Faculty Bibliography

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.

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.

Osteochondral lesions (OCL) are common among young patients and often require surgical interventions since cartilage has a poor capacity for self-repair. Bone marrow stimulation (BMS) has been used clinically for decades to treat OCLs, however a persisting challenge with BMS and other cartilage repair strategies is the inferior quality of the resulting fibrocartilaginous repair tissue. Lubrication-based therapies have the potential to improve the quality of cartilage repair tissue as joint lubrication is linked to local cartilage tissue strains and subsequent cellular responses including death and apoptosis. Recently, a full length recombinant human lubricin (rhLubricin) was developed and has been shown to lower friction in cartilage. This study investigated the effect of a single delayed injection of rhLubricin on cartilage repair in an in vivo rabbit OCL model using gross macroscopic evaluation, surface profilometry, histology, and tribology. Moderate improvement in macroscopic scores for cartilage repair were observed. Notably, quantitative analysis of Safranin-O histology showed that rhLubricin treated joints had significantly higher glycosaminoglycan content compared to saline treated joints, and there were no differences in repair integration between groups. Furthermore, rhLubricin treated joints had significantly lower friction coefficients tested across three sliding speeds compared to saline treated joints (rhLubricin: 0.15 ± 0.03 at 0.1 mm/s to 0.12 ± 0.03 at 10 mm/s, Saline: 0.22 ± 0.06 at 0.1 mm/s to 0.19 ± 0.05 at 10 mm/s). Overall, a single delayed injection of rhLubricin improved the quality and lubricating ability of the repair cartilage tissue without inhibiting repair tissue integration.

Patients with cartilage defects often experience increased meniscal degeneration. It remains unclear whether meniscal damage occurs concurrently with cartilage injury or due to later joint pathology. Limited data exists on how isolated cartilage injuries affect meniscal structure and degeneration. In osteoarthritis models, alterations to the structure and composition of meniscal ECM components have been observed, including meniscus hypertrophy characterized by excessive glycosaminoglycan deposition and fibrochondrocyte rounding. Although proteoglycan deposition increases in early OA, the timing of GAG changes relative to collagen disruption remains unclear. This study examined the correlation between changes in local proteoglycan deposition, cell morphology, and the collagen network in the meniscus following cartilage damage using an in vivo rabbit model. A medial osteochondral defect was created on the femoral condyle of New Zealand white male rabbits, and menisci were harvested 12 weeks later. Our results indicate that a medial osteochondral defect drives pathology in the underlying meniscus, likely due to altered loading conditions. The medial menisci of defect joints exhibited increased proteoglycan deposition and hypertrophy, with increased cell roundness and area in regions of elevated GAGs. Local collagen architecture showed increased fiber diameter in the medial menisci of defect joints, which positively correlated with increased GAG coverage. Abnormal collagen structures were observed, including wider variations in fiber diameters and areas of small fibers with low second harmonic generation signals, indicating poorly organized collagen. A deeper understanding of GAG regulation and fibrochondrocyte pathology in injured meniscus tissue could aid in the development of therapeutics and inform disease progression.

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.

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:.

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.

BACKGROUND/UNASSIGNED:Ankle fractures are common injuries in high-impact sports but have not been extensively studied in professional hockey. Given the high-speed, collision-heavy nature of the National Hockey League (NHL), ankle fractures may significantly affect player performance and team resources. PURPOSE/UNASSIGNED:To investigate the incidence, management, and impact of ankle fractures on return-to-play (RTP) and performance metrics among NHL players. METHODS/UNASSIGNED:A retrospective review of NHL players from 2013 to 2023 identified 30 athletes who sustained ankle fractures. Injury data, treatment intervention (surgical vs. non-surgical), and mechanism of injury were recorded from an online databse. Performance metrics were compared between pre- and post-injury seasons using non-parametric statistical methods. RESULTS/UNASSIGNED: = 0.038). No player sustained a refracture. CONCLUSION/UNASSIGNED:This study found that ankle fractures are a rare injury sustained by NHL players but do not lead to statistically significant deterioration in player performance metrics. All NHL players successfully returned to play at the NHL level at a mean time to RTP of 1.8 months. Taken together, these findings indicate that ankle fractures in NHL players have minimal effect on their ability to return to and maintain pre-injury performance levels.