Hindfoot reconstruction is a frequently performed procedure for many complex hindfoot deformities including flatfoot, end-stage arthritis, and Charcot arthropathy. Literature has supported the treatment of these patients with a tibiotalocalcaneal (TTC) arthrodesis. However, this limb salvage procedure is complex in nature and is traditionally performed as an open surgery. Minimally invasive (MIS) tibiotalar and subtalar fusions have allowed for similar efficacy as the open procedure, with the potential for less wound complications. The current study presents a guide for TTC nailing with MIS preparation of the tibiotalar and subtalar joints for severe, progressive hindfoot deformity in the high-risk patient. This technique allows for maintenance of the soft tissue envelope; maintaining the integrity of these structures may help surgeons avoid many wound related complications, infections, or need for revision. This guide provides surgeons with an effective and reproducible approach to intervene in complex cases requiring hindfoot reconstruction.Levels of Evidence: Level V Evidence.

BACKGROUND:Intraoperative fluoroscopy has become essential in orthopaedic surgery, particularly with the rise of minimally invasive surgery (MIS) techniques. As MIS techniques depend more on intraoperative imaging, MIS techniques may necessitate increased fluoroscopy use compared with open procedures. Despite the advantages of minimally invasive foot and ankle surgery, MIS techniques raise concerns about radiation exposure to both patients and surgical staff. The purpose of this study was to evaluate fluoroscopy time and radiation dose (cumulative air kerma) associated with open versus MIS bunion correction, comparing the open modified Lapidus procedure and the minimally invasive distal first metatarsal transverse osteotomy and akin osteotomy (META). It was hypothesized that the META procedure would be associated with increased radiation dose and fluoroscopy time compared with the open modified Lapidus procedure. METHODS:A retrospective review was conducted for patients who underwent bunion surgery between January 2021 and June 2025 by two fellowship-trained orthopaedic foot and ankle surgeons at a single academic institution. A total of 294 patients met inclusion criteria. Of these, 258 patients underwent a META procedure and 36 underwent an open modified Lapidus procedure. Fluoroscopy time (minutes) and radiation dose (mGy) were compared between the groups. RESULTS:A mean fluoroscopy time of 2.13 ± 1.27 (range, 0.06 to 7.05) minutes and a radiation dose of 2.02 ± 1.30 (range, 0.05 to 7.52) mGy were observed in the META cohort. An average fluoroscopy time of 1.63 ± 1.83 (range, 0.08 to 7.70) minutes and a radiation dose of 1.31 ± 1.43 (range, 0.07 to 5.98) mGy were observed in the open modified Lapidus cohort. Fluoroscopy time between the cohorts did not differ markedly ( P = 0.123); however, the META group demonstrated a higher radiation dose than the open modified Lapidus group ( P = 0.007). CONCLUSION:The META procedure had a markedly higher radiation dose compared with the open modified Lapidus procedure, although both remain substantially below the International Commission on Radiological Protection recommended occupational exposure of less than 20.00 mSv per year. Despite the META procedure generating an average radiation dose of 2.02 mGy per case, surgeons receive only 0.50% of the dose; thus, nearly 1,980 procedures would be required to exceed the 20.00 mSv annual occupational limit. These findings suggest that concerns about radiation exposure should not necessarily deter providers from performing the META technique for bunion correction. LEVEL OF EVIDENCE:III (Retrospective Comparative Study).

BACKGROUND:A calcaneal osteotomy is a common component of surgical management for various foot and ankle deformities. Open and minimally invasive surgical (MIS) calcaneal osteotomies can be performed. The purpose of this study was to compare complication rates including infection, wound dehiscence, nerve damage, hardware failure, reoperation, and nonunion between these cohorts. METHODS:All patients who underwent an open or MIS calcaneal osteotomy between March 2021 and July 2024 at a single institution were identified and retrospectively reviewed. All procedures were performed by one of 2 fellowship-trained orthopaedic foot and ankle surgeons on patients >18 years of age at the time of surgery. These procedures were performed in combination with other procedures to correct planus or cavus feet. Demographic information and postoperative complications were recorded for each patient with a minimum of 12 months follow-up. RESULTS:Forty-four patients who underwent open calcaneal osteotomy and 26 patients who underwent MIS calcaneal osteotomy met the inclusion criteria for the current study. Patients were followed for a mean 25.3 ± 11.1 months. There was no significant difference in the rate of nonunion (P = .703) or nerve complications (P = .410) between cohorts. There were fewer postoperative minor wound complications in the MIS cohort (1/26, 3.8%) compared with the open cohort (9/44, 20.5%) (P = .036) observed in the MIS cohort; however, the P = .036 difference in minor wound complications was found to be not significant after false discovery rate (FDR) adjustment. CONCLUSION:Data from the current study indicate that open and MIS calcaneal osteotomy are associated with no difference in major complication rates or amount of calcaneal correction. With the numbers available, no significant difference in total or minor complication rates could be detected after FDR adjustment, though fewer minor wound complications were observed in the MIS cohort (3.8% vs 20.5%). Both approaches were associated with significant improvements in patient-reported function and mobility; significant improvement in pain scores was observed in the MIS cohort only after FDR adjustment. LEVEL OF EVIDENCE:Level IV, retrospective cohort study.

Despite improvements in pain and function following total knee replacement (TKR), most patients do not achieve recommended levels of moderate-vigorous physical activity (MVPA), putting them at increased risk of chronic disease and mortality. Thus, there is a need for effective and scalable physical activity programs for adults with TKR. This trial aims to identify which supplemental, non-automated intervention components, when added to a fully-automated online physical activity program, contribute to the greatest increases in physical activity at 6 and 12 months. This study is a randomized trial with a factorial design using the multiphase optimization strategy (MOST) framework. Adults (N = 336) who underwent a TKR at least 12 months ago receive a fully-automated, 6-month online exercise program (Energize! ) and are randomized to receive between 0 and 4 non-automated supplemental intervention components (phone calls, progress reports to healthcare providers, videos highlighting stories from others with TKR, and/or individualized human feedback sent via email). Remote assessments occur at baseline, 3 months (mid-intervention), 6 months (post-intervention), and 12 months (following a 6-month no intervention period). The primary outcome is change in accelerometer-assessed MVPA (total minutes and percentage of participants meeting the MVPA guideline of ≥ 150 min/week. Secondary outcomes include change in pain intensity and physical function. Additionally, cost-effectiveness and intervention engagement will be evaluated. This protocol paper describes a robust and innovative approach to determine the most effective intervention components to increase MVPA after TKR. Based on study findings, an optimized, remotely delivered physical activity program will be developed for this population. ClinicalTrials.gov, ID: NCT06768762. Registered on 2025-01-06.

Background: Fluoroscopy is a vital imaging technique in orthopaedic surgery, particularly with the growing adoption of minimally invasive surgery (MIS). Because of their increased reliance on intraoperative imaging, MIS techniques may necessitate greater use of fluoroscopy and radiation compared with open procedures; therefore, the use of modern mini C-arm systems is recommended to mitigate radiation exposure. Although MIS offers significant benefits, its use also raises concerns regarding radiation exposure for both patients and surgical staff. This study evaluated radiation dose and fluoroscopy time comparing 2 common procedures used to treat insertional Achilles tendinitis: the percutaneous Zadek osteotomy (ZO) and the open midline Achilles tendon splitting Haglund resection (HR). We hypothesized that the percutaneous ZO would be associated with increased radiation dose and fluoroscopy time in comparison to the open HR but would be below the recommended occupational exposure limits. Methods: A retrospective review was conducted of all patients who underwent a percutaneous ZO or an open HR between January 2021 and July 2025. All procedures were performed by one of 2 fellowship-trained foot and ankle surgeons at a single academic institution. Radiation exposure was assessed using total radiation dose (mGy) and total fluoroscopy time (minutes). Results: A total of 139 patients met inclusion criteria. Sixty patients underwent a percutaneous ZO, whereas 79 underwent an open HR. The percutaneous ZO cohort demonstrated a mean fluoroscopy time of 2.83 ± 1.64 (range, 0.70-7.17) minutes and an average radiation dose of 3.25 ± 2.06 (range, 0.55-8.07) mGy. Meanwhile an average fluoroscopy time of 0.42 ± 0.19 (range, 0.03-0.90) minutes was observed in the open HR cohort, which had a mean radiation dose of 0.38 ± 0.20 (range, 0.02-1.17) mGy. The percutaneous ZO cohort demonstrated a significantly higher radiation dose ( P < .001) and fluoroscopy time ( P < .001). Conclusion: The percutaneous ZO was associated with a significantly higher radiation dose than the open HR; however, despite being statistically significant, this may not be clinically relevant. As surgeons receive only 0.50% of the dose, approximately 1225 percutaneous ZO procedures would be required to exceed annual safety limits. These findings suggest that radiation exposure during the percutaneous ZO technique remains well below the International Commission on Radiological Protection’s annual occupational limit of 20.00 mSv. Consistent with the ALARA principle, low-dose mini C-arm settings and protective equipment help minimize radiation exposure to patients and surgical staff. Level of Evidence: Level III, retrospective comparative study.

BACKGROUND:The modified Lapidus procedure (MLP) and metaphyseal extra-articular transverse and Akin osteotomy (META) are acceptable surgical treatment options for treating hallux valgus. The current literature is evolving when comparing the different procedures' effects on patient-reported outcomes and postoperative complications. This study aims to compare postoperative outcomes, radiographic outcomes, and patient-reported outcomes using the Patient-reported Outcome Information System for MLP and META. METHODS:This study retrospectively reviewed patients who underwent an MLP or META for the treatment of moderate to severe hallux valgus without associated first tarsometatarsal (TMT) instability between February 2020 and February 2022. Demographic data, radiographic outcomes, and Patient-reported Outcome Information System scores, including pain interference, physical function (PF), and mobility scores, were collected. The paired Student T- test and Wilcoxon rank sum test were used to compare continuous variables and the chi-squared test for categorical variables. RESULTS:A total of 145 patients were included in the study. The average follow-up for MLP and META patients was 61.3 and 52.2 weeks, respectively. META patients had significantly higher improvements in PF (5.3 vs. 2.2, P = 0.03) and mobility (5.5 vs. 2.9, P = 0.02) scores compared with MLP patients. META patients also had a significantly lower nonunion rate (2.6% vs. 14.3%, P = 0.02), implant failure rate (0% vs. 10.4%, P < 0.01), recurrence rate (0% vs. 7.4%, P = 0.02), and greater improvement in hallux valgus angle (18.6° vs. 15.8°, P = 0.03) compared with those treated with MLP. CONCLUSION:META was found to improve patient-reported outcomes markedly more than MLP, with a lower radiographic nonunion rate, implant failure rate, and recurrence rate, and higher improvement in hallux valgus angle. These findings suggest META is a viable option in patients with mild, moderate, or severe HV deformity without TMT instability. LEVEL OF EVIDENCE:III.

BACKGROUND:Forefoot fractures are among some of the most common orthopaedic injuries. Treatment of zone 2 fifth metatarsal or Jones fractures is controversial and many times dependent on surgeon preference. Management of these injuries remains without clear guidelines. Accordingly, the goal of the current systematic review is to compare the clinical outcomes and complications for both surgical fixation and conservative treatment. METHODS:Two independent authors completed a systematic review using the PubMed, EMBASE, and Cochrane Library databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol and Cochrane Handbook guidelines were followed. In addition, the Methodological Index for Non-Randomized Studies score was used to evaluate the quality and bias of the nonrandomized controlled trials. Our criteria included only studies that reported on both conservative and surgical treatment of Jones fractures. RESULTS:Ten studies including 998 patients met our criteria for inclusion. A total of 787 patients underwent conservative management while 211 patients underwent surgical fixation. The surgical cohort had a significantly lower rate of total complications (18/211 (8.5%)) in comparison with the conservative cohort (123/787 (15.6%; P = 0.02). Similarly, those who underwent surgery had a lower rate of nonunion (7/211 (3.3%) versus 91/787 (11.6%; P = 0.04)). Patient-reported outcome scores, including American Orthopaedic Foot and Ankle Society scores were significantly better at final follow-up in the surgical group (96.5) in comparison with the conservative group (84.1; P = 0.005). CONCLUSION:This systematic review found markedly fewer total complications, a lower nonunion rate, and higher mean American Orthopaedic Foot and Ankle Society scores in patients who underwent surgical management for Jones fractures in comparison with those who were treated nonoperatively. Although, conservative treatment is also a successful method of treatment, our findings support surgical treatment of Jones fractures.

This study aims to identify outcomes after corticosteroid injection (CSI) in the posterior tibial tendon (PTT) sheath. The authors retrospectively analyzed data from February 28, 2018 to January 14, 2020 and performed a follow-up patient phone call to assess subjective data. Of the 27 patients, 19 (70%) reported some relief from the procedure; 17 of 27 (63%) reported this pain improvement as > 5 on the pain scale. Common side effects were temporary flares of pain (11/27, 41%) and whitening of skin (3/27, 11%). No severe side effects, including tendon rupture, were observed. The phone survey occurred at an average of 10.08 months after injection (range 4.16 - 26.23 months). No patient experienced major complications, and 70% of patients experienced significant relief from a CSI in the PTT sheath. However, the median duration of pain relief was only 1.5 months, and the minor side effect rate was 41% (11/27), which may indicate treatment failure and should be considered along with a discussion with the patient about these risks. (Journal of Surgical Orthopaedic Advances 35(1):019 - 021, 2026).

Noninsertional Achilles tendinopathy is a degenerative condition caused by chronic mechanical overload, commonly affecting athletes and active individuals. While nonoperative treatment is preferred, approximately one-third of cases require surgery. Various surgical options exist, including debridement, tendon scraping, paratenon release, and flexor hallucis longus transfer, with open and minimally invasive techniques yielding comparable outcomes. The condition's pathophysiology remains unclear, complicating treatment standardization. Given the lack of high-quality comparative studies, surgical approaches should be individualized based on patient factors and surgeon expertise. Future research correlating histopathological findings with clinical outcomes may help refine management strategies.

BACKGROUND:Open and arthroscopic subtalar arthrodesis are safe and effective surgeries for patients with notable arthritis; however, not an established superiority among them has been found. This systematic review aims to present all of the available literature on studies directly comparing both surgeries. METHODS:Two independent authors completed a systematic literature search using the following databases: PubMed, Embase, and the Cochrane library. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol and the Cochrane Handbook guidelines were followed. In addition, the MINORS score was used to evaluate the quality and bias of the nonrandomized controlled trials. Our search criteria included only studies that included both open and arthroscopic subtalar arthrodesis. RESULTS:A total of four studies including 125 open and 130 arthroscopic surgeries met the inclusion criteria for the current systematic review. The mean age and body mass index of patients in the open and arthroscopic groups were 50.0 ± 2.3 and 47.9 ± 1.4 years and 29.0 ± 3.7 and 29.5 ± 2.6 kg/m 2 , respectively. Patients in the open cohort and arthroscopic cohort were followed for a mean of 16.9 ± 6.5 and 15.8 ± 4.7 months, respectively. Union rate was 95.4% ± 4.6% vs. 93.6 ± 4.0%, and the time to fusion was 14 ± 1.6 vs. 10.5 ± 1.6 weeks. The overall complication rate among patients who underwent open arthrodesis was 44.0%, whereas the complication rate was 39% among patients who underwent arthroscopic arthrodesis. Patients stayed in the hospital for 2.2 ± 0.9 days following an open procedure versus 1.1 ± 0.5 days following minimally invasive procedures. CONCLUSION:The current systematic review found a high rate of union among both group of patients. Although trends suggested higher union rates and fewer complications in the arthroscopic cohort, no notable differences were found. Although limited, we hope that this systematic review may help to guide evidence-based decisions when planning the surgical management of patients with severe subtalar arthritis.

Background First metatarsophalangeal (MTP) joint arthrodesis is commonly performed to treat hallux rigidus. Traditional stainless steel or titanium constructs (e.g., locking plates with screws) provide sufficient stiffness but are prone to permanent deformation after excessive pre-fusion loading, leading to plantar gapping and malalignment. Superelastic NiTiNOL staples capable of sustained dynamic compression (SDC) have been developed to address these shortcomings. Purpose To compare the biomechanical performance of first MTP arthrodesis constructs using static fixation, SDC staples, or hybrid static/SDC fixation. Study Design Controlled laboratory study using synthetic MTP joint replicas. Methods Solid foam first MTP models (N=6/group) underwent arthrodesis with one of five constructs. Specimens were cyclically loaded for 1,000 cycles at physiologic loads, followed by destructive displacement testing. Bending stiffness, plantar gapping at simulated walking loads, and permanent plantar gapping were quantified. One-way ANOVA comparisons were performed with the locking plate and screw construct as the control. Results Bending stiffness and plantar gapping at simulated walking loads were not significantly different across groups (p>.07). However, all SDC constructs demonstrated significantly reduced permanent plantar gapping compared with locking plate and screw (≤0.29 mm vs. 0.85 mm, p<.001). The four-leg Y staple alone or in combination with a static screw provided the highest bending stiffness and greatest reduction in permanent plantar gapping. Conclusion Superelastic NiTiNOL SDC staples yield equivalent construct stiffness and markedly reduce permanent plantar gapping compared with static fixation. Hybrid constructs may further enhance biomechanical stability, supporting future clinical evaluation of SDC devices in first MTP arthrodesis.

Introduction: This study aims to determine whether Patient-Reported Outcomes Measurement Information System (PROMIS) domain scores can predict elective spine surgery within 1 year of initial clinic evaluation. Methods: A retrospective query for all new patient spine clinic visits with diagnosis codes related to lower back pain was carried out at a single academic institution. A chart review was conducted to collect sociodemographic variables, clinic visit details, and PROMIS domain scores (PF [Physical Function], PI [Pain Interference], Depression, and Global Health & horbar; Physical and Global Health & horbar;Mental). Patients were divided into Surgery and No Surgery, and for time to surgery, a subanalysis was also carried out. Results: Overall, 116 (8.4%) of 1,387 new patients underwent surgery within 1 year. Race, Surgeon vs. Advanced Practice Provider (APP), and whether advanced imaging (MRI or CT myelogram) was available for interpretation were statistically associated with undergoing surgery. Patients in the Surgery group had statistically significant worse PROMIS scores in all domains when compared with the No Surgery group, and PROMIS PI was additionally associated with Time to Surgery. Multivariate analysis identified PROMIS PI, race, presence of advanced imaging interpretation, and Surgeon vs. APP as independent predictors of Surgery vs. No Surgery; however, only race and PROMIS PI were independent predictors of Time to Surgery. Conclusions: Worse new patient PROMIS PI scores were associated with undergoing surgery within one year of initial evaluation. To determine if PROMIS scores may help in a triage capacity to identify which patients are most appropriate for a surgeon visit versus a nonsurgical provider, further research is needed, thereby improving the efficiency of surgical care delivery.

BackgroundMultimodal, opioid-free regimens for postoperative pain have been increasing in popularity due to concerns regarding the current opioid crisis. Despite their increased popularity, there is limited evidence regarding the effectiveness of these regimens for outpatient forefoot procedures. This study looks to compare a multimodal, opioid-free pain control regimen to a historical opioid regimen in patients undergoing elective, outpatient forefoot procedures.MethodsData were collected prospectively in patients undergoing elective outpatient forefoot procedures, including bunion, bunionette, and lesser toe corrections, who were using a multimodal pain regimen, consisting of Acetaminophen, Meloxicam, Ketorolac, Cyclobenzaprine, and Pregabalin, from December 2020 to June 2022 and retrospectively for patient's undergoing similar procedures using an opioid-containing regimen, consisting of either oxycodone or hydrocodone, from October 2018 to February 2020 to at a single academic institution. Demographic information, VAS pain scores, satisfaction rating, and rescue opioid medication use were recorded. Continuous data were compared using the Wilcoxon Rank Sum test. A multivariable linear regression analysis was used to determine factors influencing a patient's VAS pain scores at 2 weeks postoperatively when controlling for confounding variables. All P < .05 were considered significant.ResultsA total of 41 patients were included in the opioid-free multimodal regimen group and 59 in the opioid-containing group. There was no significant difference between the multimodal group and opioid group in VAS pain score at 2 weeks postoperatively (1.4 vs 1.0, P = .26). Patients in the multimodal group had an 88% satisfaction rating. 17% required rescue opioid medications. Multivariable analysis demonstrated utilization of the multimodal pain regimen did not significantly influence VAS scores at 2 weeks postoperatively when controlling for confounding variables (P = .06).ConclusionOur multimodal, opioid-free pain control regimen demonstrated similar effectiveness, with high satisfaction and low rescue opioid use, as an opioid-containing regimen in patients undergoing elective outpatient foot and ankle procedures. These findings demonstrate this multimodal pain regimen is effective at controlling postoperative pain in patients undergoing elective outpatient forefoot procedures.Level of Evidence:II.

Background:Progressive collapsing flatfoot deformity (PCFD) is a complex pathophysiologic condition, with many different treatment options. The complexity of the condition and variety of treatments can greatly impact patient-reported outcomes (PROs), along with individual patient characteristics. The purpose of this study was to examine PROs in patients receiving surgical treatment for PCFD and compare those outcomes with patients with ankle instability or hindfoot arthritis. Methods:The Orthopaedic Foot and Ankle Outcomes Research (OFAR) Network database was queried to identify all patients with flexible PCFD, ankle instability, or hindfoot arthritis procedures from October 2017 to October 2019 with at least 12 months of follow-up. Patient satisfaction was also measured at both 6 months and 12 months. Changes in PROs and satisfaction were assessed over time and compared between those with PCFD and those with ankle instability or hindfoot arthritis using generalized logistic regression and estimating equations. Results:After adjusting for age, sex, body mass index, hypertension, autoimmune conditions, and type 2 diabetes, there were significant improvements in average Global Physical Health (P < .0001), Pain Interference (P < .0001), Pain Intensity (P < .0001), and Physical Function (P < .0001) for both groups following surgery. Changes in Pain Intensity scores between the baseline and 12-month visits were significantly different between the 2 groups (P = .0286), with those receiving PCFD surgery reporting greater change. The odds of surgical satisfaction was significantly lower at 12 months compared to 6 months for both groups. Conclusion:This study found that patients who underwent surgical management of PCFD demonstrated significant improvements in their PROs and postoperative satisfaction; however, there were lower odds of satisfaction at 12 months compared with 6 months. Additionally, PCFD patients showed greater improvement in Pain Intensity from baseline to follow-up, whereas other PROMIS domains improved similarly between groups.Level of Evidence: Level III, retrospective comparative cohort study.

OBJECTIVE:To evaluate the effect of hyperbaric oxygen (HBO) therapy on the outcomes of patients with chronic refractory osteomyelitis (CRO) when combined with modern antibiotics with modern delivery methods and/or surgical treatments. METHODS:The authors conducted a retrospective review on 58 patients with CRO from a single institution who underwent HBO therapy along with standard treatment between January 2009 and December 2019. To investigate associations with binary outcomes of interest, they estimated logistic regression models. All models were adjusted for sex, smoking status, and pertinent comorbidities. Exponentiated logistic regression model coefficients were interpreted as odds ratios for each outcome of interest. Multivariable logistic regression was used to control for potential confounding variables. RESULTS:When controlling for multiple confounding factors, patients who completed HBO treatment had 7.76 times the odds of having improvement of their CRO compared with patients who started HBO treatment but did not complete it (P = .015). Further, patients who completed HBO treatment had 7.7 times the odds of experiencing CRO improvement when controlling for CRO stage (P = .006). However, completion of HBO did not statistically significantly impact the resolution of CRO or the odds of further surgery or amputation. Patients with diabetes, peripheral vascular disease, and congestive heart failure had increased odds of having an amputation (Ps = .026, .037, and .024, respectively). CONCLUSIONS:Patients who completed HBO treatment had increased odds of experiencing improvement of their CRO compared with patients who started HBO treatment but did not complete it. Patients with CRO who had diabetes and congestive heart failure had increased odds of undergoing an amputation.

BACKGROUND:Tranexamic acid (TXA) is frequently used in knee and hip arthroplasty because of its benefits. The literature is scarce on TXA and total ankle arthroplasty (TAA). The current systematic review aims to present the available literature on the subject. METHODS:Two independent authors performed a systematic literature search using the following databases: PubMed, Embase, and the Cochrane Library. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol and the Cochrane Handbook guidelines were followed. The search criteria were based on TAA and TXA. The MINORS score criteria were used to evaluate the strength and quality of the selected studies. RESULTS:A total of eight studies including 263 TAA were completed with the usage of TXA and 228 TAA were without TXA. The average blood loss and change in hemoglobin in the TXA group was 335.4 mL and 1.45 g/dL, respectively. In the non-TXA group, average blood loss and change in hemoglobin was 441.8 mL and 1.78 g/dL, respectively. The total number of complications and wound complications reported in all studies for the TXA group were 19% and 6.8%; in the non-TXA group, 33.3% and 16.7% were observed, respectively. The difference in wound complication rate was statistically significant ( P = 0.014). Trends favoring the TXA group were found for lower transfusion, pulmonary embolism, deep vein thrombosis, and cerebrovascular accident. CONCLUSION:The utilization of TXA in TAA appears to be safe and effective. Wound complication rate was the only finding with a notable difference favoring the TXA group. The rest of the data from this systematic review demonstrate a trend toward lower in blood loss, hemoglobin decrease, and total complications when using TXA in TAA. Larger prospective studies and randomized controlled trials are needed to further guide evidence-based guidelines.

BACKGROUND:The percutaneous dorsal closing wedge calcaneal Zadek osteotomy (ZO) is an effective treatment for patients with insertional Achilles tendinopathy (IAT), although consensus is lacking on ideal patient selection. Tourné et al proposed that a preoperative calcaneal X/Y ratio <2.5 defines surgical candidacy, but this criterion remains controversial. This study evaluated whether patients with IAT benefit from percutaneous ZO regardless of preoperative X/Y ratio. METHODS:A retrospective comparative study of 27 patients undergoing percutaneous ZO was performed. Patients were stratified into 2 cohorts based on preoperative X/Y ratio (<2.5 vs ≥2.5). Primary outcomes were PROMIS scores for pain, function, and mobility at 3, 6, and 12 months. Secondary outcomes included complication rates and radiographic parameters. Minimal clinically important differences were used to assess clinical significance. RESULTS:Between May 2022 and May 2024, 27 cases were included in the current analyses. Seventeen cases had an X/Y <2.5; 10 had an X/Y ≥2.5. Both cohorts demonstrated significant improvement in PROMIS pain, function, mobility scores (P < .05). Patients with X/Y ≥2.5 demonstrated statistically greater improvement in pain scores than patients with X/Y <2.5 (P = .049) at 1-year follow-up. Ninety-eight percent of patients were satisfied following ZO intervention. CONCLUSION:Percutaneous ZO demonstrated meaningful improvement in patients' function, pain, and mobility regardless of preoperative X/Y ratio. These findings challenge the use of the <2.5 X/Y threshold as a strict selection criterion. Percutaneous ZO may be a viable option for a broader population of IAT patients than previously considered.

Background: Limited literature is available to guide surgeons on which patients with insertional Achilles tendinopathy (IAT) may be the best candidates for minimally invasive dorsal closing wedge calcaneal Zadek osteotomy (MIS ZO). We hypothesized that the severity of IAT on preoperative magnetic resonance image (MRI) may correlate with post-operative functional outcomes and help guide patient selection for treatment with MIS ZO. Methods: Patients who underwent MIS ZO for IAT ± Haglund deformity were identified and retrospectively analyzed. IAT severity was graded on preoperative MRI. Patient Reported Outcome Measurement Information System (PROMIS) scores, complications, and revisions were recorded. Continuous data were compared by analysis of variance with Bonferroni post hoc analysis. Results: Seventeen patients treated with MIS ZO, with follow-up >6 months, and preoperative MRI met our inclusion criteria. PROMIS pain scores significantly improved in patients with IAT grades 1-3, with 5, 5, and 7 patients, respectively, in each subgroup. In this small series we only identified statistically significant improvements in PROMIS function ( P = .031), and mobility ( P = .009) scores were only observed in patients with grade 2 pathology. Sixteen of 17 patients (94.2%) were very satisfied with their procedure and would undergo it again. Conclusion: In this pilot study, we did not find preoperative MRI findings to correlate well with patient-reported outcome scores following MIS ZO. Level of Evidence: Level IV, case series.

BACKGROUND:Insertional Achilles tendinopathy (IAT) is difficult to manage despite multiple surgical options. Two of the surgical options include an open midline Achilles tendon-splitting Haglund resection and a percutaneous Zadek osteotomy (ZO). The current study compared the patient-reported outcomes and complications of open vs percutaneous procedures in patients with IAT ± Haglund deformity. METHODS:A retrospective comparative study of consecutive patients who underwent either an open midline Achilles tendon-splitting Haglund resection or percutaneous ZO for IAT ± Haglund deformity at a single institution with minimum 12 months' follow-up was performed. Preoperative and postoperative Patient-Reported Outcome Measurement Information System (PROMIS) scores and complications were recorded for each patient and compared between cohorts. RESULTS:Forty-three patients were treated with an open midline Achilles tendon-splitting Haglund resection and 34 patients were treated with a percutaneous ZO for IAT ± Haglund deformity. PROMIS function (P < .001), pain (P < .001), and mobility (P < .001) scores significantly improved in patients who received either procedure. In the open midline Achilles tendon-splitting Haglund resection cohort, a significant increase in wound complications (11/43, 25.6%) was observed in comparison to the percutaneous ZO group (1/34, 2.9%; P = .007).ConclusionBoth techniques yielded clinically meaningful improvements in PROMIS scores. In this modest retrospective cohort, the percutaneous ZO was associated with fewer minor wound complications; however, this observation should be interpreted cautiously given the limited sample size, short follow-up, and potential selection bias. LEVEL OF EVIDENCE:Level III, retrospective cohort study.

BACKGROUND:Plantar fasciitis is one of the most common causes of foot pain among the population. This study aimed to review outcomes in patients undergoing Minimally invasive surgery (MIS) ultrasound-guided percutaneous plantar fasciotomy for the treatment of chronic plantar fasciitis. METHODS:A multicenter retrospective chart review of patients undergoing MIS using the Tenex device from January 2020 to December 2022. The main data points collected were Patient-Reported Outcomes Measurement Information System (PROMIS), follow-up times, revision surgery, and complications. RESULTS:56 patients underwent 60 surgeries. The average age and BMI were 48.6 years (19-80), and 33.2 kg/m2 (19.7-58.6). The average follow-up was 27 months (13.3-48.6). The average improvement in pain, physical function, and mobility PROMIS scores were 5.2 (P < 0.01), 3.6 (P = 0.01), and 3.1 (P = 0.01). CONCLUSION:MIS ultrasound-guided plantar fasciotomy appears to be a reliable surgical treatment option for chronic plantar fasciitis with high patient satisfaction and safety profile. LEVEL OF EVIDENCE:IV.