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Category: Ankle; Arthroscopy Introduction/Purpose: A hypertrophic distal fascicle of the anterior tibiofibular ligament (ATiFLdf) is commonly encountered in patients with anterior ankle impingement. Repetitive snapping of the hypertrophic ATiFLdf has the potential to create osteochondral lesions (OCLs) at the lateral talar dome. However, the clinical manifestations of these OCLs in the setting of a hypertrophic ATiFLdf has not been described to date. The purpose of this retrospective review was to determine the prevalence of OCLs of the lateral talar dome in patients with anterior ankle impingement with an associated hypertrophic ATiFLdf. In addition, we sought to evaluate the anatomy of the ATiFL to fully elucidate its role in creating chondral wear of the talus. Methods: Retrospective chart review identified 40 patients who underwent arthroscopy of the anterior ankle joint for the management of anterior ankle impingement. Pre-operative magnetic resonance imaging (MRI) scans were obtained and correlated with intra-operative arthroscopic findings. Clinical outcomes assessed included: pre- and post-operative foot and ankle outcome score (FAOS), visual analog scale (VAS), complications, failures, secondary surgical procedures, return to work data and return to sport data. Results: Thirty-two patients with a mean follow-up time of 29.3±10.4 months were included. The ATiFLdf was hypertrophic in 29 patients (90.6%), the mean thickness of which was 2.5±0.4 mm. There were 22 OCLs of the lateral talar dome (75.9%) with an associated hypertrophic ATiFLdf visualized during arthroscopy. The international cartilage repair society gradings of the lesions included: 3 (13.6%) grade I lesions, 15 (68.1%) grade II lesions, 3 (13.6%) grade III lesions, and 1 (4.6%) grade IV lesion. There was a statistically significant improvement in mean FAOS and VAS scores from pre-operative to post-operative (p< 0.001). No cases of syndesmotic instability were observed following resection of ATiFLdf. The mean post-operative Likert score was 4.1±0.4. There were 5 failures (15.6%) at a mean time of 9.0±4.7 months. Conclusion: This retrospective case series demonstrated that a hypertrophic ATiFLdf was closely associated with the development of an OCL of the lateral talar dome identified during arthroscopic evaluation. In addition, pre-operative MRI proved to demonstrate poor sensitivity for the detection of these OCLs. Suspicion should be raised for potential lateral talar dome OCLs in patients presenting with anterolateral ankle impingement with a hypertrophic ATiFLdf. Figure 1. (a) Hypertrophic ATiFLdf with associated OCL of the lateral talar dome; (b) Biter resecting hypertrophic ATiFLdf; (c) Resected hypertrophic ATiFLdf; (d) and (e) Hypertrophic ATiFLdf identified on coronal and axial MRI scans

Category: Midfoot/Forefoot; Sports Introduction/Purpose: The purpose of this study was to evaluate outcomes following the use of Platelet-Rich Plasma (PRP) for Plantar Plate Injuries. Methods: Retrospective chart review identified 13 patients who underwent a PRP injection for the treatment of plantar plate injuries. Pre-operative magnetic resonance imaging (MRI) scans were obtained and the grade of the plantar plate injury was recorded. Clinical outcomes assessed included: pre- and post-operative foot and ankle outcome score (FAOS), visual analog scale (VAS), complications, failures, secondary surgical procedures, and return to sport data. Results: Thirteen patients with a mean follow-up time of 22.1±10.4 months were included. There were 6 patients that were grade 1, 4 patients were grade 2 and 3 patients were grade 3. There was a statistically significant improvement in both FAOS (53.1 -> 86.7) and VAS scores (4.5 -> 1.1) following injection of PRP to the plantar plate. No complications were observed. There was 1 failure, which underwent a plantar condylectomy at 8.1 weeks following PRP injection. Ten patients played sport pre-operatively, all of which (100%) returned to sport at a mean time of 5.3 weeks following PRP injection. Conclusion: This retrospective review demonstrated improvement clinical and functional outcomes following injection of PRP for plantar plate injuries. There was a 100% return to sport rate at a mean time of 5.3 weeks. The failure rate was 7.7%. Further comparative studies with longer follow-up are warranted to determine the precise role of PRP for the management of plantar plate injuries.

Category: Other; Ankle Introduction/Purpose: The purpose of this study was to evaluate the efficacy of an Artificial Intelligence Large Language Model (AI-LLM) at improving the readability foot and ankle orthopedic radiology reports. Methods: The radiology reports from 100 foot or ankle X-Rays, 100 computed tomography (CT) scans and 100 magnetic resonance imaging (MRI) scans were randomly sampled from the institution’s database. The following prompt command was inserted into the AI-LLM. “Explain this radiology report to a patient in layman's terms in the second person. [Report Text]”. The mean report length, Flesch reading ease score (FRES) and Flesch-Kincaid reading level (FKRL) were evaluated for both the original radiology report and the AI-LLM generated report. The accuracy of the information contained within the AI-LLM report was assessed via a 5-point Likert scale. Additionally, any “hallucinations” generated by the AI-LLM report were recorded. Results: There was a statistically significant improvement in mean FRES scores in the AI-LLM generated X-Ray report (33.8±6.8 to 72.7±5.4), CT report (27.8±4.6 to 67.5±4.9) and MRI report (20.3±7.2 to 66.9±3.9), p< 0.001. There was also a statistically significant improvement in mean FKRL scores in the AI-LLM generated X-Ray report (12.2±1.1 to 8.5±0.4), CT report (15.4±2.0 to 8.4±0.6) and MRI report (14.1±1.6 to 8.5±0.5), p< 0.001. Superior FRES scores were observed in the AI-LLM generated X-Ray report compared to the AI-LLM generated CT report and MRI report, p< 0.001. The mean Likert score for the AI-LLM generated X-Ray, CT and MRI report was 4.0±0.3, 3.9±0.4, and 3.9±0.4, respectively. The hallucination rate in the AI-LLM generated X-Ray report, CT report and MRI report was 4%, 7% and 6%, respectively. Conclusion: AI-LLM was an efficacious tool for improving the readability of foot and ankle radiological reports across multiple imaging modalities. Superior FRES scores together with superior Likert scores were observed in the X-Ray AI-LLM reports compared to the CT and MRI AI-LLM reports. This study demonstrates the potential use of AI-LLMs as a new patient-centric approach for enhancing patient understanding of their foot and ankle radiology reports.

Category: Sports; Other Introduction/Purpose: The purpose of this study was to assess outcomes following acute Achilles tendon ruptures (AATR) sustained by athletes participating in the National Hockey League (NHL). Methods: Athletes participating in the NHL who sustained an AATR were identified using a publicly available database, match reports and injury reports. The years of inclusion was from 2008-2022. Data collected and analysed: player demographics, player position, if surgical intervention was warranted, rates of return to play, time to return to play, games missed. Pre-injury and post-injury performance outcomes collected and analysed: games played, plus/minus rating, assists, goals, game-winning goals, penalty minutes, power play assists, power play goals, production, points, short-handed assists, short-handed goals, shootout goals, shooting percentage and time on ice per game. Results: Eighteen athletes sustained an AATR in the NHL (0.000481 per 10,000 athlete-exposures). The mean age was 27.9±3.6 years and the mean BMI was 26.3±1.6kg/m 2 . There were 7 (38.9%) AATRs sustained by defenseman, 7 (38.9%) AATRs sustained by centers, 1 (5.6%) AATR sustained by right wings, 1 (5.6%) AATR sustained by left wings, 1(5.6%) AATR sustained by goaltenders and 1 (5.6%) AATR sustained by forwards. Seventeen athletes (94.4%) underwent surgical intervention. The mean number of games played prior to injury was 480.2±240.6. The RTP rate to the NHL was 88.8% at mean time of 4.8 ± 2.5 months. The mean number of games missed due to injury was with 45.1±19.4 games. There was no statistically significant difference in pre-injury performance outcomes compared to post-injury performance outcomes (p>0.05). Conclusion: This current study found that AATRs were an uncommon injury in the NHL with an incidence of 0.000481 per 10,000 athlete-exposures over a 14 year period. Sustaining an AATR was associated with a 88.8% return to play rate to the NHL together at a mean time of 4.8 ± 2.5 months with no deterioration in athletic performance. Although sustaining an AATR in the NHL poses a temporary setback, the findings of this study demonstrate that sustaining an AATR does not have a catastrophic effect on the NHL athlete's career.

Category: Arthroscopy; Other Introduction/Purpose: Posterior Tibial Tendon Insufficiency (PTTI) is a common pathology of the foot and ankle and the leading cause for adult-aquired flatfoot deformity. PTTI typically presents with loss of medial arch of the foot which may progress to hindfoot valgus, forefoot abduction, and development of midfoot osteoarthritis. Following failure of conservative management, tenosynovectomy is indicated in early stage PTTI. However, current tendoscopy techniques lead to significant soft tissue damage. Minimally invasive approaches to these arthroscopic procedures minimize damage to soft-tissue and allow for a much faster recovery. The purpose of this retrospective review is to evaluate the therapeutic and diagnostic potential of In-Office Posterior Tibial Needle Tendoscopy for PTTI. Methods: Chart review was conducted to identify patients who underwent In-Office Posterior Tibial Needle Tendoscopy with a minimum of 1-year follow-up. Data collected and assessed included: patient demographics, pathological characteristics, treatment characteristics, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score, visual analog scale (VAS) scores, return to sport (RTS), and failures. Results: Eleven patients were included at a mean follow-up of 17.4 ± 9.0 months and a mean age of 40.8 ± 14.64 years. Five patients (45.5%) were stage 1 PTTI, 5 patients were stage 2a PTTI and 1 patient was stage 2b PTTI. The mean AOFAS score improved from 45 ± 5.4 preoperatively to 70 ± 18.5 at final follow-up (p< 0.01). The mean VAS improved from 6 ± 0.7 preoperatively to 3.7 ± 1.6 at final follow-up (p< 0.01). The failure rate was 36.3%. All patients with stage 1 PTTI were asymptomatic at final follow-up. Four of the 6 patients (66.7%) with stage 2 PTTI warranted further surgical intervention. Conclusion: This retrospective study demonstrated there is therapeutic and diagnostic potential for In-Office Posterior Tibial Needle Tendoscopy. Patients with early stage PTTI had improved subjective clinical outcomes and rapid return to sport. For moderate to severe PTTI, in-office needle tendoscopy may be less beneficial. Further high quality studies are necessary to determine the optimal role of In-Office Posterior Tibial Needle Tendoscopy in the management of Posterior Tibial Tendon injury.

Category: Ankle; Other Introduction/Purpose: The purpose of this study was to evaluate the impact on cost effectives with in-office needle arthroscopy (IONA) for the management of anterior ankle pathologies in comparison to anterior ankle arthroscopy performed in a traditional formal operating suite. Methods: Data regarding costs was obtained from the local institution in the following areas: . A Monte Carlo simulation combined with DuPont analysis running 10,000 simulations was conducted to calculate the revenue, expenses and profits between the 2 cohorts. Sensitivity analyses examined the influence of patient preference and revision rates on profit and throughput. Two-sample Student's t test was performed (p < .05). Results: There was a 91.4% reduction in costs in favor of anterior ankle IONA. Sensitivity analysis revealed 4.3% of patients need to select IONA over traditional arthroscopy in an operating suite with the revision rate remaining below 42% for the proposed state profit to be higher than the current state. Conclusion: IONA is a cost-effective alternative to traditional OR arthroscopy in patients undergoing anterior ankle arthroscopy. The next steps are to assess patients' perceptions of IONA as an alternative to traditional OR arthroscopy, and to carry out clinical trials to determine the efficacy, patient-reported outcome metrics, and complications of IONA.

Category: Sports; Other Introduction/Purpose: The purpose of this study was to assess outcomes following acute Achilles tendon ruptures (AATR) sustained by elite rugby union players. Methods: Elite rugby union players who sustained an AATR were identified using a publicly available database, match reports and injury reports. "Elite rugby union" was defined as a player who played professional rugby in the following competitions: United Rugby Championship, Top 14, English Premiership, Super Rugby and international rugby for a top 20 ranked team. The years of inclusion was from 2015-2022. Data collected and analysed: player demographics, player position, if surgical intervention was warranted, rates of return to play (RTP), time to return to play, games missed. Pre-injury and post-injury performance outcomes collected and analysed: games played, tries scored, points scored. Results: Nintety-three elite rugby union players sustained an AATR between 2015-2022 (0.0146 per 10,000 athlete-exposures). The mean age was 27.8±10.1 years and the mean BMI was 30.5±7.6kg/m 2 . There were 61 (65.5%) AATRs sustained by forwards and 32 (34.5%) AATRs sustained by backs. Forty-five (48.3%) of AATRS occurred during the in-season and 48 (51.7%) AATRs occurred during training. All athletes (100%) underwent surgical intervention. The most common mechanism of injury was a non-contact injury (86.4%). The RTP rate was 68.9% at mean time of 8.9±3.9 months. There was a statistically significant decrease in the mean number of games played, tries scored and points scored following RTP. Conclusion: This current study found that AATRs were an uncommon injury in elite rugby union players with an incidence of 0.0146 per 10,000 athlete-exposures. Sustaining an AATR was associated with a 68.9% return to play rate at a mean time of 8.9±3.9 months. There was a statistically significant deterioration in key performance metrics such as mean games played, tries scored and points scored This study reinforces the potentially devastating sequelae following AATR in the elite athletic population.

Category: Sports; Other Introduction/Purpose: The purpose of this study was to assess outcomes following acute Achilles tendon ruptures (AATR) sustained by athletes participating in the Major League Soccer (MLS). Methods: Athletes participating in the MLS who sustained an AATR were identified using a publicly available database, match reports and injury reports. The years of inclusion was from 2008-2022. Data collected and analysed: player demographics, player position, if surgical intervention was warranted, rates of return to play (RTP), time to return to play, games missed. Pre-injury and post-injury performance outcomes collected and analysed: games played, assists, goals, passes, pass %, crosses, shots, shots on target and shot %. Results: Twenty-six athletes sustained an AATR in the MLS (0.008564 per 10,000 athlete-exposures). The mean age was 25.8±8.4 years and the mean BMI was 22.5±6.6kg/m 2 . There were 15 (57.7%) AATRs sustained by defensive players, 5 (19.2%) AATRs sustained by midfield players, 3 (11.6%) AATR sustained by forwards and 3 (11.6%) AATR sustained by goalkeepers. All athletes (100%) underwent surgical intervention. The mean number of games played prior to injury was 164.7±154.9. The RTP rate to the MLS was 73.1% at mean time of 11.1±5.5 months. The mean number of games missed due to injury was with 30.1±11.7 games. There was a statistically significant decrease in the mean number of games played, goals scored and shots taken following RTP. Conclusion: This current study found that AATRs were an uncommon injury in the MLS with an incidence of 0.008564 per 10,000 athlete-exposures. Sustaining an AATR was associated with a 73.1% return to play rate to the MLS at a mean time of 11.1 ± 5.5 months. There was a statistically significant deterioration in key performance metrics such as mean games played, goals scored and shots taken. This study reinforces the potentially devastating sequelae following AATR in the elite athletic population.

Category: Sports; Other Introduction/Purpose: The purpose of this systematic review was to evaluate rates of return to play and levels of performance following acute Achilles tendon ruptures (AATR) in the National Football League (NFL). Additionally, we sought to determine the prevalence rates of AATR and identify any risk factors for the development of AATR. Methods: During November 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following treatment of acute Achilles tendon ruptures (AATR) in the NFL. Twelve studies were included. Results: In total, 676 players (698 Achilles) sustained an AATR in the NFL. The playing positions that sustained the highest rates of AATRs was linebackers (19.0%), wide receivers (11.9%) and running backs (9.0%). 139 AATRs (50.4%) occurred in the preseason, 135 AATRs (48.9%) occurred during the regular season and 2 AATRs (0.7%) occurred during a post-season game. Playing surface was not associated with an increased risk of AATR. The return to play rate was 66.2% at a weighted mean time of 10.9±1.3 months. The mean number of games played per season following AATR was 12.9 games and the weighted mean career length following AATR was 2.2 ± 0.8 seasons. Overall, player performance deteriorated significantly following AATR, as demonstrated by lower power rankings and position specific metrics. Conclusion: This systematic review found was that the proportion of athletes participating in the NFL who returned to play following AATR was 66.2%. Both the mean number of games played per season and the mean number of seasons played decreased significantly following AATR. Overall, player performance deteriorated following AATR, regardless of player position. This study reinforces the potentially devastating sequelae following AATR in the elite athletic population.

Category: Trauma; Ankle Introduction/Purpose: The purpose of this study was to assess outcomes following ankle fractures sustained by elite rugby union players. Methods: Elite rugby union players who sustained an ankle fracture were identified using a publicly available database, match reports and injury reports. "Elite rugby union" was defined as a player who played professional rugby in the following competitions: United Rugby Championship, Top 14, English Premiership, Super Rugby and international rugby for a top 20 ranked team. The years of inclusion was from 2015-2022. Data collected and analysed: player demographics, player position, if surgical intervention was warranted, rates of return to play (RTP), time to return to play, games missed. Pre-injury and post-injury performance outcomes collected and analysed: games played, tries scored, points scored. Results: 107 elite rugby union players sustained an ankle fractures between 2014-2022 (0.0186 per 10,000 athlete-exposures). The mean age was 24.2±9.1 years and the mean BMI was 31.8±8.9kg/m 2 . There were 71 (61.3%) ankle fractures sustained by forwards and 36 (33.6%) ankle fractures sustained by backs. Ninety (84.1%) ankle fractures occurred during the in-season and 17 (15.9%) ankle fractures occurred during training. All athletes (100%) underwent surgical intervention. The most common mechanism of injury was direct trauma to the ankle during a tackle (55.9%). The RTP rate was 78.3% at mean time of 8.9±3.9 months. There was a statistically significant decrease in the mean number of games played, tries scored and points scored following RTP. Conclusion: This current study found that ankle fractures were an uncommon injury in elite rugby union players with an incidence of 0.0186 per 10,000 athlete-exposures. Sustaining an ankle fracture was associated with a RTP rate of 78.3% at mean time of 8.9±3.9 months. There was a statistically significant deterioration in key performance metrics such as mean games played, tries scored and points scored. This study reinforces the potentially devastating sequelae following ankle fractures in the elite athletic population.

Category: Midfoot/Forefoot; Other Introduction/Purpose: The purpose of this systematic review was to evaluate outcomes following surgical intervention for osteochondral lesions of the 1st metatarsal head. Methods: During February 2024, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following surgical intervention for the management of osteochondral lesions of the 1st metatarsal head. 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 and quality of evidence for each individual study was also assessed. Fifteen studies were included. Results: In total, 324 patients (367 metatarsal) underwent surgical intervention for a 1st metatarsal OCL at a weighted mean follow-up time of 32.1±9.2 months. The mean lesion size was 52.3 ± 8.4 mm2. The most common procedure was osteochondral autograft in 123 cases (19.4%). Other procedures performed included subchondral drilling, particulated juvenile cartilage allograft, osteochondral mosaicplasty, microfracture and anterograde drilling. There were statistically significant improvements in subjective clinical outcomes across all surgical techniques. The overall complication rate was 2.2%, the most common of which was persistent pain (1.5%). There were 29 failures (8.9%) all of which warranted a further surgical procedure. Conclusion: This systematic review demonstrated that osteochondral lesions of the 1st metatarsal head are an uncommon pathology with no consensus regarding the optimal treatment strategy. The most common surgical procedure (osteochondral autograft) restores the osteochondral unit, leading to excellent clinical outcomes at final follow-up. Microfracture destroys the subchondral plate and produces inferior quality fibrocartilage, thus should not be recommended.

Category: Sports; Midfoot/Forefoot Introduction/Purpose: The purpose of this study was to evaluate outcomes following outcomes following plantar condylectomy for the management of plantar plate injuries. Methods: Retrospective chart review identified 20 patients who underwent a PRP injection for the treatment of plantar plate injuries. Pre-operative magnetic resonance imaging (MRI) scans were obtained and the grade of the plantar plate injury was recorded. Clinical outcomes assessed included: pre- and post-operative foot and ankle outcome score (FAOS), visual analog scale (VAS), complications, failures, secondary surgical procedures, and return to sport data. Results: Twenty patients with a mean follow-up time of 32.1±7.8 months were included. There were 0 patients that were grade 1, 5 patients were grade 2 (25.0%) and 15 patients were grade 3 (75.0%). There was a statistically significant improvement in both FAOS (58.1 -> 91.4) and VAS scores (6.5 -> 1.8) following plantar condylectomy for the management of plantar plate injuries. No complications were observed. There was 1 failure, which underwent a scorpion procedure at 15.6 months following plantar condylectomy. 15 patients played sport pre-operatively, all of which (100%) returned to sport at a mean time of 7.5 weeks following plantar condylectomy. Conclusion: This retrospective review demonstrated improvement clinical and functional outcomes following plantar condylectomy for plantar plate injuries. There was a 100% return to sport rate at a mean time of 7.5 weeks. The failure rate was 5.0%. Further comparative studies with longer follow-up are warranted to determine the precise role of plantar condylectomy for the management of plantar plate injuries.

Category: Ankle; Sports Introduction/Purpose: The purpose of this study was to evaluate outcomes following autologous osteochondral transplantation (AOT) for the treatment of osteochondral lesions of the talus (OLT) at a minimum of 10-year follow-up. Methods: Retrospective chart review identified patients who underwent AOT for the treatment of OLT. Pre-operative magnetic resonance imaging (MRI) scans were obtained in all patients. Clinical outcomes assessed included: pre- and post-operative foot and ankle outcome score (FAOS), visual analog scale (VAS), patient satisfaction, complications, failures and secondary surgical procedures. Results: Thirty-nine patients with a mean lesion size was 122.3±64.1 mm 2 and mean follow-up time of 138.9±16.9months were included. The mean FAOS scores improved from a preoperative score of 51.9±16.0 to 75.3±21.9 (p < 0.001). Increasing lesion size was variable associated with inferior FAOS scores (R2=0.2228). There was statistically significant higher mean T2 relaxation values at the superficial layer at the site of the AOT graft (42.9±5.2ms) compared to the superficial layer of the adjacent native cartilage (35.8±3.8ms) (p < 0.001). Seventeen complications (43.6%) were observed, the most common of which was anterior ankle impingement (25.6%). There were 2 failures (5.1%), both of which had a history of prior bone marrow stimulation via microfracture and post-operative cysts identified on MRI. Conclusion: This retrospective review found that AOT for the treatment of large OLTs produced a 94.9% survival rate at a minimum of 10-year follow-up. Increasing lesion size was associated with inferior clinical outcomes. The findings of this study indicates that AOT is a viable long-term surgical strategy for the treatment of large OLTs.

Category: Arthroscopy; Sports Introduction/Purpose: The purpose of this retrospective review is to evaluate the clinical and radiological outcomes following In-Office peroneal Needle Tendoscopy for peroneal tendon dysfunction. Methods: Chart review was conducted to identify patients who underwent In-Office Peroneal Needle Tendoscopy with a minimum of 1-year follow-up. Data collected and assessed included: patient demographics, pathological characteristics, treatment characteristics, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, visual analog scale (VAS) scores, return to sport (RTS), and failures. Results: Ten cases were included. The mean follow-up was 30±6.3 months and the mean age was 45.27±22.15 years. There were 6 men and 4 women. IONT identified 5 tears that were not identified on pre-operative MRI. The mean AOFAS improvement was not statistically significant from 49.3 ± 8.3 preoperatively to 53.2±19.7 at final follow-up (p=0.45). There was no change in mean VAS at 5.4±2.2 preoperatively to 4.6±2.7 at final follow-up (p=.27). All patients returned to work at an average time of 3 days, however only 2 patients reported returning to their sport at the same level following in-office needle tendoscopy. The complication rate was 50% and the failure rate at final follow-up was 80%. The mean time to failure was 8 months. Conclusion: This retrospective study found that IONT is an effective modality in the management of peroneal tendon dysfunction. In particular, IONT identified peroneal tears that were not captured on pre-operative MRI and thus required treatment in an operating suite. The exact role of IONT for the management of peroneal tendon disorders remains unclear, thus further research is warranted.

Category: Midfoot/Forefoot Introduction/Purpose: 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. Methods: During January 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 analysed. Results: Ten studies were included. In total, 100 patients (100 feet) underwent suture button fixation for the management of ligamentous Lisfranc injuries at a weighted mean follow-up of 30.5±10.3 months. The AOFAS score improved from a weighted mean pre-operative score of 52.9±11.8 to a weighted mean post-operative score of 89.0±5.4. The VAS score improved from a weighted mean pre-operative score of 7.7±0.6 to a weighted mean post-operative score of 2.1±0.4. In total, 100% of patients returned to sport at a mean time of 22.3±4.8 weeks. The complication rate was 13.5%, the most common of which was residual midfoot stiffness (3.0%). No failures nor secondary surgical procedures were recorded. Conclusion: This systematic review demonstrated improvement in subjective clinical with a moderate complication rate at short-term follow-up following suture button fixation for the management of ligamentous Lisfranc injuries. No failures nor secondary surgical procedures were recorded. Further high quality comparative studies are warranted to determine the optimal role of suture button fixation in the management of ligamentous Lisfranc injuries.

Category: Midfoot/Forefoot; Other Introduction/Purpose: Cheilectomy of the 1st metatarsophalangeal joint is one of the most common procedures for the management of hallux rigidus. However, there is no consensus regarding outcomes following minimally invasive dorsal cheilectomy (MIDC) for the management of hallux rigidus. The purpose of this systematic review was to evaluate outcomes following MIDC for the management of hallux rigidus. Methods: : During November 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following MIDC for the management of hallux rigidus. In total, 6 studies were included. Results: In total, 348 patients (370 feet) underwent MIDC for hallux rigidus at a weighted mean follow-up of 37.9 ± 16.5 months. The distribution of patients by Coughlin and Shurna's classification was as follows: I (58 patients,27.1%), II (112 patients,52.3%), III (44 patients,20.6%). Three studies performed an additional 1st MTPJ arthroscopy and debridement following MIDC. Retained intra-articular bone debris was observed in 100% of patients in 1 study. The weighted mean AOFAS score improved from a preoperative score of 68.9±3.2 to a postoperative score of 87.1. The complication rate was 8.4%, the most common of which was persistent 1st MTPJ pain and stiffness. Thirty-two failures(8.7%) were observed. Thirty-three secondary procedures(8.9%) were performed at a weighted mean time of 8.6±3.2 months following the index procedure. Conclusion: This systematic review demonstrated improvements in subjective clinical outcomes together with a moderate complication rate following MIDC for the management of hallux rigidus at short-term follow-up. A moderate re-operation rate at short-term follow-up was recorded. The marked heterogeneity between included studies and paucity of high quality comparative studies limits the generation of any robust conclusions.

Category: Ankle; Sports Introduction/Purpose: 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) and autologous osteochondral transplantation (AOT) procedures for the management of large osteochondral lesions (OCLs) of the talus. Methods: Patients who underwent second-look needle arthroscopy following either TOPIC or AOT procedure were prospectively recruited. 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 ad-hoc 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: This study demonstrated that AOT and TOPIC lead to high-quality reparative cartilage at short-term to mid-term follow-ups, but 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. In addition to arthroscopic evaluation of the reparative cartilage, this procedure has therapeutic capabilities and can resect bony and soft tissue sources of anterior ankle impingement.

Category: Ankle Arthritis; Ankle Introduction/Purpose: Social determinants of health (SDOH) encompass environmental, institutional, and intrinsic conditions that can influence an individual's access to and utilization of healthcare over their lifespan. While SDOH effects are linked to disparities in patient-reported outcomes post hip and knee arthroplasty, their impact on total ankle arthroplasty (TAA) remains unclear. This study sought to examine how SDOH factors affect access to appropriate orthopedic treatment and their repercussions on patient-reported outcomes following TAA. Methods: In January 2024, a systematic review of the PubMed, Embase and the Cochrane Library was conducted to identify studies reporting at least 1 SDOH and its effect on access to health care, clinical outcomes, or patient-reported outcomes following TAA. Results: Fifty-eight studies, involving 212,944 patients, were analyzed. The INBONE system emerged as the most utilized Total Ankle Arthroplasty (TAA) system. Factors contributing to healthcare access delays included female gender, advanced age, worker's compensation claims, comorbidities, tobacco use, federally subsidized insurance, lower education, racial/ethnic minority status, low-income residence, low-volume surgery regions, unemployment, and preoperative narcotic use. Black patients experienced significantly worse postoperative clinical and patient-reported outcomes, along with heightened pain following TAA. Lower education level independently predicted poor surgical and patient-reported outcomes, increased pain, and lower patient satisfaction. Moreover, patients with federally subsidized insurance demonstrated significantly worse postoperative clinical and patient-reported outcomes. Conclusion: The impediments created by SDOH lead to worse clinical and patient-reported outcomes following TAA including increased risk of postoperative complications, TAA failure, higher rates of revision surgery, and decreased ability to return to work. Orthopedic surgeons, policy makers, and insurers should be aware of the aforementioned SDOH as markers for characteristics that may predispose to inferior outcomes following RCR.

Category: Sports; Arthroscopy Introduction/Purpose: Graft transplantation is a widely used treatment for large osteochondral lesions of the talus. However, cyst formation surrounding the graft is of concern. 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 correlation of clinical outcomes with the presence of postoperative cysts. Methods: A 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 additionally described. Results: Thirteen studies were included with 382 ankles that were radiologically assessed at follow-up after osteochondral autograft, allograft, and osteoperiosteal transplantation. The rates of cystic occurrence for the osteochondral autograft transplantation group, the allograft transplantation group, and the osteoperiosteal transplantation group were 42% (95% CI 24-61), 58% (95% CI 40-74), and 34% (95% CI 12-67), respectively, without any significant differences noted between these treatment groups. Six studies studied the relationship between the presence of cysts and clinical outcomes: none of these studies found a significant relationship between these two variables. Conclusion: Postoperative 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.

Background: The purpose of this systematic review was to evaluate outcomes following intra-articular injection of hyaluronic acid (HA) for the treatment of hallux rigidus. Methods: During April 2024, a systematic review of the MEDLINE, EMBASE, and Cochrane Library databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data collected and analyzed were number of patients, patient age, follow-up, subjective clinical outcomes, complications, and failures. Results: Five studies were included. In total, 218 patients (218 feet) underwent intra-articular injection of HA at a weighted mean follow-up time of 4.4 ± 1.4 months (range, 3-6). There was an improvement in postinjection visual analog scale (VAS) pain at rest scores, VAS pain during activity scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores, and Foot Health Status Questionnaire (FHSQ) scores. In total, 21 complications (10.0%) were observed, the most common of which was transient postinjection pain in 20 patients (9.6%). There were 7 patients (3.2%) who underwent secondary procedures (3.2%). One randomized control trial (RCT) demonstrated no difference in outcomes between an intra-articular injection of HA compared to an intra-articular injection of saline. One RCT demonstrated superior FHSQ scores following between an intra-articular injection of HA compared to an intra-articular injection of triamcinolone acetonide. Conclusion: This systematic review suggests that intra-articular injection of HA for the treatment of hallux rigidus may lead to improved clinical outcomes with a low complication rate at short-term follow-up. However, the low level and quality of evidence underscores the need for further high-quality studies to be conducted to identify the precise role of HA in the treatment of hallux rigidus.

Background: As no evidence-based treatment guidelines exist for chronic Achilles tendon rupture (CATR), a systematic review of the literature was performed to compare the different treatment options and recommend a literature-based algorithm. Methods: In June 2022, MEDLINE, Embase, and Cochrane Library databases were systematically reviewed based on the PRISMA guidelines. The level of evidence (LOE) and quality of evidence were evaluated, and statistics on clinical outcomes and complications were calculated. Results: Twenty-seven studies with 614 patients were included. Three studies were LOE III and 25 studies were LOE IV. The mean Achilles tendon rupture score improved from a preoperative weighted mean of 38.8 ± 12.4 to a postoperative score 90.6 ± 4.7. The overall complication rate was 11.4%. Single techniques were used in 23 studies and dual techniques were used in 5 studies. The FHL tendon transfer was the most frequently used technique. We devised an algorithmic approach based on time from injury to surgical intervention and the length of the gap between the tendon stumps: >3 months: FHL transfer; 5 cm, semitendinosus autograft. Conclusion: Surgical management of CATR produced improvements in patient-reported outcome scores at midterm follow up, but a high complication rate (11.4%) was noted. Our proposed treatment algorithm may assist in shared decision making for this complex problem.

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus is a common degenerative joint condition of the foot. In advanced stages of the disease, extensive procedures have been utilized including Keller arthroplasty, interpositional arthroplasty (IPA), arthrodesis, total joint replacement or synthetic cartilage replacement. IPA is a surgical procedure that attempts to maintain joint motion through insertion of a biologic spacer into the joint. However, there is still a paucity of overall clinical data regarding outcomes and complication rates following IPA procedure for the treatment of hallux rigidus.The purpose of the current study was to systematically review the outcomes of IPA in the treatment of hallux rigidus. Methods: A systematic search of the MEDLINE, EMBASE and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcomes collected and analysed included: AOFAS score, VAS score, SF36 score, range of motion, radiographic parameters, and postoperative complications. The level and quality of evidence were recorded and assessed. Results: Sixteen studies with a total of 433 patients met inclusion/exclusion criteria. The mean AOFAS improved from 56.8±7.3 (range, 43.2-64.3) preoperatively to 84.0±6.7 (range, 71.6-90.0) postoperatively. The preoperative weighted mean total ROM was 37.7±16.2 degrees and the postoperative weighted mean total ROM was 60.3±13.4 degrees. Five studies examined joint space narrowing on plain radiographs. The mean preoperative joint space was 1.2±0.2 mm (range, 1 -1.5) and the mean postoperative joint space was 2.5±0.5 mm (range, 1.9-3). The complication rate was 18.2% with metatarsalgia as the most commonly reported complication. One study was Level III and 15 studies were Level IV. Conclusion: This systematic review demonstrates improvement in functional and ROM outcomes following IPA. The procedure however has a high complication rate. There is a low level and quality of evidence in the current literature with inconsistent reporting of data. Therefore, further well designed studies must be carried out to determine the efficacy of IPA in the treatment of hallux rigidus.

Category: Ankle, Sports Introduction/Purpose: Autologous osteochondral transplantation (AOT) has demonstrated favourable outcomes in the treatment of osteochondral lesions of the talus (OLT). Recent studies have reported high rates of return to play sports following AOT for OLT, however variable rates of return to play have been reported ranging from 50 to 95%. In addition, little information regarding optimal standardized rehabilitation protocols and return to play guidelines has been demonstrated. The purpose of this study is to determine the rate of return to play following AOT for OLT by systematic review and meta-analysis and report subsequent rehabilitation protocols. Methods: The MEDLINE, EMBASE and The Cochrane Library databases was evaluated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using specific inclusion/exclusion criteria. The quality of evidence was evaluated using the Modified Coleman Methodology Score (MCMS). Predetermined data was extracted on a datasheet with the return to play calculated as a percentage of patients that returned to sport. Rehabilitation protocols were recorded as the earliest time that range of motion, partial weightbearing and full weightbearing commenced was recorded. The quality of return to play guidelines in each study was evaluated based on the criteria by Zaman et al. Well defined return to play criteria was allocated a score of 4, poorly defined criteria allocated a score between 1 to 3 and no return to play criteria allocated 0. The meta-analysis of return to play was performed using previously published criteria. Results: The search strategy yielded 8 studies evaluating 200 ankles with a mean follow-up of 44.3 ± 26.8 months (range, 16 to 84 months), mean age of 31.3 ± 6.92 years (range, 22.7 to 42 years) and mean OLT size of 119.2 ± 35.3 mm2 (range, 68.9 to 180 mm2). The mean time to return to play was 4.55 ± 2.19 months (range, 3 to 6.1 months). The reported rates of return to play ranged from 50% to 95.2%. The accumulative rate of return to play was 83.8% (140/167), with 77.4% (48/62) of athletes returning to pre-injury status. Based on the fixed-effect model, the rate of return to play was 81.5% (Figure 1). The quality of return to play criteria was poor in all. Conclusion: This systematic review indicates high rate of return to play following AOT in the athletic population. Rehabilitation protocols were largely inconsistent and were primarily based on individual surgeon protocols. The included studies were of low level and quality of evidence, therefore, further well-designed studies are warranted to sufficiently improve the reporting accuracy for rate of return to play.

Category: Ankle, Ankle Arthritis Introduction/Purpose: Joint arthritis is one of the leading musculoskeletal disorders in the adult population. The surgical treatment for end-stage ankle arthritis generally includes arthrodesis, distraction arthroplasty and total replacement. Recently, new therapeutic approaches, including the use of biologics, have been developed. Among the many sources, the adipose tissue is considered a greater chondrogenic potential and thus a lot of attention is being placed on it in the treatment of arthritis. Although several studies reported good clinical outcomes of adipose-based therapies for knee arthritis, there is a paucity of studies reporting the effects of adipose-based therapies for ankle arthritis. The purpose of this study is to evaluate the effect of intra- articular injection of autologous micronized adipose tissue in patients with end-stage ankle arthritis. Methods: A retrospective cohort study investigating consecutive patients treated with arthroscopic debridement and micronized adipose tissue injection for end-stage ankle arthritis was performed. Micronized adipose tissue was obtained from abdomen using a minimal manipulation technique in a closed system (Lipogems) without the addition of enzymes or any other additives. Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS), Short-Form 12 (SF-12), and visual analog scale (VAS) scores preoperatively and at final follow-up. Results: Total of 12 patients were included. The mean age was 57.5 years and mean follow-up time was 13.1 months. Mean symptoms, pain, daily activities and quality of life scores in FAOS significantly improved from 44.5, 41.3, 58.9, and 20.6 preoperatively to 76.2, 70.1, 80.9, and 60.7 postoperatively, respectively at final follow-up (p

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Open modified Broström-Gould procedure is generally accepted as the gold-standard treatment for chronic lateral ankle instability. Recently an arthroscopic lateral ankle ligament repair technique has become increasingly popular in an effort to reduce post-operative pain and facilitate early recovery. The purpose of the current systematic review was to evaluate the current evidence on arthroscopic lateral ankle ligament repair techniques and to compare the clinical outcomes of arthroscopic and open techniques for chronic lateral ankle instability with meta-analysis. Methods: A systematic search of MEDLINE and EMBASE databases was performed during August 2017. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Variable reporting outcome data, clinical outcomes, and percentage of patients who returned to sport at previous level were also evaluated. Comparative studies were compared using RevMan version 5.3, and a p-value of < 0.05 was considered statistically significant. Results: Twelve studies for a total of 421 ankles were included; 92% of studies were LOE III or IV and the QOE in all studies was of poor or fair quality. There were three comparative studies of open and arthroscopic repair procedures, with two Level III studies and one Level I study. There was a significant difference in favor of arthroscopic repair at final follow-up for the Karlsson- Peterson score (MD; 2.59, 95%CI, -0.19 to 2.36, I2=0%, p=0.10) and the AOFAS score (MD; 1.50, 95%CI, 0.41 to 2.59, I2=0%, p=0.007) in the comparative studies. The overall complication rate was 13.4% in the included studies but in the comparative studies there was no statistically significant difference between open and arthroscopic repair (12.1% vs 11.4%, p=0.90). Conclusion: The current systematic review demonstrated that arthroscopic lateral ankle ligament repair may yield favorable clinical outcomes and may be superior to open procedure in the short-term, but there is no clinical evidence to support the advantages of the arthroscopic procedure over the open procedure in the mid- long-term follow-up. There was a relatively high complication rate associated with the arthroscopic procedures, with a 13.4% complication rate, although recent comparative studies demonstrated similar complication rates.

Category: Arthroscopy, Hindfoot Introduction/Purpose: Open plantar fascia release is an established surgical treatment for plantar fasciitis traditionally. However, it has long recovery period and complications with conflicting late results. Recently, endoscopic plantar fascia release has gained popularity, providing good outcomes with early return to activity. However, there is still a paucity of overall clinical data regarding outcomes and complication rates following endoscopic procedure for the treatment of plantar fasciitis. The purpose of the current study was to systematically review the outcomes of endoscopic plantar fascia release in the treatment of plantar fasciitis. Methods: A systematic review was preformed using, MEDLINE, EMBASE and Cochrane library databases based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included were evaluated with regards to level of evidence (LOE) and quality of evidence (QOE) using the Coleman methodological score. Clinical outcomes and complications were also evaluated. Results: Twenty-one studies including 601 feet were included in this systematic review. The mean patient age was 48.5±5.2 years, and the mean follow-up time was 26.9±22.7 months. Sixteen studies used the AOFAS score for clinical outcome measure. The mean preoperative AOFAS score was 52.3±24.1 and the postoperative score was 88.8±4.1. The VAS score was utilized in 10 studies. The mean preoperative score was 7.8±0.8 and the postoperative score was 1.8±0.7. In total 111 of 601 (18.7%) patients had complications. The most common complication was recurrence of pain with 45 patients (7.5%). Twenty-two patients (3.7%) experienced paraesthesia and numbnesss. Seventeen patients (2.8%) required subsequent operations including gastrocnemius release, hematoma drainage, and baxter nerve release. Conclusion: The current systematic review demonstrates that overall there were good clinical and functional outcomes following endoscopic procedure for the treatment of plantar fasciitis. However, there was a relatively high complication rate (18.7%) associated with the endoscopic procedures. Due to the low level of evidence and poor qualities of evidence, further well designed studies are necessary to determine the clinical outcomes and complications of endoscopic plantar fasciotomy.

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Peroneal tendon disorders frequently result in refractory posterolateral ankle and hindfoot pain which disables patients from daily activity and sports. Diagnosis can be challenging in certain cases of peroneal tendon pathology, such as subluxation and stenosis. Additionally, traditional open surgery is associated with complications including surgical scarring and injury to the sural nerve. Therefore peroneal tendoscopy has gained popularity as an effective diagnostic and treatment procedure. Recently tendoscopic groove deepening technique has been reported for the treatment of chronic subluxation or stenosing tenosynovitis of peroneal tendons. In this case series, we present the effectiveness of tendoscopic groove deepening procedure for subluxation or stenosis of the peroneal tendons. Methods: A retrospective cohort study investigating patients treated with tendoscopic groove deepening the fibular groove and concentrated bone marrow (CBMA) injection for the treatment of peroneal subluxation or stenosing peroneal tenosynovitis. Retrospective chart review was performed, and clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS) and Short-Form 12 (SF-12) preoperatively and at final follow-up. Results: Twenty patients diagnosed with subluxation and/or stenosis were included. The mean age was 35.1±9.2 years and the mean follow-up time was 32.5±12.4 months. Mean symptoms, pain, daily activities, sports activities and quality of life scores in FAOS significantly improved from 56.8, 74.1, 72.3, 36.2 and 22.7 preoperatively to 86.5, 83.2, 92.3, 70.2 and 63.8 postoperatively, respectively at final follow-up (p

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Arthroscopic bone marrow stimulation (BMS) is the most common reparative surgical intervention in the treatment of small osteochondral lesions of the talus (OLT). BMS has shown favorable short term clinical outcomes but several recent studies have shown less satisfactory results in the mid- to long-term due to fibrocartilagenous repair tissue deterioration over time following BMS. However, conflicting results with good mid- to long-term outcomes following BMS have been reported. There is still a lack of evidence on the success rates of BMS at mid-term and longer-term follow-up. The purpose of this systematic review was to evaluate the clinical evidence of mid- to long-term outcomes following BMS for the treatment of OLT. Methods: A systematic search of the MEDLINE, EMBASE and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological quality of evidence was decifered using the Modified Coleman methodology score (MCMS). Studies reporting outcomes of BMS for primary ostechndral lesions at a minimum 4-year follow-up were included. Clinical outcomes, radiological outcomes, and reported data were evaluated. Results: Fifteen studies containing 853 patients (858 ankles) were included at a weighted-mean follow-up time of 71.9 (48-141) months. The mean age was 35.3 (24.7-41.9) and the mean lesion size was 110.5mm2 (87-140). Nine studies (60%) used the AOFAS ankle hindfoot score with a weighted-mean postoperative score of 89.9 (78.4-91.8). Six studies showed both pre and post-operative AOFAS scores and showed a weighted-mean improvement of 24.5 (16-38.5). Four studies utilised the VAS score. The weighted-mean postoperative VAS scores were 2.4 (1.8-2.6). Three studies (20%) measured post-opeartive MRI at mid-term using the MOCART score and showed 48% complete filling, 74% complete integration, 76% surface damage, and 78% inhomogeneous repair tissue. Complication rate was 3.2% and reoperation rate was 6% following BMS at mid-term. Conclusion: This systematic review found good clinical outcomes following BMS for primary OLT at mid-term follow-up based on the AOFAS score. The complication rates were relatively low and the data showed a reoperation rate of 6% at mid-term. However, the radiological and MRI outcomes did not show similarly positive results, which may lead to recurrence and reoperation at long-term. Data were variable and numerous aspects largely under-reported in the literature relevant to the systematic review. Further high quality studies, a validated outcome scoring system and further MRI reports are required to accurately assess the success of BMS at mid-term.

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Microfracture (MF) remains a dominant treatment strategy for symptomatic osteochondral lesions of the talus (OLT). Micronized cartilage allograft (BioCartilage) is a biologic scaffold and is utilized for MF augmentation to improve the quality for cartilage regeneration. However, there is still lack of evidence on efficacy of BioCartilage as an adjunct to MF, as no comparative studies have been reported to date. The purpose of this study is to clarify the effectiveness of BioCartilage as an adjuvant to MF compared to MF alone in the treatment of OLT. Methods: A retrospective cohort study comparing patients treated with MF with BioCartilage and MF alone between 2014 and 2017 was undertaken. Patients with a minimum follow-up time of 12 months were included. All patients received concentrated bone marrow aspirate injection at the time of surgery. Clinical outcome was evaluated with the Foot and Ankle Outcome Score (FAOS) pre- and postoperatively. Postoperative MRIs were evaluated using a modified Magnetic Resonance Observation of Cartilage Tissue (MOCART) score. Comparisons between groups were made with the Man-Whitney U test for continuous variables and the Chi-squared test or Fisher exact test for categorical variables. Results: Twenty-four patients underwent MF with BioCartilage (MF-BC group) and 24 patients underwent MF alone (MF group). The mean age was 40.8 years in MF-BC group and 47.8 years in MF group (p=0.068). The mean follow-up time was 19.2 months in MF-BC group and 24.5 months in MF group (p=0.042). Both groups showed significant improvements in all FAOS subscales. No significant differences between groups were found in postoperative FAOS subscales including symptoms, pain, daily activities, sports activities and quality of life (MF-BC; 72.8, 77.8, 87.4, 60.8, 56.6, MF; 73.3, 79.3, 86.0, 60.9, 60.6, respectively, p>0.05). The mean MOCART score in MF-BC group was higher (73.2vs64.1), but not statistically significant (p=0.315). When assessing each MOCART parameter individually, MF-BC group had significant better infill in the defect (p=0.028). Conclusion: MF with BioCartilage is an effective treatment strategy for the treatment of OLT and results in similar functional outcomes compared with MF alone in the short-term. However, MF with BioCartilage provides better cartilage infill in the defect on MRI. This finding suggests that the repair seen in a cartilage defect treated with BioCartilage augmentation may be superior to treatment with MF alone. Further long-term follow-up studies are warranted.

Category: Midfoot/Forefoot, Sports Introduction/Purpose: Sesamoidectomy is the most common surgical procedure for the treatment of hallux sesamoid pathology, including fracture, acute separation of bipartite sesamoid, sesamoiditis, and avascular necrosis (AVN). However, there is a concern of complications following sesamoidectomy, such as the development of hallux valgus/varus and transfer metatarsalgia due to the altered mechanical loading on the forefoot. Recent systematic review showed high complication rate of 22.5% following sesamoidectomy, prompting surgeons to find alternative methods. Concentrated bone marrow aspirate (CBMA) may have the potential to treat sesamoid disorders with avoidance of sesamoid resection. However, there is no studies investigating the effect of CBMA for sesamoid disorders. The purpose of this study was to evaluate the functional outcomes following the use of CBMA for hallux sesamoid disorders. Methods: A retrospective cohort study investigating consecutive patients treated with CBMA injection for the treatment of sesamoid disorders were performed. The sesamoid disorders included sesamoiditis, symptomatic bipartite or chronic nonunited sesamoid and AVN. The CBMA injection was indicated for patients with failed a minimum of 3 months non-surgical management including activity limitation, customized orthotics, physiotherapy and extracorporeal shockwave therapy. Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS), Short-Form 12 (SF-12), and visual analog scale (VAS) scores preoperatively and at final follow-up. Results: Total of 13 feet were included. The mean age was 26.9 years and mean follow-up time was 19.1 months. Patient demographic is shown in Table 1. Mean symptoms, pain, daily activities, sports activities and quality of life scores in FAOS significantly improved from 63.9, 55.4, 68.4, 37.3, and 30.9 preinjection to 91.2, 84.1 92.9, 72.7, and 64.8 postinjection, respectively at final follow-up (p