Faculty Bibliography

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.

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.

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.

Needle arthroscopy is a minimally invasive technique available for the management of common foot and ankle pathologies. Owing to the limitations associated with first-generation needle arthroscopic models, specifically visualization and fluid management, needle arthroscopy has undergone revitalization over the past decade. Newer systems are now using chip on tip visualization capability as well as improved fluid pumps allowing for direct intervention under improved visualization. The smaller diameter of the needle arthroscope permits procedures to be conducted in both the operating room and office setting under wide-awake conditions. We present this review to detail the history of needle arthroscopy and highlight how needle arthroscopy has improved care for patients with foot and ankle disorders.

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.

PURPOSE/UNASSIGNED:Achilles tendon disorders are frequently seen in sports, and its rupture is one of the most common and debilitating injury. Among the most used surgical techniques there are traditional open surgeries, minimally invasive, and percutaneous techniques. The choice of technique often depends on the nature of the injury, the athlete's profile, and the surgeon's preferences. This systematic review aimed to analyze the functional outcomes, return to sport (RTS) rate and time, and complications in patients who underwent surgical repair for acute Achilles tendon lesions. METHODS/UNASSIGNED:The PubMed, MEDLINE, Scopus, and Cochrane Central databases were used for the research, and 9 studies were included. The first author, journal name, year of publication, patient demographics, type of sports, level of play, dominant limb and follow-up period were recorded for each article. Data extracted for quantitative analysis included different types of lesions, types of surgical repair, RTS rate and time, the visual analog scale (VAS) for pain, the AOFAS score, the Tegner score, and the ATRS score, and the number and types of complications. RESULTS/UNASSIGNED:A total of 748 patients who underwent surgical repair of Achilles tendon were identified. Male patients represented 84% of the cases. The frequency-weighted mean age at the time of the operation was 40.7 ± 11.8 years, and the frequency-weighted mean follow-up was 40.9 ± 11.7 months. The postoperative functional outcomes improved. A total of 579 patients (77.4%) returned to sport. Postoperative infection was reported in 25 patients (3.3%) and Achilles tendon re-rupture was reported in 17 patients (2.3%). CONCLUSIONS/UNASSIGNED:Patients who underwent Achilles tendon surgical repair reported successful functional outcomes and low postoperative pain scores after a mean 3.5-year follow-up. Postoperative AOFAS and Tegner scores higher than the normative values can be achieved. The RTS rate was 77% with a mean time of 8.1 months. Postoperative infection and tendon re-rupture were the most common reported complications. LEVEL OF EVIDENCE/UNASSIGNED:Level III.

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.

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.

BACKGROUND:Concentrated bone marrow aspirate (CBMA) has become increasingly popular in the management of osteochondral lesions of the talus (OLT) due to its rich content of mesenchymal stem cells (MSCs) and bioactive substances that promote chondrogenesis and articular cartilage repair. However, comprehensive evaluations of clinical outcomes regarding the use of CBMA in OLT have yet to be published. The purpose of this review is to provide an evidence-based overview of clinical outcomes following the utilization of CBMA in the surgical management of OLT. METHODS:Using the search terms: ([CBMA] OR [concentrated bone marrow aspirate] OR [bone marrow aspirate] OR [bone marrow-derived mesenchymal stem cells]) AND ([talus] OR [ankle] OR [osteochondral lesion]), we systematically reviewed PubMed/Medline, Scopus, and Cochrane databases in February 2025. Inclusion criteria consisted of clinical studies published in English within the past 10 years that examined ankle pain or functional outcomes after treating OLT in adults with CBMA. Animal studies and studies including patients aged <18 years were excluded, as were systematic reviews and meta-analyses. RESULTS:Fifteen articles met inclusion criteria. CBMA showed beneficial effects in functional and pain outcomes across different applications: as a standalone therapy, in conjunction with debridement, and alongside reparative or replacement techniques. However, results varied, with some studies noting superior outcomes with CBMA compared to controls, while others found no significant differences. Radiologic outcomes assessed by Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring and complications were also mixed, suggesting benefits in some reparative techniques but not in others. CONCLUSIONS:.