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Metatarsal head stress fractures pose treatment challenges with no established consensus. In this article, we introduce a percutaneous treatment involving autologous bone marrow aspirate concentrate (BMAC) injection without surgical fixation in a 21-year-old basketball player with a stress fracture of the right fifth metatarsal head. He underwent this procedure following unsuccessful 8 months of conservative treatment. Twelve weeks after the procedure, a CT scan confirmed complete healing, facilitating his return to sports. This innovative method offers a promising alternative, avoiding the associated morbidity of surgical intervention. Further research, comparing refracture rates with surgical options, is warranted to inform treatment decisions for this uncommon injury and validate the efficacy of percutaneous BMAC injection. Plain Language Summary What is the study about? Metatarsal head stress fractures are uncommon and challenging to treat, often requiring surgery if conservative methods fail. This report introduces a successful alternative: a percutaneous injection of bone marrow aspirate concentrate (BMAC) directly into the fractured area, avoiding surgical risks. BMAC contains stem cells and growth factors that promote healing. In this case, a collegiate basketball player with a fifth metatarsal head fracture underwent this procedure after conservative treatments failed over 8 months. What were the results? Twelve weeks after the procedure, CT scan showed complete healing, allowing the player to return to sports without complications. What do the results mean? This innovative approach offers a promising option for refractory fractures, potentially sparing patients from surgery and its associated complications. Further research comparing refracture rates with surgical methods is needed to guide treatment decisions for this rare injury effectively. Article highlights Fifth metatarsal head fractures Rare foot injury with no consensus on the best approach for its management. Typically treated conservatively first before surgical interventions are pursued. Percutaneous bone marrow aspirate concentrate procedure detail A source of mesenchymal stromal stem cells and growth factors that has been utilized to enhance orthopedic procedures. Collected from posterior iliac crest. Injected into the intra-osseous space of the fifth metatarsal head under ultrasound-guidance. Clinical implications Percutaneous BMAC injection presents a novel treatment option for refractory metatarsal head stress fractures. Offers a promising alternative to surgical intervention, avoiding associated complications. Further research needed to compare refracture rates between percutaneous BMAC injection and surgical fixation. [ABSTRACT FROM AUTHOR]

The Minimum Information for Studies Evaluating Biologics in Orthopedics (MIBO) guidelines were developed in May 2017 to encourage improved reporting standards, promote increased transparency and reproducibility, and enhance clinical evaluation capabilities. The MIBO guidelines consist of 23 checklist items considered necessary to critically appraise clinical studies evaluating platelet-rich plasma (PRP).To assess randomized controlled trials that evaluated PRP for the treatment of knee osteoarthritis in order to systematically review their adherence to the MIBO guidelines.Systematic review. Level 1a.A search was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were randomized controlled trials reporting on knee osteoarthritis treated with intra-articular PRP. The studies were categorized into pre-, peri-, and post-MIBO groups based on the start date of data collection. The overall MIBO scores, defined as percentage of checklist items out of the 23 checklist items reported in 1 study, individual item scores, defined as percentage of studies reporting the checklist item within a specified group, and overall item score defined as the average of the individual item scores from all the included studies were calculated.The review included 87 studies (7925 patients; 8118 knees). Of these, 51 studies were assigned to the pre-MIBO group, 19 studies to the peri-MIBO group, and 17 studies to the post-MIBO group. The overall MIBO score was 72%. No statistically significant differences in MIBO scores were found among the 3 MIBO groups (P = .345). The majority of the studies (62 studies; 71%) had MIBO scores <80%. MIBO items with particularly low item scores included reporting of whole-blood characteristics (20%), platelet recovery rate (22%), PRP analysis (30%), and PRP activation (47%). No significant difference among the 3 MIBO groups was found for the item scores except for the reporting of the recipient details (P = .012).This study highlights the deficiencies in adherence to the MIBO guidelines, particularly in reporting key variables such as whole-blood characteristics, platelet recovery rate, PRP analysis, and PRP activation. These findings suggest that the publication of the MIBO guidelines has not resulted in improved reporting practices in studies investigating intra-articular PRP for the treatment of knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Abstracts: Lacertus fibrosus Syndrome (LFS) is a rare cause of persistent medial elbow pain in baseball players, often not considered in the initial diagnostic considerations. This case report details a 19-year-old collegiate baseball player who presented with insidious left anterior medial elbow pain, initially diagnosed as biceps tendonitis. The patient did not experience pain relief after six months of conservative management. Sonopalpation during diagnostic ultrasound localized the source of pain to the median nerve at the level of the lacertus fibrosus, and the decision was made to perform ultrasound-guided hydrodissection of the median nerve at this level. The procedure resulted in rapid and sustained symptom relief without the scarring that has been associated with traditional surgical techniques. To date, there has been no study investigating the use of ultrasound-guided hydrodissection targeting lacertus fibrosus. This report highlights the importance of considering LFS in throwing athletes with persistent elbow pain, and advocates for considering ultrasound-guided hydrodissection as a management option for patients with clinical suspicion of LFS., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)