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/UNASSIGNED:Hallux varus is an uncommon pathology with no consensus regarding outcomes following the various surgical techniques available for its management. The purpose of this systematic review was to evaluate clinical outcomes, radiographic parameters, and complications following surgical management of hallux varus. METHODS/UNASSIGNED:During August 2025, the PubMed, Embase, and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following surgical management of hallux varus. RESULTS/UNASSIGNED:Eleven studies comprising 152 patients (159 feet) were included. Among patients treated with soft-tissue procedures, the weighted mean age was 53.5 ± 5.1 years with a weighted mean follow-up time of 35.3 ± 11.1 months. The weighted mean American Orthopedic Foot and Ankle Society (AOFAS) score improved 25.6 points, with corresponding improvements in hallux valgus angle (HVA) of 17.5°. The complication and failure rates were 18.9% and 11.3%, respectively. In the osteotomy cohort, the weighted mean age was 52.4 ± 6.0 years and the weighted mean follow-up time was 44.3 ± 15.6 months. The weighted mean AOFAS score improved 23.7 points, with improvements in of 24.5°. The complication and failure rates were 1.7% and 3.3%, respectively. In the arthrodesis cohort, the weighted mean age was 63.3 ± 0.7 years and the weighted mean follow-up time was 44.2 ± 30.1 months. The mean AOFAS improved 51 points, with improvements in HVA of 25.2°. The overall complication and failure rates were 10.7% and 3.6%, respectively. CONCLUSIONS/UNASSIGNED:Surgical management of hallux varus is associated with meaningful improvements in clinical outcomes and radiographic alignment across a range of operative techniques. No technique could be definitively identified as superior given the absence of comparative studies and variability in reported outcomes. Future studies should prioritize prospective, comparative designs with standardized outcome measures and long-term follow-up to better establish optimal management strategies for hallux varus. REGISTRATION/UNASSIGNED:CRD420261280842 (Prospero identifier). LEVEL OF EVIDENCE/UNASSIGNED:IV, systematic review.

BACKGROUND:Freiberg's disease is a rare osteochondrosis of the metatarsal head that can cause progressive pain, deformity, and loss of function. The two most widely used joint-preserving surgical options for advanced disease are dorsiflexion closing wedge metatarsal osteotomy (DCWMO) and autologous osteochondral transplantation (AOT). To date, no meta-analysis has directly compared these procedures. This systematic review and meta-analysis aimed to evaluate functional, radiographic, and complication outcomes of AOT versus DCWMO in Freiberg's disease. METHODS:A systematic search of PubMed, Embase, and Cochrane Library was conducted in August 2025 according to PRISMA guidelines. Inclusion criteria were clinical studies comparing or reporting outcomes of AOT or DCWMO in Freiberg's disease. Risk of bias was assessed using JBI Critical Appraisal Tools. Pairwise meta-analyses were performed for comparative studies evaluating American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual analogue scale (VAS) pain, range of motion (ROM), and complications. Single-arm pooled analyses were conducted for AOT and DCWMO separately to provide context for within-group improvements and complication rates. Random-effects models were applied throughout. RESULTS:Sixteen studies involving 259 toes were included: 62 treated with AOT and 197 with DCWMO. Three comparative studies (n = 70) demonstrated significantly greater functional gain with AOT (AOFAS mean difference [MD] 7.15, 95 % CI 4.29-10.02; I²=0 %) and superior dorsiflexion both postoperatively (MD 7.85°, 95 % CI 4.40-11.29; I²=0 %) and in terms of gain from baseline (MD 7.46°, 95 % CI 3.77-11.14; I²=0 %). Absolute postoperative AOFAS and VAS pain scores were similar between groups, as were improvements in plantarflexion. DCWMO consistently shortened the metatarsal head (pooled mean 1.76 mm), whereas AOT preserved or slightly increased length (-0.20 mm). Complications were significantly lower with AOT (risk difference -0.20, 95 % CI -0.35 to -0.04; risk ratio 0.23, 95 % CI 0.05-0.96). Single-arm pooled analyses confirmed large improvements in AOFAS (∼25 points) and VAS (∼5 points) for both groups, with pooled complication rates of 1 % for AOT and 6 % for DCWMO. CONCLUSION/CONCLUSIONS:Both AOT and DCWMO provide meaningful pain relief and functional improvement in advanced Freiberg's disease. However, AOT demonstrated superior functional gains, greater preservation of motion and metatarsal length, and fewer complications, suggesting it may represent the preferred joint-preserving option, particularly for Smillie stage III-IV disease. Future prospective comparative trials with standardized outcome reporting and exploration of lower-morbidity donor graft sources are warranted to refine surgical decision-making. LEVEL OF EVIDENCE/METHODS:Level II, systematic review and meta-analysis.

BACKGROUND/UNASSIGNED:Knee ligament injuries are common in elite rugby union players and are associated with performance limitations. However, comparative data on long-term performance and career patterns after isolated anterior cruciate ligament (ACL) versus medial collateral ligament (MCL) injuries remain limited. METHODS/UNASSIGNED:A retrospective review of elite rugby union players who sustained an isolated partial or complete ACL or MCL tear from 2013 to 2025 was performed. Data were collected from rugby databases and media reports, and included player demographics, injury characteristics, and performance metrics. A Wilcoxon signed rank test was used to compare pre-injury and post-injury performance metrics, with a p value < 0.05 determined as statistically significant. RESULTS/UNASSIGNED:Twenty-eight players sustained ACL injuries and 23 sustained MCL injuries. At 9.8 ± 3.1 months, 96.4% of ACL-injured players returned to sport, while 100% of MCL-injured players returned at 1.9 ± 2.1 months. ACL-injured players demonstrated significant declines in games played, tries, and points scored in the season following injury. Over time, performance largely stabilized, but total seasons played decreased. Players with MCL injuries demonstrated short-term performance declines but played a. similar number of seasons before and after injury. Re-injury occurred in 17.9% of ACL cases and 13.0% of MCL cases, with greater re-injury frequency and shorter intervals between injuries in the ACL cohort. CONCLUSION/UNASSIGNED:ACL injuries in elite rugby union players were associated with longer return to sport (RTS) times and fewer post-injury seasons despite recovery of performance metrics. MCL injuries allowed faster RTS and preserved career length but were associated with decreased performance. Re-injury led to further performance decline in both cohorts. These findings highlight distinct patterns of career and performance impact following ACL versus MCL injury in elite rugby union players. LEVEL OF EVIDENCE/UNASSIGNED:IV.

Minimally invasive surgery (MIS) has revolutionized foot and ankle care by emphasizing delicate tissue handling, reduced postoperative pain, and faster recovery through small incisions and precise instrumentation. The evolution of MIS spans 4 distinct historical "seasons," from its early development in the mid-20th century to its global resurgence in the 2010s, driven by improved techniques, education, and international collaboration. Today, MIS extends beyond hallux valgus correction to include complex procedures such as first metatarsophalangeal joint, subtalar joint, tibiotalar joint, and tibiotalocalcaneal arthrodesis, with evidence demonstrating comparable or superior outcomes to open approaches. This review details the history of MIS in foot and ankle orthopedics and how this paradigm shift continues to redefine standards and improves outcomes in foot and ankle surgery.

CONTEXT/BACKGROUND:Although ankle sprains are among the most common musculoskeletal injuries, prior studies have not systematically reviewed the educational quality of related YouTube videos. We aimed to evaluate the characteristics, sources, and educational quality of YouTube videos addressing ankle sprains. DESIGN/METHODS:Cross-sectional analysis of online material. METHODS:We performed 4 independent YouTube searches on ankle sprains and recorded the top 25 results for each search. After screening 100 videos, we included 73 total videos for final analysis. We evaluated video content using 3 validated tools: Global Quality Scale (GQS), the Patient-Friendliness Scale, and the Journal of the American Medical Association criteria. RESULTS:A total of 73 YouTube videos accumulated over 20.7 million views (mean: 283,546). Videos received 14.8 likes and 1.04 comments per 1000 views. Among included videos, the mean GQS score measured 3.75, Patient-Friendliness Scale score measured 3.48, and Journal of the American Medical Association score measured 1.19, indicating good accessibility, moderate educational quality, and poor transparency. Physicians produced the highest overall quality and transparency (GQS: 3.89, Journal of the American Medical Association: 1.50). Rehabilitation-focused content emerged as the most common theme (36%), maintaining good quality and accessibility (GQS: 3.77, Patient-Friendliness Scale: 4.23). CONCLUSION/CONCLUSIONS:YouTube offers wide access to ankle sprain information, yet video quality, accessibility, and transparency remain low. Physician-created and rehabilitation-focused videos demonstrated superior educational value, although highly viewed videos did not correspond with higher quality. These findings highlight the need for more reliable, high-quality ankle sprain content on online platforms.

BACKGROUND:Acute Achilles tendon ruptures (AATRs) are devastating injuries for athletes, yet outcomes in elite rugby union players remain poorly characterized. HYPOTHESIS/OBJECTIVE:Elite rugby union players who sustain AATRs will demonstrate significantly reduced performance metrics postinjury compared with preinjury levels. STUDY DESIGN/METHODS:Retrospective case series. LEVEL OF EVIDENCE/METHODS:Level 4. METHODS: value <0.05 was determined as statistically significant. RESULTS: = -0.47 to -0.72). CONCLUSION/CONCLUSIONS:AATRs in elite rugby union players were associated with significant declines in performance metrics in both the immediate postinjury season and across subsequent seasons. These findings highlight the substantial performance impact of AATRs and support the need for improved position-specific prevention strategies and targeted postinjury rehabilitation protocols. CLINICAL RELEVANCE/CONCLUSIONS:Clinicians can use these findings to counsel rugby athletes and teams on prognosis, treatment decisions, and realistic performance expectations after AATRs.

BACKGROUND:Posterior malleolus (PM) fractures compromise overall ankle stability, lending to poorer long-term prognosis without adequate fixation. There remains inconsistency in the preferred surgical approach to fixation of the posterior malleolus, however arthroscopic approaches can reduce trauma to the soft tissue envelope and may improve clinical and radiographic outcomes. This study reviews the technical considerations of arthroscopic-assisted reduction and fixation of PM fractures and the associated clinical outcomes. METHODS:A systematic review of Pubmed, EMBASE, and UNE Library Services databases included studies evaluating arthroscopic assisted treatment of ankle fractures with associated posterior malleolus fragment. RESULTS:Seven studies evaluating 101 patients who underwent fixation of ankle fractures with posterior malleolus involvement met inclusion criteria. Twenty-seven patients underwent open reduction internal fixation (ORIF) alone and 74 patients underwent various arthroscopic-assisted reductions of PM fractures. The studies reported no significant difference in VAS and AOFAS scores in ORIF vs arthroscopic approach, and favorable VAS, AOFAS, OMAS, and FADI scores in arthroscopically treated patients. Acceptable radiographic differences were reported in each case. Complication rates in arthroscopic groups were minimal (mean 12 %). Reported benefits of arthroscopic assistance include improved visualization, debridement, and manipulation of the posterior malleolar fragment. CONCLUSION/CONCLUSIONS:Fixation of ankle fractures involving the posterior malleolus consistently report favorable clinical outcomes in patients treated with arthroscopy, with many patients achieving desirable AOFAS, OMAS, FADI, and VAS scores with a very low complication rate. LEVEL OF EVIDENCE/METHODS:Level I, systematic review.

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/UNASSIGNED:Peroneal tendon disorders span tendinopathy, tenosynovitis, intrasheath subluxation, stenosis, and tears, and may be challenging to diagnose accurately with clinical examination and MRI alone. Peroneal tendoscopy offers a minimally invasive, diagnostic-therapeutic option. We systematically reviewed clinical indications, intraoperative findings, procedures, imaging accuracy, complications, and patient-reported outcomes following peroneal tendoscopy. METHODS/UNASSIGNED:Eight studies (190 patients; 195 ankles) were reviewed. Data on demographics, indications, procedures, PROMs, return to sport (RTS), complications/failures, and imaging-tendoscopy agreement were extracted and pooled when constructs aligned. Random-effects meta-analyses generated pooled means or proportions with 95 % CIs (Hartung-Knapp adjustment). Where applicable, diagnostic performance of preoperative assessment was compared with tendoscopy as reference. RESULTS/UNASSIGNED:Across 190 patients (195 ankles), pooled mean age was 32 years (95 % CI 25.0-39.0), follow-up 30.3 months (95 % CI 20.8-39.8); 71 % of ankles had traumatic aetiologies. Indications were broad, with recurrent subluxation/dislocation, intrasheath subluxation, and refractory lateral ankle pain common. Frequently performed procedures included synovectomy/debridement (94 ankles), groove deepening (34 ankles), excision of space occupying lesions (65 ankles; predominantly low-lying muscle bellies [LLMB] and peroneus quartus), tendon repair/tubularization (23 ankles), and tendoscopic retinacular repair (14 ankles). Six studies reported validated PROMS with four reporting AOFAS suitable for pooling. Postoperative AOFAS averaged 96.6 (95 % CI 94.3-99.0) with a pooled mean gain of +19.8 (95 % CI 18.5-21.2); JSSF, FAOS and SF-12 improved significantly. RTS occurred at a pooled 13.3 weeks (95 % CI 10.6-16.0), with RTS of 12.2 ± 0.6 weeks after tendoscopic retinacular stabilization and 14.8 ± 2.0 weeks after groove deepening. Overall complications were 7.6 % (13 events) and mainly consisted of persistent ankle pain and minor wound issues. Failure rate was 1.5 % and two revision surgeries (1.0 %) were reported. Diagnostic agreement was high at the aggregate level (MRI overall sensitivity 0.90, specificity 0.72), but lesion-level performance varied: MRI was strong for tears and tenosynovitis, weaker for stenosis. Composite preoperative diagnosis in a large series showed high specificity (0.97) but only moderate sensitivity (0.76), with LLMB frequently under-recognized preoperatively. CONCLUSIONS/UNASSIGNED:Peroneal tendoscopy provides meaningful functional gains, timely RTS, and a low adverse-event burden across a wide indication spectrum, and it complements imaging by clarifying dynamic/space-conflict pathology. Longer, prospective comparative studies are warranted.