Faculty Bibliography

BACKGROUND:The purpose of this systematic review was to evaluate the impact of mental health disorders (MHDs) on the clinical and functional outcomes following total ankle arthroplasty (TAA) for the treatment of end-stage ankle arthritis. METHODS:A systematic review of the EMBASE, MEDLINE, and Cochrane Library databases was conducted in April 2024 following PRISMA guidelines. Data collected included patient demographics, clinical outcomes, complications, and failures. RESULTS:Six studies published between 2019 and 2023 were included, involving a total of 8772 patients who underwent TAA. Among these, 1076 patients (12.3 %) had a pre-operative MHD. The weighted mean age was 64.1 ± 4.9 years, and the mean postoperative follow-up was 4.6 ± 7.2 months. There were inferior subjective clinical outcomes in patients with an associated MHD, as demonstrated by lower scores in the Self-Administered Foot Evaluation Questionnaire (SAFE-Q), Visual Analogue Scale (VAS), and American Orthopaedic Foot and Ankle Society (AOFAS) scores compared to patients without a MHD. Additionally, patients with MHDs had high complication rates (23.7 %), including 76 prosthetic complications (6.1 %) and 15 cases (1.2 %) requiring revision procedures. However, no significant differences in objective outcomes such as joint mobility or implant failure rates were found between those with and without MHDs. CONCLUSION/CONCLUSIONS:MHDs adversely affect subjective outcomes and complications following TAA, highlighting the need for integrated mental health management in preoperative and postoperative care. Further research is needed to understand the precise role of mental health in TAA outcomes.

INTRODUCTION/BACKGROUND:The Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) guidelines were developed in 2017 in order to establish a standardized approach for reporting key characteristics in platelet rich plasma (PRP)-based studies. However, the adherence to the guidelines from authors publishing data on studies related to the use of PPR in the management of osteochondral lesions of the talus (OLTs) has not yet been determined. The purpose of this study was to analyze how well clinical trials on PRP interventions for OLTs adhered to the MIBO guidelines. METHODS:PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to perform a systematic review of the PubMed, Embase and Cochrane Library databases. Inclusion criteria clinical studies that assessed PRP interventions for OLTs. The original 23 MIBO checklist items were separated and modified into a 46-point checklist. Adherence was determined by calculating the total percentage of checklist items that each article adequately and clearly reported from the 46-point checklist. RESULTS:A total of 9 studies (356 patients) with a weighted mean age of 42.1 ± 6.1 years were included in this study. The weighted mean follow-up was 32.2 ± 8.7 months. Overall, only 42.8 % ± 5.2 % of the 46-point MIBO checklist items were reported per article with no articles displaying adherence rates of 100 %. No articles had adherence rates ≥ 50 %, 6 (66.7 %) had adherence rates between 40.0 % and 49.9 % and 3 (33.3 %) had adherence rates less than 39.9 %. There was no difference in mean adherence rates between studies published prior to publication of the MIBO guidelines in May 2017 (41.7 %) and after publication of the MIBO guidelines in May 2017 (44.0 %) (p = 0.6473). There was variation in adherence rates between categories with the "Postoperative Care" category having the highest adherence rate (83.3 %) while the "Activation" category and the "Whole Blood Processing" had the lowest adherence rates (5.6 %). CONCLUSION/CONCLUSIONS:This systematic review demonstrated that clinical studies evaluating outcomes following the use of PRP in the setting of OLTs poorly adhered to MIBO guidelines. None of the included studies had adherence rates ≥ 50 % and only 1 of the 12 MIBO categories had adherence rates ≥ 80 %. Interestingly, there was no difference in the mean adherence rates in studies conducted before and after publication of the MIBO guidelines in May 2017. This study underscores the need for superior reporting of critical data related to PRP in studies evaluating outcomes in patients with OLTs augmented with PRP.

BACKGROUND/UNASSIGNED:Lateral epicondylitis (LE), commonly known as tennis elbow, is a condition involving inflammation of the extensor carpi radialis brevis tendon at its attachment to the lateral epicondyle of the humerus. In recent years, platelet-rich plasma (PRP) therapy, an ortho-biologic treatment, has emerged as a promising option for the treatment of LE. Despite promising results in clinical trials, variability in PRP preparation and administration is a barrier to consistent outcomes. To address this, the Minimum Information for Studies Evaluating Biologics in Orthopedics (MIBO) guidelines were created in 2017 to establish a standardized approach for reporting findings in PRP-based studies. The objective of this study was to analyze and compare the rate of adherence of the MIBO guidelines in the use of PRP in treating LE. METHODS/UNASSIGNED:This systematic review evaluates the adherence of studies on PRP for LE to MIBO guidelines using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Adherence was determined by calculating the total percentage of checklist items that each study adequately and clearly reported from the 46-point checklist. RESULTS/UNASSIGNED:A total of 26 studies (954 patients) were included. Overall, only 52.2% of the 46-point MIBO checklist was reported per article on average with 0 articles displaying adherence rates of 100%. There was no significant difference in the mean adherence rates between studies prior to publication of the MIBO guidelines (45.2%) and after (53.7%). CONCLUSIONS/UNASSIGNED:This review demonstrated that studies evaluating the outcomes and procedures of the use of PRP in the setting of LE have poor adherence to MIBO guidelines. There was no difference in the adherence rates in studies published before and after the creation of MIBO guidelines in 2017. Level of evidence: II.

BackgroundThe exact incidence of cyst formation after graft transplantation for osteochondral lesions is unknown. The primary purpose was to assess and compare cystic occurrence after autografting, allografting, and osteoperiosteal grafting for osteochondral lesions of the talus. Our secondary aim was to assess the correlation of clinical outcomes with the presence of postoperative cysts.MethodsA literature search was performed up to October 2023 through PubMed, Embase (Ovid), and Cochrane Library. The primary outcome was the postoperative cystic occurrence rate. A random-effects model with moderator analysis was used to calculate differences in occurrence rates between treatment groups. The relationship between the presence of cysts and clinical outcomes was described.ResultsThirteen studies were included with 382 ankles. The average radiological follow-up at which the presence of cystic occurrence was assessed ranged from 12 to 84 months. The rates of cystic occurrence for the osteochondral autograft transplantation group, the allograft transplantation group, and the osteoperiosteal transplantation group were 42% (95% confidence interval [CI] = 24-61), 58% (95% CI = 40-74), and 34% (95% CI = 12-67), respectively, without any significant differences noted. No relationship between the presence of cysts and clinical outcomes was found.ConclusionPostoperative cystic occurrence is common after osteochondral autograft transplantation (42%), allograft transplantation (58%), and osteoperiosteal transplantation (34%) in osteochondral lesions of the talus-without significant intertreatment differences. The postoperative presence of cysts was not correlated with clinical outcomes. Future research should assess whether the postoperative presence of cysts correlates with (clinical) outcomes at longer follow-up.Level of Evidence:Level IV, systematic review and meta-analysis.

Ankle osteoarthritis (OA) is a degenerative condition that impacts quality of life. Total ankle replacement (TAR) represents a significant advancement in orthopedic surgery. Objectives: The purpose was to provide an overview of the indications, outcomes, and complications of anterior and lateral surgical approaches in TAR, as well as return to sport following surgery. Methods: The PubMed, MEDLINE, Scopus, and Cochrane Central databases were searched. The keywords used were "total ankle arthroplasty", "total ankle replacement", "ankle anterior approach", "ankle lateral approach", "outcomes", "return to sport", and "complications", and the search included articles published from 2014 to 2024. Results: Successful functional outcomes, return to athletic activity, and return to the previous level of sports performance after surgery have been reported at rates of over 60%. The anterior approach restores the normal tibial slope but presents a high risk of wound-healing complications and medial malleolar fractures. The lateral approach allows an anatomic placement of the implant, but it is associated with fibular complications and a high risk of revision surgery. Return to sport is feasible in low-impact sports such as cycling, swimming, and dancing. Conclusions: The anterior and lateral approaches for TAR yielded satisfactory functional outcomes and rates of return to athletic activity. Different intra- and post-operative complications and revision surgery should be managed properly to optimize outcomes.

Posterior tibial tendoscopy is an important diagnostic and therapeutic tool in the treatment of disorders of the posterior tibial tendon. In this article, the relevant surface anatomy, portal placement, and diagnostic tendoscopy are reviewed. We also compare and contrast the benefits and drawbacks associated with performing this procedure using a 1.9-mm 0° needle endoscope compared with using a 2.7-mm or 4.0-mm 30° endoscope.

Anterior ankle arthroscopy is an important diagnostic and therapeutic tool in the treatment of pathologies of the ankle joint. In a series of 7 articles, the basics of ankle arthroscopy are reviewed. In this article (part 1), patient positioning, tourniquet placement, and draping for anterior ankle joint arthroscopy are reviewed.

Ankle arthroscopy is an important diagnostic and therapeutic tool in the treatment of pathologies of the ankle joint. In a series of 7 articles, the basics of ankle arthroscopy are reviewed. In this article (part 4), surface anatomy, portal placement, and diagnostic arthroscopy of the posterior ankle joint are reviewed. We also compare the benefits and limitations associated with performing this procedure with a 1.9-mm 0° endoscope versus a 2.7- or 4.0-mm 30° endoscope.

Ankle arthroscopy is an important diagnostic and therapeutic tool in the treatment of pathologies of the posterior ankle joint. In a series of 7 articles, the basics of ankle arthroscopy are reviewed. In this Technical Note (Part 3), patient positioning, tourniquet placement, and draping are reviewed for posterior ankle arthroscopy.

UNLABELLED:Achilles tendoscopy is an important diagnostic and therapeutic tool in the treatment of pathologies of the Achilles tendon. In this article, the basics of Achilles tendoscopy are reviewed, including the relevant surface anatomy, portal placement, and diagnostic tendoscopic techniques. We also compare the benefits and limitations associated with performing Achilles tendoscopy with a 1.9-mm 0° needle endoscope compared to utilizing a 2.7-mm or 4.0-mm 30° endoscope. LEVEL OF EVIDENCE/UNASSIGNED:Level V, technique.