two-dimensional grayscale cines with interpretable four-chamber, left ventricular outflow tract, and right ventricular outflow tract standard views were included. Seven ob-gyns and seven maternal-fetal medicine specialists reviewed each examination in randomized order both with and without AI assistance and assessed the presence or absence of each finding suspicious for CHD with confidence scores. Outcomes included readers' performance in identifying the presence of any finding and each finding at the examination level, as measured by the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity. In addition, reading time and confidence were evaluated. RESULTS:The detection of any suspicious finding significantly improved for AI-aided compared with unaided readers with a significantly higher AUROC (0.974 [95% CI, 0.957-0.990] vs 0.825 [95% CI, 0.741-0.908], P=.002), sensitivity (0.935 [95% CI, 0.892-0.978] vs 0.782 [95% CI, 0.686-0.878]), and specificity (0.970 [95% CI, 0.949-0.991] vs 0.759 [95% CI, 0.630-0.887]). AI assistance also resulted in a significant decrease in clinician interpretation time and increase in clinician confidence score (226 seconds [95% CI, 218-234] vs 274 seconds [95% CI, 265-283], P<.001; 4.63 [95% CI, 4.60-4.66] vs 3.90 [95% CI, 3.85-3.95], P<.001, respectively). CONCLUSION/CONCLUSIONS:The use of AI-based software to assist clinicians was associated with enhanced identification of findings suspicious for CHD on prenatal ultrasonography.