Faculty Bibliography

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.

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 ankle joint. In a series of 7 articles, the basics of ankle arthroscopy are reviewed. In this article (Part II), anterior ankle surface anatomy, portal placement, and diagnostic arthroscopy are reviewed. We also review benefits and drawbacks associated with a 1.9-mm 0° arthroscope in comparison to a standard 2.7-mm or 4.0-mm 30° arthroscope.

Peroneal tendoscopy is an important diagnostic and therapeutic tool in the treatment of pathologies of the peroneal tendon. In this article, the basics of peroneal tendoscopy are reviewed, including the relevant surface anatomy, portal placement, and diagnostic tendoscopic techniques. We also compare the benefits and limitations associated with performing this peroneal tendoscopy with a 1.9-mm 0° needle endoscope compared to using a 2.7-mm or 4.0-mm 30° endoscope.

Achilles tendon pathologies are prevalent, impacting ~6% of the general population and up to 50% of elite endurance runners over their lifetimes. These conditions substantially affect quality of life and work productivity, leading to substantial societal costs. Achilles tendinopathy (AT) is a condition marked by localized pain and functional impairment related to mechanical loading. AT can considerably impair participation and potentially also performance in sports and daily activities. The aetiology of AT is multifactorial and repetitive overloading of the tendon is often observed as the inciting factor by health professionals. However, AT can also be associated with adverse effects of certain medication, ageing and various comorbidities. Characteristic tendon changes include proteoglycan accumulation, fluid accumulation with swelling and hypervascularization. Tissue disorganization advances as pathological changes in matrix structure are driven by altered cellular function and makeup, often accompanied by persistent inflammation. Treatment strategies include various interventions, although these can be protracted and challenging for both patients and health-care providers, often with high failure rates. Current research focuses on understanding the pathological processes at the cellular and molecular levels to distinguish between disease categories and to investigate the role of inflammation, metabolic maladaptation and mechanical stress. Emerging therapeutic approaches need to be developed to address these underlying mechanisms. These approaches focus on optimizing rehabilitation protocols and advancing the development of adjunct therapies, such as advanced therapy medicinal products, alongside the integration of precision medicine to improve treatment outcomes.

BACKGROUND:The purpose of this systematic review was to evaluate the clinical and radiological outcomes at short-term follow-up following suture button fixation for the management of ligamentous Lisfranc injuries. AIM/OBJECTIVE:To assess the effectiveness of suture button fixation in managing ligamentous Lisfranc injuries through a systematic evaluation of short-term clinical and radiological outcomes. METHODS:During March 2024, the PubMed, EMBASE, and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following suture button fixation for the management of ligamentous Lisfranc injuries. Data regarding patient demographics, pathological characteristics, subjective clinical outcomes, radiological outcomes, complications, and failure rates were extracted and analyzed. RESULTS:Eight studies were included. In total, 94 patients (94 feet) underwent suture button fixation for the management of ligamentous Lisfranc injuries at a weighted mean follow-up of 27.2 ± 10.2 months. The American Orthopaedic Foot and Ankle Society score improved from a weighted mean pre-operative score of 39.2 ± 11.8 preoperatively to a post-operative score of 82.8 ± 5.4. The weighted mean visual analogue scale score improved from a weighted mean pre-operative score of 7.7 ± 0.6 preoperatively to a post-operative score of 2.0 ± 0.4. In total, 100% of patients returned to sport at a mean time of 16.8 weeks. The complication rate was 5%, the most common complication of which was residual midfoot stiffness (3.0%). No failures nor secondary surgical procedures were recorded. CONCLUSION/CONCLUSIONS:This systematic review demonstrated that suture button fixation for ligamentous Lisfranc injuries produced improved clinical outcomes at short-term follow-up. In addition, there was an excellent return-to-sport rate (100%) at a weighted mean time of 16.8 weeks. This review highlights that suture button fixation is a potent surgical treatment strategy for ligamentous Lisfranc injuries; however, caution should be taken when evaluating this data in light of the lack of high quality, comparative studies, and short-term follow-up.

BACKGROUND:Demineralized bone matrix (DBM) is a commonly utilized allogenic bone graft substitute to promote osseous union. However, little is known regarding outcomes following DBM utilization in foot and ankle surgical procedures. AIM/OBJECTIVE:To evaluate the clinical and radiographic outcomes following DBM as a biological adjunct in foot and ankle surgical procedures. METHODS:During May 2023, the PubMed, EMBASE and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following DBM for the management of various foot and ankle pathologies. Data regarding study characteristics, patient demographics, subjective clinical outcomes, radiological outcomes, complications, and failure rates were extracted and analyzed. In addition, the level of evidence (LOE) and quality of evidence (QOE) for each individual study was also assessed. Thirteen studies were included in this review. RESULTS:metatarsal cohort, and calcaneal fracture cohort was 85.6%, 100%, and 100%, respectively. The weighted mean visual analog scale in the osteochondral lesions of the talus cohort improved from a pre-operative score of 7.6 ± 0.1 to a post-operative score of 0.4 ± 0.1. The overall complication rate was 27.2%, the most common of which was non-union (8.8%). There were 43 failures (10.8%) all of which warranted a further surgical procedure. CONCLUSION/CONCLUSIONS:This current systematic review demonstrated that the utilization of DBM in foot and ankle surgical procedures led to satisfactory osseous union rates with favorable wound complication rates. Excellent outcomes were observed in patients undergoing fracture fixation augmented with DBM, with mixed evidence supporting the routine use of DBM in fusion procedures of the ankle and hindfoot. However, the low LOE together with the low QOE and significant heterogeneity between the included studies reinforces the need for randomized control trials to be conducted to identify the optimal role of DBM in the setting of foot and ankle surgical procedures.

OBJECTIVE:The purpose of this prospective study was to evaluate the quality of the reparative cartilage during second-look needle arthroscopy following talar osteoperiostic grafting from the iliac crest (TOPIC) or autologous osteochondral transplantation (AOT) procedure for the management of large osteochondral lesions (OCLs) of the talus. DESIGN/METHODS:Prospective case series. METHODS:Patients who underwent second-look needle arthroscopy following either TOPIC or AOT procedure were prospectively recruited when they needed a second look. The primary outcome was the assessment of the quality of the reparative cartilage via second-look needle arthroscopy scored by the International Cartilage Repair Society (ICRS) score. The secondary outcomes were the number and nature of needle arthroscopy interventions and complications associated with these interventions. RESULTS:Five patients underwent second-look needle arthroscopy following TOPIC procedure and 11 patients underwent second-look in-office needle arthroscopy following AOT. The mean ICRS in the TOPIC cohort was 9.4 ± 1.0 at a mean time of 24.4 months following the index procedure. The mean ICRS in the AOT cohort was 10.6 ± 1.3 at a mean time of 58.8 months following the index procedure. No complications were observed in either cohort. CONCLUSION/CONCLUSIONS:This study demonstrated that TOPIC and AOT lead to adequate-looking quality reparative cartilage at short-term to mid-term follow-ups. However, further studies with larger patient cohorts and longer follow-ups are warranted. Furthermore, second-look needle arthroscopy is a safe and viable minimally invasive procedure that can effectively evaluate the quality of reparative cartilage following surgical intervention for OCLs of the talus.