Comparison of Postoperative Complications by Surgical Technique After Acute Midsubstance Achilles Tendon Repair.

Background: Midsubtance Achilles tendon ruptures remain the most common tendon injury within the lower extremity. While the incidence continues to rise, changing immobilization protocols, surgical techniques, and surgeon preferences have evolved over the past few decades.

Purpose: To compare the overall complication rate among 3 major surgical techniques (open, percutaneous, and suture anchor) across a large, heterogeneous orthopaedic group in a major metropolitan area.

Managing Hallux Rigidus in the Elite Athlete.

Hallux rigidus can present a difficult problem to both competitive and elite athletic populations. Once an appropriate diagnostic workup has been performed, nonoperative management strategies, including anti-inflammatory medications, injection therapies, shoewear modifications, and orthotic devices, represent the mainstay conservative management options. Surgical management can be considered where an athlete's athletic performance is limited.

Editorial Commentary: Large, Deep, and Cystic Osteochondral Lesions of the Talus May Be Better Treated With Bone Grafting Techniques or Autologous Osteochondral Transplantation Rather Than Bone Marrow Stimulation.

Osteochondral lesions of the talus are a challenging problem to treat. Debridement with bone marrow stimulation has represented the mainstay of treatment for the injuries, with good to excellent results reported. However, some patients do not do well with simple debridement and bone marrow stimulation, which yields a surface of fibrocartilage rather than articular cartilage.

Management of High-Energy Tibial Pilon Fractures.

➤ Pilon fractures in the younger patient population are frequently high-energy, intra-articular injuries and are associated with devastating, long-term impacts on patient-reported outcomes and health-related quality of life, as well as high rates of persistent disability.➤ Judicious management of associated soft-tissue injury, including open fractures, is essential to minimizing complications. Optimizing medical comorbidities and negative social behaviors (e.

Paediatric ankle cartilage lesions: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle.

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on "Pediatric Ankle Cartilage Lesions" developed at the 2019 International Consensus Meeting on Cartilage Repair of the Ankle.

Thread Delamination in 4.5 mm AO Cannulated Screws: A Small Case Series in the Pediatric Trauma Population.

Background: Thread delamination associated with cannulated screws have been reported but likely represent an under-recognized complication in the orthopaedic literature. The purpose of this study is to report the occurrence of repeated hardware failures through thread delamination in the setting of a commonly used orthopaedic cannulated screw implant in a small cohort involving pediatric fracture care at a single academic level I trauma center.

Methods: Between August 2015 and December 2020, 9 cases of hardware failure associated with 4.

Temporizing Care of Acute Traumatic Foot and Ankle Injuries.

Temporizing care has become a critical part of the treatment armamentarium for select foot and ankle injuries. Indications for performing temporizing care are based on the specific injury pattern, the host, associated injuries, as well as surgeon resources. Foot and ankle injuries are often associated with severe adjacent injury to the soft tissue sleeve.

Stress Shielding of Ligaments Using Nonabsorbable Suture Augmentation May Influence the Biology of Ligament Healing.

Nonabsorbable suture augmentation of ligament reconstruction has seen an increase in use over the past several years with the goal of protecting the newly reconstructed ligament while allowing early rehabilitation for a potential earlier return to activity and sport. By spanning the joint with a durable nonabsorbable suture, this construct shares the stress and load seen by the reconstructed ligament, thereby protecting it from forces that could result in an early failure during the early ligamentization phase of the tendon graft. However, stress shielding of the ligament via nonabsorbable suture augmentation is also a double-edged sword, as a reduction in the stress and load seen by the ligament during this healing phase may ultimately have an impact on the final strength and composition of the reconstructed ligament.

The Mandated Publication of Individual Hospital Charge Description Masters Does Not Permit the Estimation of Complex Procedure Charges.

Background: As healthcare spending continues to rise, price transparency is crucial for patients to calculate a reasonable cost estimate for tests and procedures. Legislative efforts have been successful at mandating increased hospital price transparency, including publishing charge description masters (CDMs), but their usefulness in permitting patients to assess the cost for complex procedures is unclear. We sought to determine CDM and diagnosis-related group (DRG) prevalence and evaluate whether these are effective tools for patients to preemptively ascertain the costs for simple and complex tests and procedures.

Evidence-based Treatment of Failed Primary Osteochondral Lesions of the Talus: A Systematic Review on Clinical Outcomes of Bone Marrow Stimulation.

Objective: The purpose of this study is to systematically review the literature and to evaluate the outcomes following bone marrow stimulation (BMS) for nonprimary osteochondral lesions of the talus (OLT).

Design: A literature search was performed to identify studies published using PubMed (MEDLINE), EMBASE, CDSR, DARE, and CENTRAL. The review was performed according to the PRISMA guidelines.

The Use of a Synthetic Cartilage Implant for Hallux Rigidus: A Systematic Review.

Hallux rigidus is a common pathology afflicting the foot, for which various joint salvage techniques have been described with a multitude of different implants. Recently, a synthetic cartilage implant composed of polyvinyl alcohol (PVA) received FDA premarket approval for the treatment of arthritis of the great toe. The purpose of this study was to (1) systematically review the clinical evidence supporting the use of a PVA implant in hallux rigidus and (2) determine the strength of the recommendation that can be made supporting the use of a PVA implant by evaluating the quality of evidence available.

Platelet-Rich Plasma Versus Corticosteroids for Plantar Fasciitis: A Systematic Review of Randomized Controlled Trials.

Background: Plantar fasciitis is the most common cause of plantar heel pain. Several recent randomized control trials (RCTs) have been published comparing the use of platelet-rich plasma (PRP) and corticosteroids (CSs) for the treatment of plantar fasciitis.

Purpose: To perform a systematic review of RCTs to compare whether PRP or CS injections result in decreased pain levels and improved patient outcomes in the treatment of plantar fasciitis.

How Should Postoperative Cellulitis Be Treated in Patients With Total Ankle Arthroplasty (TAA) in Place?

Recommendation: In the absence of evidence, we recommend that (1) patients with total ankle arthroplasty (TAA) in place who develop postoperative cellulitis be evaluated thoroughly to rule out periprosthetic joint infection of the ankle, and that (2) isolated cellulitis may be treated with antibiotics, elevation, and close monitoring. Aspiration can be considered in certain cases, with the potential risk of introducing deep space infection.

Level Of Evidence: Consensus.

The Role of Platelet-Rich Plasma in Cartilage Pathology: An Updated Systematic Review of the Basic Science Evidence.

Purpose: To review the basic science studies on platelet-rich plasma (PRP) for cartilage and determine whether there has been an improvement in methodology and outcome reporting that would allow for a more meaningful analysis regarding the mechanism of action and efficacy of PRP for cartilage pathology.

Methods: The PubMed/MEDLINE and EMBASE databases were screened in May 2017 with publication dates of January 2011 through May 2017 using the following key words: "platelet-rich plasma OR PRP OR autologous conditioned plasma (ACP) OR ACP AND cartilage OR chondrocytes OR chondrogenesis OR osteoarthritis OR arthritis." Two authors independently performed the search, determined study inclusion, and extracted data.

Medical comorbidities increase the rate of surgical site infection in primary Achilles tendon repair.

Purpose: To assess the effects of medical comorbidities on the incidence of surgical site infection following primary Achilles tendon repair. A secondary aim was to assess the effects of specific medical comorbidities on the cost and extent of healthcare utilization related to surgical site infection following primary Achilles tendon repair.

Methods: 24,269 patients undergoing primary Achilles tendon repair between 2005 and 2012 were examined.

Suture Button Versus Syndesmotic Screw for Syndesmosis Injuries: A Meta-analysis of Randomized Controlled Trials.

Background: Operative treatment is indicated for unstable syndesmosis injuries, and approximately 20% of all ankle fractures require operative fixation for syndesmosis injuries.

Purpose: To perform a meta-analysis of randomized controlled trials evaluating clinical outcomes between suture button (SB) and syndesmotic screw (SS) fixation techniques for syndesmosis injuries of the ankle.

Study Design: Meta-analysis.

Postoperative Reoperations and Complications in 32,307 Ankle Fractures With and Without Concurrent Ankle Arthroscopic Procedures in a 5-Year Period Based on a Large U.S. Healthcare Database.

Residual symptoms often persist even after successful operative reduction and internal fixation (ORIF) of ankle fractures. Concurrent ankle arthroscopic procedures (CAAPs) have been proposed to improve clinical outcomes; however, a dearth of evidence is available supporting this practice. The purpose of the present study was to investigate the reoperation and complication rates after ORIF of ankle fractures with and without CAAPs.

Post-treatment Follow-up, Imaging, and Outcome Scores: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle.

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on Post-treatment Follow-up, Imaging and Outcome Scores developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle.

Revision and Salvage Management: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle.

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article was to report on the consensus statements on "Revision and Salvage Management" developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle.