Background Fractures of the anterior process of the calcaneus (APC) are frequently misdiagnosed as ankle sprains and may progress to symptomatic nonunion. Degan type III APC fractures involve the calcaneocuboid joint and are conventionally managed surgically. Extracorporeal shock wave therapy (ESWT) has not previously been reported for this fracture type. Case presentation A 21-year-old male collegiate hurdler presented with a 2-year history of left lateral foot pain. Computed tomography confirmed a neglected Degan type III APC nonunion. After declining surgery, he underwent 9 sessions of focused ESWT (peak energy flux density 0.07-0.25 mJ/mm²) in 3-session sets over 19 weeks, combined with a 3-month sports restriction from the start of treatment. Pain resolved completely (visual analog scale 75/100 → 0/100), and he returned to competitive hurdling at 6 months after starting ESWT. Computed tomography at 14 months after ESWT initiation confirmed bony bridging. Conclusion Extracorporeal shock wave therapy was associated with clinical improvement and radiological healing in this individual case and may warrant further investigation as a non-surgical option in young athletes with a neglected Degan type III APC nonunion who decline surgery.
Background Suture augmentation has been introduced to enhance stability and accelerate rehabilitation following modified Broström repair for chronic lateral ankle instability, however, its clinical value remains uncertain. Methods PubMed, Embase, and Cochrane Library databases were systematically searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcomes included patient demographics, radiographic parameters, clinical outcomes, return to sport (RTS), complications, failures, and revisions. Meta-analyses comparing augmented and non-augmented repairs were performed. Results Sixteen studies were included, with 672 patients undergoing anterior talofibular ligament (ATFL) repair with suture augmentation, and 315 patients without suture augmentation. Both cohorts demonstrated significant improvements in radiographic and clinical outcomes. Suture augmentation demonstrated a faster RTS (13.0 vs 19.6 weeks) but a lower overall RTS rate (74.0% vs 82.9%). There was no statistically significant difference in complications (risk ratio [RR] = 0.86, 95% confidence interval [CI], 0.30-2.47) or failures (RR = 0.65, 95% CI, 0.25-1.65). Open suture augmentation demonstrated a higher reported complication (6.9% vs 0%) and failure rate (3.1% vs 0.8%) compared with arthroscopic augmentation. Conclusion This systematic review and meta-analysis did not demonstrate clinically meaningful differences in radiographic parameters, patient-reported outcomes, complications, or failure rates between isolated modified Broström repair and suture-augmented repair. Although suture augmentation was associated with a faster RTS, this did not translate into higher overall RTS rates, indicating that earlier return does not equate to improved functional recovery. Arthroscopic techniques may demonstrate lower complication rates than open approaches, however, this observation should be interpreted with caution given the limited and non-comparative evidence base. Level of Evidence: IV, systematic review and meta-analysis
Introduction There is a need to assess the use of knotless sutures in cohorts with chronic ankle instability (CAI). Methods A literature search of Embase, Ovid MEDLINE, Cochrane Library and Scopus was conducted from each database’s inception to August 15, 2025. Eligible studies reported patients with CAI undergoing foot and ankle surgery with knotless suture repair. This review was registered in PROSPERO (ID: CRD420251106305). Results A total of 11 studies comprising 476 patients met the eligibility criteria. American Orthopaedic Foot and Ankle Society (AOFAS) scores preoperatively were 63.23 (95% confidence interval [CI]: 60.60-65.86, I 2 = 91%) and at final follow-up were 90.67 (95% CI: 88.09-93.24, I 2 = 96%). Karlsson-Peterson (KP) scores preoperatively were 62.75 (95% CI: 61.16-64.34, I 2 = 79%) and at final follow-up were 88.03 (95% CI: 84.20-91.87, I 2 = 97%). Visual analog scale (VAS) scores preoperatively were 5.80 (95% CI: 4.34-7.25, I 2 = 100%) and at final follow-up were 1.23 (95% CI: 0.74-1.72, I 2 = 96%). Anterior drawer preoperatively was 7.37 mm (95% CI: 5.21-9.53, I 2 = 98%) and postoperatively was 3.12 mm (95% CI: 1.08-5.16, I 2 = 99%). Talar tilt preoperatively was 7.00 0 (95% CI: 3.92-10.08, I 2 = 98%) and postoperatively was 3.11 0 (95% CI: 2.76-3.46, I 2 = 29%). The overall complication rate was 6% (95% CI: 0.03-0.09, I 2 = 57%). The reoperation rate was 2% (95% CI: −0.01-0.03, I 2 = 0%). Conclusion Based on low-quality evidence, knotless repair appears associated with improved functional scores and a low complication rate in this pooled analysis. Direct comparative studies against traditional Broström-Gould knotted approaches are warranted to determine the gold standard in CAI repair moving forward.
Interest in adipose-derived orthobiologics and extracellular vesicles (EVs) has expanded as clinicians seek minimally invasive treatments for musculoskeletal disorders. However, culture-expanded adipose-derived stromal cells, stromal vascular fraction, microfragmented adipose tissue (MFAT), and isolated EVs are biologically and regulatorily distinct products. This narrative review summarizes their biological rationale, processing, clinical evidence, regulatory considerations, and potential application in foot and ankle surgery. Randomized studies in knee osteoarthritis suggest that MFAT may provide symptomatic improvement, but it has not consistently demonstrated superiority over other orthobiologic injections, and the certainty of evidence remains low. Preclinical EV studies provide biological plausibility for effects on tendon healing, tendon-to-bone integration, and cartilage repair. However, substantial heterogeneity in cellular source, preparation, dose, and experimental model limits translation. Human orthopaedic EV evidence remains confined to early studies in knee osteoarthritis using placental or umbilical cord derived products, with limited and conflicting evidence of efficacy and no completed studies specific to the foot and ankle. No adipose-derived regenerative medicine or EV product is Food and Drug Administration-approved for an orthopaedic indication. Current evidence therefore does not support routine clinical use or claims of tissue regeneration. Standardized product characterization and well-designed comparative trials are required to establish safety, efficacy, and appropriate clinical applications.
Introduction Elective ankle hardware removal is classified as a clean surgical procedure, although postoperative wound complications remain a relevant source of morbidity. The role of routine preoperative antibiotic prophylaxis in this setting remains uncertain. Methods A retrospective observational study was conducted including patients who underwent elective ankle hardware removal between 2019 and 2025. The primary outcome was postoperative wound complications. Univariate analysis and multivariable logistic regression were performed. Results A total of 160 patients were included, and wound complications occurred in 13 patients (8.1%). In univariate analysis, older age, higher body mass index, active smoking, peripheral vascular disease, and an estimated glomerular filtration rate <90 mL/min/1.73 m² were associated with wound complications. The exploratory high clinical-risk group had a higher complication rate than the low-risk group (14.3% vs 1.5%; P = .007). In the multivariable analysis, age (odds ratio [OR] 1.067; 95% confidence interval [CI] 1.014-1.122; P = .012), body mass index (OR 1.166; 95% CI 1.025-1.325; P = .019), and active smoking (OR 4.90; 95% CI 1.19-20.00; P = .028) were associated with wound complications. Wound complication rates were identical between patients who did and did not receive preoperative cefazolin (7.7% vs 7.7%; P = 1.000). Conclusions These findings highlight older age, BMI, and active smoking as factors to consider during preoperative risk assessment before elective ankle hardware removal. No association between preoperative antibiotic prophylaxis and wound complications was observed; however, this finding should be interpreted cautiously given the limited number of patients who received preoperative antibiotics. Level of Evidence: Level III, retrospective observational study
