Faculty Bibliography

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.

BackgroundThe exact incidence of cyst formation after graft transplantation for osteochondral lesions is unknown. The primary purpose was to assess and compare cystic occurrence after autografting, allografting, and osteoperiosteal grafting for osteochondral lesions of the talus. Our secondary aim was to assess the correlation of clinical outcomes with the presence of postoperative cysts.MethodsA literature search was performed up to October 2023 through PubMed, Embase (Ovid), and Cochrane Library. The primary outcome was the postoperative cystic occurrence rate. A random-effects model with moderator analysis was used to calculate differences in occurrence rates between treatment groups. The relationship between the presence of cysts and clinical outcomes was described.ResultsThirteen studies were included with 382 ankles. The average radiological follow-up at which the presence of cystic occurrence was assessed ranged from 12 to 84 months. The rates of cystic occurrence for the osteochondral autograft transplantation group, the allograft transplantation group, and the osteoperiosteal transplantation group were 42% (95% confidence interval [CI] = 24-61), 58% (95% CI = 40-74), and 34% (95% CI = 12-67), respectively, without any significant differences noted. No relationship between the presence of cysts and clinical outcomes was found.ConclusionPostoperative cystic occurrence is common after osteochondral autograft transplantation (42%), allograft transplantation (58%), and osteoperiosteal transplantation (34%) in osteochondral lesions of the talus-without significant intertreatment differences. The postoperative presence of cysts was not correlated with clinical outcomes. Future research should assess whether the postoperative presence of cysts correlates with (clinical) outcomes at longer follow-up.Level of Evidence:Level IV, systematic review and meta-analysis.

Ankle osteoarthritis (OA) is a degenerative condition that impacts quality of life. Total ankle replacement (TAR) represents a significant advancement in orthopedic surgery. Objectives: The purpose was to provide an overview of the indications, outcomes, and complications of anterior and lateral surgical approaches in TAR, as well as return to sport following surgery. Methods: The PubMed, MEDLINE, Scopus, and Cochrane Central databases were searched. The keywords used were "total ankle arthroplasty", "total ankle replacement", "ankle anterior approach", "ankle lateral approach", "outcomes", "return to sport", and "complications", and the search included articles published from 2014 to 2024. Results: Successful functional outcomes, return to athletic activity, and return to the previous level of sports performance after surgery have been reported at rates of over 60%. The anterior approach restores the normal tibial slope but presents a high risk of wound-healing complications and medial malleolar fractures. The lateral approach allows an anatomic placement of the implant, but it is associated with fibular complications and a high risk of revision surgery. Return to sport is feasible in low-impact sports such as cycling, swimming, and dancing. Conclusions: The anterior and lateral approaches for TAR yielded satisfactory functional outcomes and rates of return to athletic activity. Different intra- and post-operative complications and revision surgery should be managed properly to optimize 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.

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: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.

BACKGROUND:The purpose of this systematic review was to evaluate the impact of mental health disorders (MHDs) on the clinical and functional outcomes following total ankle arthroplasty (TAA) for the treatment of end-stage ankle arthritis. METHODS:A systematic review of the EMBASE, MEDLINE, and Cochrane Library databases was conducted in April 2024 following PRISMA guidelines. Data collected included patient demographics, clinical outcomes, complications, and failures. RESULTS:Six studies published between 2019 and 2023 were included, involving a total of 8772 patients who underwent TAA. Among these, 1076 patients (12.3 %) had a pre-operative MHD. The weighted mean age was 64.1 ± 4.9 years, and the mean postoperative follow-up was 4.6 ± 7.2 months. There were inferior subjective clinical outcomes in patients with an associated MHD, as demonstrated by lower scores in the Self-Administered Foot Evaluation Questionnaire (SAFE-Q), Visual Analogue Scale (VAS), and American Orthopaedic Foot and Ankle Society (AOFAS) scores compared to patients without a MHD. Additionally, patients with MHDs had high complication rates (23.7 %), including 76 prosthetic complications (6.1 %) and 15 cases (1.2 %) requiring revision procedures. However, no significant differences in objective outcomes such as joint mobility or implant failure rates were found between those with and without MHDs. CONCLUSION/CONCLUSIONS:MHDs adversely affect subjective outcomes and complications following TAA, highlighting the need for integrated mental health management in preoperative and postoperative care. Further research is needed to understand the precise role of mental health in TAA outcomes.

INTRODUCTION/BACKGROUND:The Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) guidelines were developed in 2017 in order to establish a standardized approach for reporting key characteristics in platelet rich plasma (PRP)-based studies. However, the adherence to the guidelines from authors publishing data on studies related to the use of PPR in the management of osteochondral lesions of the talus (OLTs) has not yet been determined. The purpose of this study was to analyze how well clinical trials on PRP interventions for OLTs adhered to the MIBO guidelines. METHODS:PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to perform a systematic review of the PubMed, Embase and Cochrane Library databases. Inclusion criteria clinical studies that assessed PRP interventions for OLTs. The original 23 MIBO checklist items were separated and modified into a 46-point checklist. Adherence was determined by calculating the total percentage of checklist items that each article adequately and clearly reported from the 46-point checklist. RESULTS:A total of 9 studies (356 patients) with a weighted mean age of 42.1 ± 6.1 years were included in this study. The weighted mean follow-up was 32.2 ± 8.7 months. Overall, only 42.8 % ± 5.2 % of the 46-point MIBO checklist items were reported per article with no articles displaying adherence rates of 100 %. No articles had adherence rates ≥ 50 %, 6 (66.7 %) had adherence rates between 40.0 % and 49.9 % and 3 (33.3 %) had adherence rates less than 39.9 %. There was no difference in mean adherence rates between studies published prior to publication of the MIBO guidelines in May 2017 (41.7 %) and after publication of the MIBO guidelines in May 2017 (44.0 %) (p = 0.6473). There was variation in adherence rates between categories with the "Postoperative Care" category having the highest adherence rate (83.3 %) while the "Activation" category and the "Whole Blood Processing" had the lowest adherence rates (5.6 %). CONCLUSION/CONCLUSIONS:This systematic review demonstrated that clinical studies evaluating outcomes following the use of PRP in the setting of OLTs poorly adhered to MIBO guidelines. None of the included studies had adherence rates ≥ 50 % and only 1 of the 12 MIBO categories had adherence rates ≥ 80 %. Interestingly, there was no difference in the mean adherence rates in studies conducted before and after publication of the MIBO guidelines in May 2017. This study underscores the need for superior reporting of critical data related to PRP in studies evaluating outcomes in patients with OLTs augmented with PRP.

Multiple open and endoscopic techniques have been described for recalcitrant cases of plantar fasciitis. Compared with open techniques, endoscopic plantar fasciotomy has been shown to be safe and effective with decreased postoperative pain and quicker recovery, as well as decreased risk of soft tissue and neurovascular injury, while retaining the ability to provide direct visualization of the plantar fascia to facilitate proper release. Single-portal endoscopic techniques may offer additional advantages including less portal site and postoperative pain, earlier return to activities, and cost-effectiveness and higher patient satisfaction when performed in the office setting. This Technical Note describes the authors' technique for nanoscopic plantar fasciotomy using a single-portal needle arthroscopy system, as well as advantages and limitations of this technique.

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.