Faculty Bibliography

BACKGROUND/UNASSIGNED:Spring ligament disruption is a primary contributor to the development of progressive collapsing flatfoot deformity (PCFD). The purpose of this systematic review is to evaluate the radiographic findings, clinical outcomes, complications, and failures following spring ligament repair with and without augmentation. METHODS/UNASSIGNED:During December 2025, the PubMed, Cochrane, and EMBASE library databases were systematically searched to identify studies examining radiographic findings, clinical outcomes, complications, and failures in patients who underwent spring ligament repair with and without augmentation. RESULTS/UNASSIGNED:Nine studies including 209 patients (212 feet) with spring ligament injuries were analyzed. Patients who underwent spring ligament repair with and without augmentation were evaluated. Both treatment approaches were associated with clinically meaningful improvements in radiographic alignment, with mean talo-first metatarsal angle (TFMA) correction of 12.9° following isolated repair and 11.0° following repair with augmentation. Clinical outcomes also improved, with mean increases in American Orthopaedic Foot and Ankle Society (AOFAS) scores of 24.1 and 29.8 points for isolated repair and repair with augmentation, respectively. Complication rates were low for both isolated repair (4.5 %) and repair with augmentation (6.7 %), with corresponding failure rates of 1.3 % and 3.3 %, respectively. CONCLUSION/UNASSIGNED:Spring ligament repair with and without augmentation is associated with meaningful improvements in radiographic alignment and clinical outcomes in patients with PCFD. Across the included studies, both treatment approaches also demonstrated low complication and failure rates. While suture augmentation may provide additional mechanical support in select patients, the available evidence precludes direct comparative conclusions regarding the superiority of the technique over isolated spring ligament repair. Further high-quality, comparative studies are warranted to definitively establish the optimal surgical method for managing spring ligament injuries. LEVEL OF EVIDENCE/UNASSIGNED:IV.

BACKGROUND:The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (COG) was developed in response to increasing rates of opioid-related hospital visits and deaths in Canada, and uncertain benefits of opioids for chronic non-cancer pain (CNCP). Following publication, we developed a list of evaluable outcomes to assess the impact of this guideline on practice and patient outcomes. METHODS:A working group at the National Pain Centre at McMaster University used a modified Delphi process to construct a list of clinical and patient outcomes important in assessing the uptake and application of the COG. An advisory group then reviewed this list to determine the relevance and feasibility of each outcome, and identified potential data sources. This feedback was reviewed by the National Faculty for the Guideline, and a National Advisory Group that included the creators of the COG, resulting in the final list of 5 priority outcomes. RESULTS:Five outcomes were judged clinically important and feasible to measure: 1) Effects of opioids for CNCP on quality of life, 2) Assessment of patient's risk of addiction before starting opioid therapy, 3) Monitoring patients on opioid therapy for aberrant drug-related behaviour, 4) Mortality rates associated with prescription opioid overdose and 5) Use of treatment agreements with patients before initiating opioid therapy for CNCP. Data sources for these outcomes included patient's medical charts, e-Opioid Manager, prescription monitoring programs and administrative databases. CONCLUSION:Measuring the impact of best practice guidelines is infrequently done. Future research should consider capturing the five outcomes identified in this study to evaluate the impact of the COG in promoting evidence-based use of opioids for CNCP.