Faculty Bibliography

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: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.

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.

BACKGROUND:The Hospital Frailty Risk Score (HFRS) is associated with adverse events after joint replacement, but outcomes following total ankle arthroplasty (TAA) remain unclear. METHODS:The National Readmissions Database (2017-2019) identified patients undergoing primary TAA, classified as frail or non-frail using HFRS. Thirty-day readmission rates, length of hospital stay (LOS), and hospitalization costs were compared between cohorts. Univariate analysis was used to compare 30-day complication rates, reoperation rates, and disposition designation. RESULTS:From a total of 6147 patients who underwent TAA, frail patients had longer LOS (2.4 vs. 1.6 days, p < 0.01), higher costs ($27,181 versus $24,777; p < 0.01), and more discharge to higher-level care (44.0 % versus 26.0 %; p < 0.01). Frailty was associated with longer LOS (IRR 1.36; p < 0.001) and increased costs (IRR 1.07; p < 0.001), but not associated with 30-day readmissions, complications, or reoperations. CONCLUSION/CONCLUSIONS:Frailty was associated with longer LOS, higher costs, and increased discharge to higher-level care in patients undergoing TAA. LEVEL OF EVIDENCE/METHODS:IV.

BACKGROUND:Total ankle arthroplasty (TAA) provides pain relief and motion preservation for end-stage ankle arthritis, yet outcomes and utilization vary widely. Social determinants of health (SDOHs) such as socioeconomic, demographic, and behavioral factors may contribute to these disparities, but their influence on TAA has not been systematically evaluated. METHODS:A systematic review was registered on PROSPERO (CRD420251156933) and performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the PROGRESS-Plus framework to identify studies examining the impact of SDOH on TAA utilization and outcomes. PubMed, Embase, and Scopus were searched through 2025. Study quality was assessed with the Risk Of Bias In Nonrandomized Studies of Interventions tool, and certainty of evidence for each domain was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Data were synthesized narratively with random-effects meta-analysis where feasible. RESULTS:Forty-four studies including more than 200,000 patients were analyzed. Social determinants were found to influence both access to TAA and postoperative outcomes. Men demonstrated slightly better postoperative function, whereas women reported more pain and higher rates of nonhome discharge. Older patients experienced more perioperative complications but achieved similar long-term implant survival compared with younger cohorts. Patients from minority racial and ethnic groups had higher complication rates and were less likely to receive TAA compared with arthrodesis. Lower income, public insurance, and treatment in rural or lower-volume hospitals were consistently linked with reduced access to TAA, longer hospital stays, and greater healthcare costs. Behavioral factors such as smoking and preoperative opioid use were strongly associated with wound complications, prolonged hospitalization, and poorer recovery. CONCLUSION/CONCLUSIONS:SDOH significantly shape access to surgery, complication risk, and recovery after TAA. Recognition of these influences and targeted strategies such as preoperative optimization, equitable referral pathways, and improved access to rehabilitation may help reduce disparities and improve outcomes in ankle arthroplasty. LEVEL OF EVIDENCE/METHODS:Level III, systematic review of predominantly Level III studies.

BACKGROUND/UNASSIGNED:Lateral ankle sprains are the most common lower extremity injury in athletes, most often involving the anterior talofibular ligament (ATFL). Although ATFL repair outcomes are well studied, optimal management for patients with generalized ligamentous laxity (GLL) remains less understood. PURPOSE/UNASSIGNED:To (1) evaluate the radiographic findings, clinical measures, and complications in patients with GLL undergoing modified Broström-Gould repair and to (2) assess the role of suture augmentation in optimizing outcomes. STUDY DESIGN/UNASSIGNED:Systematic review; Level of evidence, 4. METHODS/UNASSIGNED:During July 2025, the PubMed, EMBASE, and Cochrane library databases were systematically searched to identify studies examining outcomes and complications in GLL patients who underwent modified Broström-Gould repair. RESULTS/UNASSIGNED:= .03). When suture augmentation was performed, no significant difference in complication rates existed between cohorts. CONCLUSION/UNASSIGNED:Patients with GLL experienced significantly higher rates of complication and failure following modified Broström-Gould repair compared with patients without ligamentous laxity. Suture augmentation may lower complication rates in GLL patients, but its effect on failure rates remains undetermined, as no studies directly compared augmented and nonaugmented GLL patients. Importantly, both GLL patients and patients without ligamentous laxity experienced clinical improvements from the modified Broström-Gould repair. While GLL increases the risk of mechanical complications, it should not be considered a contraindication to undergoing the modified Broström-Gould procedure. However, suture augmentation may be beneficial for GLL patients to reduce the risk of complications after undergoing ATFL repair. REGISTRATION/UNASSIGNED:CRD420251182303 (PROSPERO identifier).

BACKGROUND:Patient-specific instrumentation (PSI) has been proposed to improve accuracy and efficiency in total ankle arthroplasty (TAA). Although cadaveric studies suggest improved precision, the clinical value of PSI over standard instrumentation (SI) remains uncertain. METHODS:A systematic review and meta-analysis following PRISMA guidelines was performed using PubMed, Embase, and Cochrane databases through July 2025. Comparative studies evaluating PSI vs SI in TAA were included. Outcomes analyzed included patient-reported outcome measures (PROMs), radiologic alignment, intraoperative efficiency, complication and revision rates, and cost. Random effects models were used to pool standardized or mean differences (MDs) or risk ratios with 95% CIs. RESULTS: < .001). No statistically significant differences were detected in complication and revision rates. Cost analysis produced conflicting results, with one study suggesting potential savings and another finding PSI more expensive after accounting for preoperative imaging. CONCLUSION/CONCLUSIONS:PSI in TAA reduces fluoroscopy time but does not appear to enhance functional outcomes, complication rates, or revision risk compared with SI in the short term. PSI may result in greater deviation from sagittal alignment, and its cost-effectiveness remains uncertain. High-quality prospective studies with long-term follow-up are needed to clarify its role in routine and complex cases.

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:This systematic review and meta-analysis aimed to evaluate the outcomes of intra-articular hyaluronic acid (HA) injections for the treatment of ankle osteoarthritis (OA). METHODS:A systematic review of the MEDLINE, EMBASE, and Cochrane Library databases was conducted in February 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data extracted included patient demographics, injection protocols, subjective clinical outcomes, ankle range of motion, complications, and failures. RESULTS:Six randomized controlled trials (RCTs) were included, comprising 145 patients (149 ankles) who received intra-articular HA injections and 129 patients (138 ankles) in the control cohorts. The weighted mean follow-up was 5.2 ± 3 months for the HA group. There were no significant differences between HA and control groups in terms of visual analog scale (VAS) pain scores, American Orthopaedic Foot and Ankle Society (AOFAS) scores, and ankle osteoarthritis scale (AOS) scores. Complication rates were similar between groups, with transient injection site pain being the most common complication. CONCLUSION/CONCLUSIONS:: I, meta-analysis of randomized controlled trials.

Schwannomas are benign encapsulated nerve sheath tumors that are rarely found in the lower extremity. We report a unique case of a 65-year-old woman presenting with chronic lateral ankle instability and a palpable mass posterior to the lateral malleolus. Magnetic resonance imaging revealed an 11 by 6 by 10 mm lesion contiguous with the sural nerve. The mass was excised via meticulous enucleation with nerve preservation. Histopathology confirmed a cellular schwannoma. The patient underwent concurrent ankle arthroscopy and lateral ligament repair, thereby achieving complete resolution of symptoms and return to function at 6 months. This is the first reported case of a sural nerve schwannoma associated with chronic lateral ankle instability.