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Supplemental material, sj-pdf-1-hss-10.1177_15563316231160458 for Common Football Foot and Ankle Injuries: Non-Surgical and Surgical Management by David Cho, Saanchi Kukadia and Mark Drakos in HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery

Supplemental material, sj-pdf-2-hss-10.1177_15563316231160458 for Common Football Foot and Ankle Injuries: Non-Surgical and Surgical Management by David Cho, Saanchi Kukadia and Mark Drakos in HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery

Supplemental material, sj-pdf-3-hss-10.1177_15563316231160458 for Common Football Foot and Ankle Injuries: Non-Surgical and Surgical Management by David Cho, Saanchi Kukadia and Mark Drakos in HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery

Category: Sports; Other Introduction/Purpose: Blood flow restriction (BFR) therapy involves the use of a tourniquet to partially occlude blood flow to the affected limb, creating an anaerobic environment during exercise. This is thought to stimulate growth and recovery by increasing the body's anabolic response. BFR therapy can be initiated shortly after surgery since it allows for significant muscle activation with limited load bearing. To date, no existing study has evaluated the effect of using BFR therapy for recovery following Achilles tendon rupture and repair, after which patients often experience significant losses in calf strength and girth. This is a randomized controlled trial designed to study whether BFR can minimize loss of calf strength and muscle volume after Achilles rupture compared to a conventional physical therapy protocol. Methods: Patients presenting with an acute Achilles tendon rupture were randomized into the BFR or control group. Patients in the control group performed at-home exercises and began in-person physical therapy at 6 weeks postoperatively, as is the standard of care in our practice. The exercises were standardized across groups with BFR the isolated variable. The primary outcome studied was ankle plantarflexion strength as measured during isokinetic strength testing 3 months after surgical repair. We also tested knee strength during flexion and extension. All strength tests were performed at two rotational speeds. Calf atrophy was assessed by measuring the circumference of both calves 15 cm below the joint line at the time of operation and at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively. Finally, Patient-Reported Outcome Measurement Information System (PROMIS) scores were collected pre- and postoperatively. Results: The study enrolled 43 patients, 24 of whom were assigned to the BFR group. 30 patients completed strength testing at 3 months and 26 at 6 months. Calf measurements through 3 months were completed for 39 patients and 6 month measurements were completed for 32 patients. Results for ankle plantarflexion strength at 3 months are displayed in Table 1, showing that patients in the BFR group demonstrated greater absolute strength in the operative calf compared to the control group, but no significant advantage in strength relative to the uninvolved calf. We failed to detect a significant difference in strength between groups for ankle dorsiflexion, knee extension, or knee flexion. Our model of calf circumference over time showed that BFR had a positive but insignificant correlation to calf circumference (p = 0.59). The only factors that demonstrated a significant (pConclusion: We have observed significant advantages in the BFR group when analyzing absolute calf strength metrics when compared to a randomized control group. This indicates that, when used during rehabilitation following Achilles rupture, BFR therapy may increase the strength of the operative leg and may facilitate recovery and outcome.

Category: Ankle; Other Introduction/Purpose: Peroneal tendon injuries are a common cause of lateral ankle pain and instability. While the use of hamstring autograft has been proposed as a viable surgical option for peroneus brevis reconstruction, reported outcomes with this technique are limited in the literature. We present patient-reported and clinical outcomes for patients who underwent peroneus brevis reconstruction with hamstring autograft. Methods: Thirty-one patients were retrospectively identified who underwent peroneus brevis reconstruction with hamstring autograft for peroneal tendinopathy between February 2016 and May 2019. All patients who had a peroneus brevis reconstruction were included and all concomitant procedures were noted. Patient-Reported Outcomes Measurement Information System (PROMIS) surveys were prospectively collected preoperatively and at a minimum of 1 year postoperatively (average 24.25, range 12-52.70) months. Retrospective chart review was performed to evaluate the incidence of postoperative complications and reoperations at an average of 30.23 (range, 14.62-53.72) months. Results: When evaluating pre and postoperative patient-reported outcome surveys (n=26; 84%), on average patients reported improvement in every PROMIS domain evaluated, with significant improvement in Physical Function (+5.99; p=0.006), Pain Interference (-8.11; pConclusion: Patients undergoing peroneus brevis reconstruction with hamstring autograft experienced excellent patient- reported and clinical outcomes. Few postoperative complications were observed, and patients reported improvements across all patient-reported outcome domains, with significant improvements for pain and function domains. Reconstruction with hamstring autograft represents a viable surgical option in the setting of peroneal tendinitis or tears.