Faculty Bibliography

Extracorporeal shock wave therapy (ESWT) is a promising treatment for plantar fasciitis (PF), however, treatment results have varied due to inconsistencies among types of shock wave treatment and devices used. This retrospective chart review includes patients who underwent ESWT using the OrthoGold 100â„¢ shock wave device (MTS, Konstanz, Germany) for PF between January, 2013 and September, 2018. There were 108 patients (119 heels) identified, with a mean age of 51.7 ± 16.5 (Range 21-83) years. Patients were treated weekly for 3 weeks, with 2000 impulses per session at an energy flux density between 0.10 and 0.17 mJ/mm². Mean follow-up duration was 11.5 ± 9.7 (Range 3-51) months. Mean pre-ESWT pain visual assessment scale improved from 6.7 ± 1.7 to 2.6 ± 2.7 (p < .001). The Foot and Ankle Outcome Score subscales: pain, function of daily living, function of sports and recreational activities and quality of life domains improved from 53.7 ± 14.9 to 75.7 ± 16.7 (p < .001), from 38 ± 15.2 to 71.8 ± 23 (p < .001), from 55.8 ± 16.4 to 71.4 ± 18 (p < .001), from 42.4 ± 21.5 to 59.4 ± 20.3 (p < .001) and from 44.9 ± 16.4 to 69 ± 23.9 (p < .001), respectively. Eighty-eight (81.5%) patients were satisfied with the procedure at final follow-up. Treatment of PF with unfocused shock waves was well tolerated and led to significant pain reduction, functional improvement, and patient satisfaction.

OBJECTIVE:The purpose of this study is to systematically review the literature and to evaluate the outcomes following bone marrow stimulation (BMS) for nonprimary osteochondral lesions of the talus (OLT). DESIGN/METHODS:A literature search was performed to identify studies published using PubMed (MEDLINE), EMBASE, CDSR, DARE, and CENTRAL. The review was performed according to the PRISMA guidelines. Two authors separately and independently screened the search results and conducted the quality assessment using the Methodological Index for Non-Randomized Studies (MINORS). Studies were pooled on clinical, sports, work, and imaging outcomes, as well as revision rates and complications. The primary outcome was clinical success rate. RESULTS:Five studies with 70 patients were included in whom nonprimary OLTs were treated with secondary BMS. The pooled clinical success rate was 61% (95% confidence interval [CI], 50-72). The rate of return to any level of sport was 83% (95% CI, 70-91), while the return to pre-injury level of sport was 55% (95% CI, 34-74). The rate of return to work was 92% (95% CI, 78-97), and the complication rate was assessed to be 10% (95% CI, 4-22). Imaging outcomes were heterogeneous in outcome assessment, though a depressed subchondral bone plate was observed in 91% of the patients. The revision rate was 27% (95% CI, 18-40). CONCLUSIONS:The overall success rate of arthroscopic BMS for nonprimary osteochondral lesions of the talus was 61%, including a revision rate of 27%. Return to sports, work, and complication outcomes yielded fair to good results.

The management of symptomatic osteochondral lesions of the talus (OLTs) can be challenging. The number of ways of treating these lesions has increased considerably during the last decade, with published studies often providing conflicting, low-level evidence. This paper aims to present an up-to-date concise overview of the best evidence for the surgical treatment of OLTs. Management options are reviewed based on the size of the lesion and include bone marrow stimulation, bone grafting options, drilling techniques, biological preparations, and resurfacing. Although many of these techniques have shown promising results, there remains little high level evidence, and further large scale prospective studies and systematic reviews will be required to identify the optimal form of treatment for these lesions. Cite this article: Bone Joint J 2021;103-B(2):207-212.

PURPOSE/OBJECTIVE:(1) To determine the rate of return to play following autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLT) and (2) report subsequent rehabilitation protocols. METHODS:A systematic review of the PubMed, Embase, and The Cochrane Library databases was performed according to the PRISMA guidelines based on specific eligibility criteria. Return to play data was meta-analysed and subsequent rehabilitation protocols were summarised. Level of evidence and quality of evidence (Zaman's criteria) were also evaluated. RESULTS: = 0.140, p = 0.023). The most common time to ankle motion post-surgery was immediately and the most common time to full weight-bearing was 12 weeks. CONCLUSIONS:This systematic review indicated a high rate of return to play following AOT in the athletic population. Size of OLT was not found to be a predictor of return to play, whereas advancing age was a predictor. Rehabilitation protocols were largely inconsistent and were primarily based on individual surgeon protocols. However, the included studies were of low level and quality of evidence. LEVEL OF EVIDENCE/METHODS:Level IV.

BACKGROUND/UNASSIGNED:The purpose of this study was to evaluate the clinical and radiological outcomes following a polyvinyl alcohol hydrogel implant in the treatment of hallux rigidus. METHODS/UNASSIGNED:A retrospective cohort study investigating patients treated with a polyvinyl alcohol hydrogel implant for hallux rigidus was performed. Clinical outcomes were evaluated with the Foot and Ankle Outcomes Score (FAOS) and visual analog scale (VAS) score at the final follow-up. Plain radiographs were assessed postoperatively. Eleven patients (11 feet) with a mean follow-up of 20.9 months (range, 14-27 months) were included. The mean age was 60.3 years. RESULTS/UNASSIGNED:= .012). On postoperative plain radiographs, implant subsidence was observed 60% (6/10) at 4 weeks after surgery and 90% (9/10) at the final follow-up. Fifty percent (5/10) showed radiologic lucency around the implant. Forty percent (4/10) had erosion of the proximal phalanx of the great toe. Four patients (36%) reported no improvement following surgery at the final follow-up, which were considered as failures. Three patients required additional surgery related to the implants. An additional patient is waiting to revise the implant. CONCLUSION/UNASSIGNED:Our current cohort study demonstrated a high failure rate with the polyvinyl alcohol hydrogel implant in patients with hallux rigidus. Significant radiologic subsidence with lysis around the implant, erosion of the proximal phalanx countersurface, and implant wear are harbingers for concern in the long term. LEVEL OF EVIDENCE/UNASSIGNED:Level IV, case series.

Background Endoscopic plantar fascia release (EPFR) is an established surgical treatment for recalcitrant plantar fasciitis. Few studies assess the mid to long-term outcomes of this procedure making it difficult for surgeons and patients to establish realistic postoperative expectations. The purpose of this systematic review is to provide a comprehensive review on the outcomes of endoscopic plantar fascia release in the treatment of plantar fasciitis at mid- and long-term follow up. Methods A systematic review was performed using MEDLINE, EMBASE and Cochrane library databases in March 2018 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.[1] Studies included were evaluated with regards to level of evidence (LOE) and quality of evidence (QOE) using the Coleman methodological score. Clinical outcomes and complications were also evaluated. Results Twenty-one studies including 601 feet were included in this systematic review with a mean follow up of 26.9 months. 16 papers used the American Orthopaedic Foot and Ankle Society (AOFAS) score. The weighted mean preoperative AOFAS score was 52.3 and the postoperative score was 88.75 out of 100. The total number of patients who had complications was 111 of 601 (18.7%). The most common complication was recurrence of pain experienced by 7.49% of patients (45 of 111). Conclusion Endoscopic plantar fascia release provides good clinical and functional outcomes in patients with refractory plantar fasciitis. This procedure is associated with a moderately high complication rate. However, heterogeneous study designs and low level and quality of evidence limit the current literature. As a result, further well designed studies are necessary to determine the optimal treatment for refractory chronic plantar fasciitis

OBJECTIVE:To evaluate the effect of intra-articular injection of autologous micronized adipose tissue (MAT) with ankle arthroscopic debridement in patients with advanced-stage posttraumatic osteoarthritis (PTOA) of ankle. DESIGN/METHODS:A retrospective cohort study investigating patients treated with arthroscopic debridement and autologous MAT injection for ankle PTOA was performed. Patients with Kellgren-Lawrence (KL) grade 3 to 4 were included. Visual analogue scale (VAS), Foot and Ankle Outcome Scores (FAOS), and patient satisfaction were evaluated. RESULTS:= 0.048). CONCLUSIONS:Autologous MAT injection is a safe and potentially beneficial procedure for advanced-stage ankle PTOA as an adjunct to arthroscopic debridement, although more than one-third of patients were unsatisfied with the procedure. This procedure may be more beneficial for KL grade 3 patients than grade 4 patients. However, future investigations are necessary to define the role of MAT for ankle PTOA.

BACKGROUND/UNASSIGNED:Hamstring injuries are common and account for considerable time lost to play in athletes. Platelet-rich plasma has potential as a means to accelerate healing of these injuries. PURPOSE/UNASSIGNED:(1) To present the evidence of platelet-rich plasma injection in the treatment of hamstring injuries, (2) evaluate the "best-case scenario" in dichotomous outcomes, and (3) evaluate the "worst-case scenario" in dichotomous outcomes. STUDY DESIGN/UNASSIGNED:Systematic review and meta-analysis. METHODS/UNASSIGNED:values <.05 were considered statistically significant. RESULTS/UNASSIGNED:A total of 10 studies were included with 207 hamstring injuries in the platelet-rich plasma group and 149 in the control group. The fixed effects model for mean time to return to play, which compared platelet-rich plasma + physical therapy and physical therapy alone, significantly favored platelet-rich plasma + physical therapy (mean difference, -5.70 days). The fixed effects model for reinjury rates, which also compared platelet-rich plasma + physical therapy with physical therapy alone insignificantly favored platelet-rich plasma + physical therapy (risk ratio, 0.88). The best-case scenario fixed effects model for reinjury rates insignificantly favored platelet-rich plasma + physical therapy (risk ratio, 0.82). The worst-case scenario fixed effects model for reinjury rates insignificantly favored physical therapy alone (risk ratio, 1.13). The mean ± SD complication rate for either postinjection discomfort, pain, or sciatic nerve irritation was 5.2% ± 2.9% (range, 2.7% to 9.1%). CONCLUSION/UNASSIGNED:There has been statistically nonsignificant evidence to suggest that PRP injection ± PT reduced mean time to RTP or reinjury rates compared to no treatment or PT alone for hamstring injuries in a short-term follow-up. The complication profiles were favorable. Further studies of high quality and large cohorts are needed to better support or disprove the consensus of the systematic review and meta-analysis.

Background/UNASSIGNED:Plantar fasciitis is the most common cause of plantar heel pain. Several recent randomized control trials (RCTs) have been published comparing the use of platelet-rich plasma (PRP) and corticosteroids (CSs) for the treatment of plantar fasciitis. Purpose/UNASSIGNED:To perform a systematic review of RCTs to compare whether PRP or CS injections result in decreased pain levels and improved patient outcomes in the treatment of plantar fasciitis. Study Design/UNASSIGNED:Systematic review; Level of evidence, 1. Methods/UNASSIGNED:< .05 was considered to be statistically significant. Results/UNASSIGNED:< .00001, respectively). Conclusion/UNASSIGNED:In patients with chronic plantar fasciitis, the current clinical evidence suggests that PRP may lead to a greater improvement in pain and functional outcome over CS injections.

BACKGROUND/UNASSIGNED:Treatment for post-traumatic osteoarthritis (PTOA) of the ankle remains challenging. Distraction arthroplasty (DA) is an alternative for patients who are averse to or poor candidates for arthrodesis or joint replacement. The purpose of this study was to examine the role of microfracture (MFX) and concentrated bone marrow aspirate (CBMA) on the outcome of patients undergoing DA for end-stage PTOA of the ankle joint. METHODS/UNASSIGNED:Ninety-five patients who underwent DA for the treatment of end stage PTOA from 2009 to 2014 were selected from the hospital ankle registry. Demographic data, functional activity levels, complications, and radiographs taken at 6, 12, 24, and 36 months postoperatively were reviewed. Foot and Ankle Outcome Scores (FAOS) were obtained at the same time intervals. A total of 78 patients were included in this study. Interventions were divided into 4 groups for comparison: DA+MFX (n = 8), DA+MFX+CBMA (n = 35), DA+CBMA (n = 22), and DA alone (n = 13). RESULTS/UNASSIGNED:= .01). The use of MFX was associated with significantly lower FAOS scores. CONCLUSION/UNASSIGNED:The current study showed no benefit from MFX when combined with DA in the treatment of PTOA. CBMA may have helped mitigate the adverse effect of MFX but conferred no benefit when used with DA alone. DA remains a useful alternative to ankle arthrodesis and arthroplasty in patients with PTOA. However, MFX and biologic augmentation using CBMA appeared to have no additional benefit. LEVEL OF EVIDENCE/UNASSIGNED:Level III, comparative study.