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Background: The use of telerehabilitation after sports medicine procedures such as an arthroscopic rotator cuff repair (ARCR) and anterior cruciate ligament reconstruction (ACLR) has rapidly increased in recent years; however, the functional outcomes and patient satisfaction with telerehabilitation compared to in-person rehabilitation remain unclear. The purpose of this study was to compare the functional outcomes and patient satisfaction with telerehabilitation to in-person rehabilitation in a randomized controlled trial after two common sports procedures, ARCR and ACLR. Methods: Two randomized controlled trials were conducted involving patients scheduled to undergo ARCR or ACLR by one of six fellowship-trained sports medicine surgeons between October 2020 and November 2021. Each trial had an enrollment goal of 60 patients. Subjects were randomized 1:1 to receive telerehabilitation or in-person rehabilitation postoperatively. Functional outcome and satisfaction metrics were collected at baseline and at post-operative visits and compared between groups. Results: In total, 16 ACLR patients were enrolled, of whom 10 (62.5%) were assigned to in-person rehabilitation and 6 (37.5%) to telerehabilitation. Additionally, 32 ARCR patients were enrolled, of whom 20 (62.5%) were assigned in-person rehabilitation and 12 (37.5%) were assigned telerehabilitation. In total, of the 30 patients assigned to in-person rehabilitation, none reported a crossover to telerehabilitation. Of the 18 patients initially assigned to telerehabilitation, 12 (67%) completed the final follow-up survey, of which 11 (92%) reported a crossover; 9 patients completed in-person rehabilitation and 2 patients completed hybrid in-person and telerehabilitation. Conclusions: Patients preferred in-person rehabilitation compared to telerehabilitation after ACLR and ARCR, as evidenced by the nearly ubiquitous crossover from telerehabilitation to in-person rehabilitation in both studies. Our findings suggest that telerehabilitation protocols still need to be perfected, and that there may be a role for a hybrid in-person and tele-rehab model.

Purpose: To determine the prevalence of spin in systematic reviews (SRs) and meta-analyses of clinical studies of the remplissage procedure. Methods: Two reviewers independently performed a literature search of the PubMed, Scopus, and Embase databases using the search term “remplissage” in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The full article of each included SR was assessed for the presence of the 15 most common types of spin. Methodologic quality was assessed using the second version of A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). Results: A total of 15 SRs (8 accompanied by meta-analyses; 6 Level III and 9 Level IV) were included. Overall, 13 SRs (86.7%) contained at least 1 form of spin, with 33 unique instances of spin recorded; the mean frequency was 2.2 ± 1.3 (range, 0-4). The most prevalent form of spin, present in 11 studies (73%), was type 9 (“conclusion claims the beneficial effect of the experimental treatment despite reporting bias”). There were 14 uses of spin classified as misleading reporting, 16 classified as misleading interpretation, and 3 classified as inappropriate extrapolation. The mean 5-year impact factor of the publishing journals was 4.4 ± 0.9 (range, 0-6.1), the mean number of citations per SR was 33.3 ± 24.9 (range, 0-55), and the mean number of citations per month since publication was 0.68 ± 0.44 (range, 0-1.48). According to the AMSTAR 2 assessment, confidence in the results of the SRs was rated as critically low for 20% of reviews, low for 33.3%, and moderate for 46.7%. Conclusions: Most SRs of the remplissage procedure are affected by the presence of spin. Favorable reporting was observed in the absence of definite findings, as was minimization of drawbacks for certain populations. Level of Evidence: Level IV, systematic review of Level III and IV studies.

Introduction: Articular cartilage injuries of the knee are a complex and challenging clinical pathology. Objectives: The purpose of this study was to establish consensus statements via a Delphi process on osteochondral autograft (OATS) and osteochondral allograft (OCA) in the setting of cartilage defects in the knee. Methods: A consensus process on knee cartilage injuries utilizing a modified Delphi technique was conducted. Seventy-nine surgeons across 17 countries participated in these consensus statements. Twenty-seven questions were generated on OATS and OCA, with 3 rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was defined as 100% agreement with a proposed statement. Results: Of the 27 total questions and consensus statements on OATS and OCA developed from 3 rounds of voting, 0 achieved unanimous consensus, 11 achieved strong consensus, 7 achieved consensus, and 9 did not achieve consensus. Conclusions: The statements that achieved strong consensus pertained to the contraindications of OATS and OCA, the preferred site for harvest, storage conditions and timeframe for grafting, site preparation, surgical approach, graft step-off, impact of multiple grafts on clinical outcome, and ways to minimize complications. The statements that did not reach consensus regarded indications for OATS, locations for OATS and OCA, backfilling, sizing, supplemental fixation, marrow venting, and the use of orthobiologics for OCA.

Introduction: Articular cartilage injuries of the knee are a complex and challenging clinical pathology. Objectives: The purpose of this study was to establish consensus statements via a Delphi process on clinical and research follow-up for knee cartilage injuries. Methods: A consensus process on knee cartilage injuries utilizing a modified Delphi technique was conducted. Seventy-seven surgeons across 17 countries were invited to participate in these consensus statements. Nine questions were generated on clinical and research follow-up, with 3 rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was defined as 100% agreement with a proposed statement. Results: Of the 9 total questions and consensus statements on clinical and research follow-up developed from 3 rounds of voting, 1 achieved unanimous consensus, 5 achieved strong consensus, 1 achieved consensus, and 2 did not achieve consensus. Conclusions: The statement that achieved unanimous consensus was on physical examination findings. The statements that achieved strong consensus were related to defining and monitoring treatment success, patient-reported outcomes, research follow-up, and second-look arthroscopy in the setting of recurrence. The statements that did not achieve consensus were related to routine imaging and length of clinical follow-up after operative intervention.

Introduction: Articular cartilage injuries of the knee are a complex and challenging clinical pathology. Objectives: The purpose of this study was to establish consensus statements via a Delphi process on the nonoperative management of knee cartilage injuries. Methods: A consensus process on knee cartilage injuries utilizing a modified Delphi technique was conducted. Seventy-nine surgeons across 17 countries participated in these consensus statements. Eight questions were generated on the nonoperative management of knee cartilage injuries, with 3 rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was defined as 100% agreement with a proposed statement. Results: Of the 8 total questions and consensus statements on nonoperative management developed from 3 rounds of voting, 1 achieved unanimous consensus, 2 achieved strong consensus, 2 achieved consensus, and 3 did not achieve consensus. Conclusions: The statements that achieved unanimous or strong consensus related to indications, contraindications, and prognostic factors for nonoperative management of knee cartilage injuries. The statements that did not achieve consensus were primarily related to the use of non–weight-bearing, injections, and biophysical stimulation in the treatment of knee cartilage injuries.

Introduction: Articular cartilage injuries of the knee are a complex and challenging clinical pathology. Objectives: The purpose of this study was to establish consensus statements via a Delphi process on concomitant procedures for knee cartilage injuries. Methods: A consensus process on knee cartilage injuries utilizing a modified Delphi technique was conducted. Seventy-nine surgeons across 17 countries participated in these consensus statements. Twelve questions were generated on concomitant procedures, with 3 rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was defined as 100% agreement with a proposed statement. Results: Of the 12 total questions and consensus statements on concomitant procedures developed from 3 rounds of voting, 0 achieved unanimous consensus, 5 achieved strong consensus, 5 achieved consensus, and 2 did not achieve consensus. Conclusions: The statements achieving consensus were primarily related to the tibiofemoral joint, meniscal insufficiency, and ligamentous stability. Concomitant procedures, including osteotomy, meniscal repair or transplantation, and ligamentous repair or reconstruction, should be performed with cartilage procedures for the most optimal outcome. The statements that did not reach consensus were related to the patellofemoral joint and unloading osteotomies in patients with normal alignment.

Introduction: Articular cartilage injuries of the knee are a complex and challenging clinical pathology. Objectives: The purpose of this study was to establish consensus statements via a Delphi process on the management of failed knee cartilage surgery. Methods: A consensus process on knee cartilage injuries utilizing a modified Delphi technique was conducted. Seventy-nine surgeons across 17 countries participated in these consensus statements. Eleven questions were generated on the management of failed knee cartilage surgery, with 3 rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was defined as 100% agreement with a proposed statement. Results: Of the 11 total questions and consensus statements on the management of failed knee cartilage surgery developed from 3 rounds of voting, 0 achieved unanimous consensus, 10 achieved strong consensus, and 1 achieved consensus. Conclusions: The statements that achieved strong consensus related to revision cartilage indications, contraindications, lesion size, prior procedures, unipolar/bipolar lesions, and salvage procedures. The statement that did not achieve strong consensus was related to the management of a failed osteochondral autograft/allograft.

Introduction: Articular cartilage injuries of the knee are a complex and challenging clinical pathology. Objectives: The purpose of this study was to establish consensus statements via a Delphi process on bone marrow stimulation (BMS) for knee cartilage injuries. Methods: A consensus process on knee cartilage injuries utilizing a modified Delphi technique was conducted. Seventy-nine surgeons across 17 countries participated in these consensus statements. Fourteen questions were generated on BMS, with 3 rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was defined as 100% agreement with a proposed statement. Results: Of the 14 total questions and consensus statements on BMS developed from 3 rounds of voting, 0 achieved unanimous consensus, 3 achieved strong consensus, 4 achieved consensus, and 7 did not achieve consensus. Conclusions: The statements that achieved strong consensus related to lesion site preparation, ability to differentiate healthy/damaged cartilage, and distance between BMS holes. The statements that did not achieve consensus were primarily related to the indications for BMS, as well as the instrumentation and whether orthobiologics/scaffolds should be utilized.

Introduction: Articular cartilage injuries of the knee are a complex and challenging clinical pathology. Objectives: The purpose of this study was to establish consensus statements via a Delphi process on rehabilitation and return to play (RTP) following knee cartilage injuries. Methods: A consensus process on knee cartilage injuries utilizing a modified Delphi technique was conducted. Seventy-nine surgeons across 17 countries participated in these consensus statements. Eleven questions were generated on rehabilitation and RTP, with 3 rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was defined as 100% agreement with a proposed statement. Results: Of the 11 total questions and consensus statements on rehabilitation and RTP developed from 3 rounds of voting, 0 achieved unanimous consensus, 2 achieved strong consensus, 4 achieved consensus, and 5 did not achieve consensus. Conclusions: The statements achieving consensus were related to the benefits of early motion and that concomitant procedures may alter the rehabilitation process. RTP following cartilage-related procedures typically follows a rehabilitation guideline largely dependent on the type of cartilage procedure. The statements that did not reach a consensus were related to specific timing to meet goals.

Introduction: Articular cartilage injuries of the knee are a complex and challenging clinical pathology. Objectives: The purpose of this study was to establish consensus statements via a Delphi process on the diagnosis of knee cartilage injuries. Methods: A consensus process on knee cartilage injuries utilizing a modified Delphi technique was conducted. Seventy-nine surgeons across 17 countries participated in these consensus statements. Eleven questions were generated on the diagnosis of knee cartilage injuries, with 3 rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was defined as 100% agreement with a proposed statement. Results: Of the 11 total questions and consensus statements regarding the diagnosis of knee cartilage injuries developed from 3 rounds of voting, 0 achieved unanimous consensus, 8 achieved strong consensus, and 3 achieved consensus. Conclusions: The majority of the statements regarding diagnosis achieved strong consensus, which related to aspects of the physical exam and history, imaging and documentation, and assessment of concomitant injury or bony malalignment that aid in surgical decision-making. The statements that did not achieve strong consensus were determining when a lesion is symptomatic, documentation of imaging, and when a diagnostic arthroscopy is indicated.

Introduction: Articular cartilage injuries of the knee are a complex and challenging clinical pathology. Objectives: The purpose of this study was to establish consensus statements via a Delphi process on cartilage fixation techniques and indications. Methods: A consensus process on knee cartilage injuries utilizing a modified Delphi technique was conducted. Seventy-nine surgeons across 17 countries participated in these consensus statements. Fourteen questions were generated on cartilage fixation, with 3 rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was defined as 100% agreement with a proposed statement. Results: Of the 14 total questions and consensus statements on cartilage fixation developed from 3 rounds of voting, 0 achieved unanimous consensus, 8 achieved strong consensus, 3 achieved consensus, and 3 did not achieve consensus. Conclusions: The statements achieving strong consensus related to indications and contraindications, the expectation that younger patients experience better outcomes, and an agreement that procedures should be done as soon as possible but no limit on timeframe, cartilage preparation techniques, and the use of fragment stability to guide cartilage fixation techniques. The statements that did not achieve consensus related to the minimum size of cartilage fragments that can be fixed, if purely cartilaginous lesions can be fixed, and the fixation techniques.

Introduction: Articular cartilage injuries of the knee are a complex and challenging clinical pathology. Objectives: The purpose of this study was to establish consensus statements via a Delphi process on chondrocyte-based cartilage (CBC) approaches and scaffolds for cartilage injury. Methods: A consensus process on knee cartilage injuries utilizing a modified Delphi technique was conducted. Seventy-nine surgeons across 17 countries participated in these consensus statements. Ten questions were generated on chondrocyte-based approaches and scaffolds, with 3 rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was defined as 100% agreement with a proposed statement. Results: Of the 10 total questions and consensus statements on CBC repair developed from 3 rounds of voting, 1 question achieved unanimous consensus, 6 achieved strong consensus, 2 achieved consensus, and 1 did not achieve consensus. Conclusions: The statements that achieved strong or unanimous consensus were related to indication and relative indications for CBC repair, harvesting site for chondrocytes, differentiating healthy and unhealthy cartilage, sizing defects, minimizing complications, and orthobiologics utility. These consensus statements regarding chondrocyte-based approaches and scaffolds for cartilage injury will hopefully assist clinicians in the management of this challenging pathology.

Background: Excellent short-term outcomes after reverse shoulder arthroplasty (RSA) have been reported, but longer term outcomes in the existing literature are sparse and vary widely. The purpose of this study is to systematically assess the existing literature to quantify functional outcomes and complication rates after RSA at a minimum of five years of follow-up. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-analyses-compliant systematic literature search of the PubMed and Embase databases was undertaken. Studies reporting outcomes after primary RSA for nontrauma-related indications with a minimum of 5-year follow-up were included. Results: Overall, 20 studies satisfied all inclusion criteria. This represented 1591 shoulders in 1556 patients (32.1% males), with a mean age of 70.2 ± 5.0 years and mean follow-up of 8.8 years, or 106.2 ± 30.1 months (60-243). At final follow-up, the mean reported Constant Murley score was 62.1 ± 5.0 (49.0-83.0). The mean adjusted Constant Murley score was 83.5 ± 12.5 (58-111.9). The mean American Shoulder and Elbow Surgeons score was 81.8 ± 4.6, while the mean subjective shoulder value was 74.6 ± 6.4. Overall, 88% of patients rated their satisfaction as either good or very good. The range of active forward flexion, abduction, external, and internal rotation were respectively, 126° ± 13°, 106° ± 11°, 22° ± 11°, and 6° ± 2°. The overall rate of revision surgery was 4.9% (0%-45.5%). Regarding complications, the rate of prosthetic joint infection was 4.3% (0%-26.7%), shoulder dislocation was 3.7% (0%-20.4%), and acromial fracture was 2.0% (0%-8.8%). At final follow-up, 30.9% of shoulders had some degree of scapular notching. Conclusion: This systematic review shows that RSA results in high satisfaction rates, good clinical outcomes, as well as modest complication and revision rates at minimum 5-year follow-up.

Purpose: The purpose of this study was to analyze the quality and readability of information regarding rotator cuff repair surgery available using an online AI software. Methods: An open AI model (ChatGPT) was used to answer 24 commonly asked questions from patients on rotator cuff repair. Questions were stratified into one of three categories based on the Rothwell classification system: fact, policy, or value. The answers for each category were evaluated for reliability, quality and readability using The Journal of the American Medical Association Benchmark criteria, DISCERN score, Flesch-Kincaid Reading Ease Score and Grade Level. Results: The Journal of the American Medical Association Benchmark criteria score for all three categories was 0, which is the lowest score indicating no reliable resources cited. The DISCERN score was 51 for fact, 53 for policy, and 55 for value questions, all of which are considered good scores. Across question categories, the reliability portion of the DISCERN score was low, due to a lack of resources. The Flesch-Kincaid Reading Ease Score (and Flesch-Kincaid Grade Level) was 48.3 (10.3) for the fact class, 42.0 (10.9) for the policy class, and 38.4 (11.6) for the value class. Conclusion: The quality of information provided by the open AI chat system was generally high across all question types but had significant shortcomings in reliability due to the absence of source material citations. The DISCERN scores of the AI generated responses matched or exceeded previously published results of studies evaluating the quality of online information about rotator cuff repairs. The responses were U.S. 10th grade or higher reading level which is above the AMA and NIH recommendation of 6th grade reading level for patient materials. The AI software commonly referred the user to seek advice from orthopedic surgeons to improve their chances of a successful outcome.

Reverse shoulder arthroplasty (RSA) is used in the treatment of traumatic and arthritic pathologies, with expanding clinical indications and as a result there has been an increase in clinical research on the topic. The purpose of this study was to examine the statistical fragility of randomized control trials (RCTs) reporting outcomes from RSA. A systematic search was undertaken to find RCTs investigating RSA. The Fragility Index (FI) was calculated using Fisher’s exact test, by sequentially altering the number of events until there was a reversal of significance. The Fragility Quotient (FQ) was calculated by dividing the FI by the trial population. Each trial was assigned an overall FI and FQ calculated as the median result of its reported findings. Overall, 19 RCTs warranted inclusion in the review, representing 1146 patients, of which 41.2% were male, with a mean age of 74.2 ± 4.3 years and mean follow-up of 22.1 ± 9.9 months. The median RCT population was 59, with a median of 9 patients lost to follow-up. The median FI was 4.5, and median FQ was 0.083, indicating more patients did not complete the trial than the number of outcomes which would have to change to reverse the finding of significance. This review found that the RCT evidence for RSA management may be vulnerable to statistical fragility, with a handful of events required to reverse a finding of significance.

Purpose: The purpose of this study was to compare bone marrow stimulation using micro-computed tomography (micro-CT) analysis of an abrasion arthroplasty technique, drilling k-wire technique, traditional microfacture awl, or a microdrill instrument for subchondral bone defects. Methods: Eleven cadaveric distal femoral specimens were obtained and divided into 3 common areas of osteochondral defect: trochlea and weightbearing portions of the medial and lateral femoral condyles. Each area of interest was then denuded of cartilage using a PoweRasp and divided into quadrants. Each quadrant was assigned either a 1.6 mm Kirschner wire (k-wire), 1.25 mm microfracture awl, 1.5 mm fluted microdrill, PowerPick, or a curette (abrasion arthroplasty) to create 4 channels into the subchondral bone sing the same instrument. Subchondral bone and adjacent tissue areas were then evaluated using micro-CT to analyze adjacent bone destruction and extension into the bone marrow. Results: Overall, there was a significantly decreased area of bone destruction or compression using the microdrill (0.030 mm) as compared to the microfracture awl (0.072 mm) and k-wire (0.062 mm) (P < .05). Within the trochlea and the medial femoral condyle, there was significantly decreased bony compression with the microdrill as compared to the awl and k-wire (P < .05); however, when stratified, this was not significant among the lateral femoral condylar samples (P = .08). Conclusion: Bone marrow stimulation causes bony compression that may negatively impact subchondral bone and trabecular alignment. It is important to understand which tools used for bone marrow stimulation cause the least amount of damage to the subchondral bone. Clinical Relevance: This study demonstrates the decreased subchondral bony defects seen with the microdrill versus the traditional microfracture awl indicating that when performing bone marrow stimulation, the microdrill may be a less harmful tool to the subchondral bone.

Purpose: To assess and compare glenoid version in patients with anterior shoulder instability (ASI), posterior shoulder instability (PSI), and a control group. Methods: The operative notes of all patients that had undergone arthroscopic shoulder instability repair between January 2017 and May 2022 were retrospectively reviewed. Magnetic resonance imaging scans were then analyzed, and glenoid version was measured by a single blinded observer. A P value

Background: Gaelic Athletic Association (GAA) games are collision sports played at an amateur level, which represent the most popular sports played on the island of Ireland. Each year, many GAA players in Ireland require surgical stabilization with either arthroscopic Bankart repair (ABR) or open Latarjet (OL) procedures in the setting of anterior shoulder instability. The purpose of this study was to evaluate the clinical outcomes, recurrence, and return to play (RTP) in athletes who play GAA games having undergone surgical stabilization with either ABR or OL procedures in the setting of anterior shoulder instability. Methods: A retrospective review of all patients with anterior shoulder instability whom had stabilization with either ABR or OL under a single surgeon between 2012 and 2018 was performed. Patients who were athletes partaking in GAA sports were followed up by chart review and telephone survey to assess their clinical outcomes including satisfaction, pain as measured on the visual analog scale score, the Subjective Shoulder Value, recurrence, complications, and revision surgeries. In addition, RTP rates, time to RTP, level of RTP, and Shoulder Instability–Return to Sport after Injury scores were evaluated. Results: A total of 200 GAA athletes (194 males) with a mean age of 23.9 ± 6.1 years with mean follow-up of 50.4 ± 24 months were included in this study. A total of 98.1% patients were satisfied with their procedure at the latest follow-up, with an overall recurrence rate of 5%. A total of 6.5% of athletes required revision surgery, of whom 4% required revision stabilization (all of whom had recurrence). The overall rate of RTP was 88% at mean 6.0 ± 1.7 months postoperatively, with 75% of athletes returning at the same or higher levels than their preinjury level. There were no significant differences for all outcome measures analyzed between patients who had ABR or OL procedures. Conclusion: GAA athletes with anterior shoulder instability treated with either ABR or OL procedures report excellent clinical outcomes at medium-term follow-up, with high satisfaction rates, excellent functional outcomes, and high rates of RTP. Furthermore, this cohort demonstrates low rates of recurrence after stabilization with few requiring revision surgery.

Category: Ankle; Hindfoot; Sports; Trauma Introduction/Purpose: While surgery is often indicated in the treatment of chronic ankle instability (CAI), there lacks consensus on which procedure is preferable in light of the multiple different procedures available. In this systematic review, we evaluate the recent literature on the anatomical reconstruction of the lateral ligaments in the treatment of CAI in an effort to identify differences in clinical and radiological outcomes between allograft and autograft reconstruction techniques. Methods: A systematic search of PubMed, EMBASE, and Cochrane Library databases was performed in October 2019 resulting in 13 studies ranging from the years 1991 to 2017. The studies included were carefully evaluated with regards to the level of evidence (LOE) and quality of evidence (QOE), clinical and radiological outcomes, complications, revision rates and return to sport. Results: Thirteen studies including a total of 296 ankles were included; Within the autograft group, the weighted mean AOFAS improved from 66.9 to 95.9 at a weighted mean follow-up of 29.6 months, KPSSAF scores improved from 48 to 92.2 at a weighted mean follow-up of 37 months, VAS scores improved from 6.8 to 0.2 at a weighted mean follow up of 33.5 months, and the complication rate was 7.7% at a follow up of 31.2 months. Within the allograft group the AOFAS improved from 53.7 to 89.3 at a follow-up of 35.5 months, KPSSAF scores improved from 42.8 to 90.4 at a follow up of 34 months, VAS scores improved from 7.3 to 1.9 at a follow up of 38 months, and the complication rate was 7% at a follow up of 34.9 months. Conclusion: The current systematic review demonstrated that anatomical reconstruction of CAI resulted in favorable clinical and radiological outcomes, low complication and revision rates and excellent return to sport rates in the short-term follow-up. Comparison of autograft and allograft reconstruction techniques for chronic lateral ankle instability showed minor differences both clinically and radiologically but none which would suggest superiority of one technique over another.

Purpose: To evaluate the outcomes of arthroscopic Bankart repair with remplissage (ABRR) compared with the arthroscopic Latarjet (AL) procedure for anterior shoulder instability in patients with a labral tear and a concomitant engaging Hill-Sachs lesion. Methods: A retrospective review of patients who underwent either ABRR or the AL procedure for a diagnosis of anterior shoulder instability with a concomitant engaging Hill-Sachs lesion between 2011 and 2019 was performed. Recurrent instability, the visual analog scale score, the Subjective Shoulder Value, the Western Ontario Shoulder Instability score, patient satisfaction, willingness to undergo surgery again, and return to work or sport were evaluated. Results: Our study included 41 patients treated with ABRR and 26 treated with the AL procedure. At final follow-up, there was no difference between patients who underwent ABRR and those who underwent the AL procedure in the reported Western Ontario Shoulder Instability score (21.8% vs 28.2%, P = .33) or any of its components, the visual analog scale score (0.9 vs 1.4, P = .32), the Subjective Shoulder Value (78.4 vs 74.5, P = .6062), the rate of satisfaction (81.6% vs 85.6%, P = .54), or whether patients would undergo surgery again (81.6% vs 96.1%, P = .16). Overall, 5 patients in the ABRR group and 2 patients in the AL group had recurrent instability events (12.2% vs 7.8%, P = .70), with no significant difference in the rate of recurrent dislocation (12.2% vs 3.8%, P = .39). Conclusions: In patients with anterior shoulder instability and a concomitant Hill-Sachs lesion, both ABRR and the AL procedure were shown to be reliable treatments, with a low rate of recurrent instability and excellent patient-reported outcomes in appropriately selected patients. However, our study could not determine whether there was critical glenoid bone loss in patients undergoing ABRR, and surgeons should still exercise caution in performing ABRR in patients with high-grade glenoid bone loss or in those with failed prior stabilizations. Level of Evidence: Level III, retrospective cohort study.

Category: Ankle Introduction/Purpose: The use of bulk osteochondral allograft (OCA) is often warranted in patients with a large osteochondral lesion of the talus (OLT). Previous literature reported that bulk OCA has high failure and revision rates, suggesting these procedures should be thought of as an intermediate step, buying time before arthrodesis or arthroplasty is required. However, recent studies suggest that the long-term survival of bulk OCA has improved and that these procedures may provide a definitive solution for large OLT. The purpose of this study was to systematically review the literature to ascertain the outcomes of bulk OCA for OLT. Methods: Two independent reviewers performed the literature search based on PRISMA guidelines, utilizing the EMBASE, MEDLINE, and The Cochrane Library Databases. Studies were included if they reported outcomes of OLTs which were managed by bulk OCA. Results: Overall, 9 studies with 112 patients (55.4% males) including 115 ankles with a mean follow-up of 72.7 (8 - 240) months were included in this review. Pre-operative OLT characteristics showed that 68.4% were medial lesions, with a mean lesion size of 3.04cm 2 (0.7 - 6.1 cm 2 ). Overall, 23.5% of patients required revision surgery following bulk OCA; 10.4% (12/115) underwent subsequent arthrodesis, 1.7% (2/115) underwent revision osteochondral grafting and 9.6% (11/115) underwent arthroscopic debridement. Radiological outcomes reporting graft failure was 21.3% (13/61), joint space narrowing was 25.2% (29/115) and cysts were present in 19.5% (15/77) of cases. Conclusion: Patients experience satisfactory patient-reported clinical outcomes in the medium term following bulk OCA in the management of OLT. Despite recent advances in graft procurement and storage radiological graft failure and the requirement for additional surgeries still remain. At this time can only be recommended in cases that are refractory to other treatments and where the patient is aware that this may be a temporizing procedure before arthroplasty or arthrodesis.

Category: Ankle; Hindfoot Introduction/Purpose: The purpose of this systematic review was to evaluate changes in the alignment of the hindfoot following total knee arthroplasty (TKA), subjective clinical outcomes following surgical intervention and to analyze the level of evidence (LOE) and quality of evidence (QoE) of the included studies. Methods: MEDLINE, EMBASE, and Cochrane Library databases were systematically reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting changes in the postoperative alignment of the hindfoot following TKA were included. The level and quality of evidence were recorded and assessed. Results: Eleven studies with a total of 1142 patients (1358 knees) met the inclusion/exclusion criteria. Six studies were of level of evidence II and 5 studies were of level of evidence III. Patients with preoperative varus knee deformity and valgus hindfoot deformity demonstrated improvement in hindfoot alignment post-TKA. Patients with preoperative varus knee deformity and varus hindfoot deformity demonstrated no improvement in hindfoot alignment following TKA. Twelve different radiographic parameters were used to measure the alignment of the hindfoot across the included studies, with the tibio-calcaneal angle (TCA) most frequently utilized (27.3%). Conclusion: This systematic review demonstrated that the hindfoot may display compensatory changes in alignment following total knee arthroplasty in patients with knee osteoarthritis. However, the marked heterogeneity between the included studies and poor quality of evidence limits any meaningful cross-sectional comparisons between studies. Further, well-designed studies are necessary to determine the changes and outcomes of hindfoot alignment following total knee arthroplasty.

Category: Midfoot/Forefoot; Sports Introduction/Purpose: To provide an overview and evaluation of the available evidence on surgical intervention for 5th metatarsal fractures in the athletic population. Methods: PubMed, Cochrane, and Embase databases were systematically reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The level and quality of evidence (LOE and QoE) were recorded and assessed. Return to sport/play (RTS/RTP), radiographic outcomes, complications, reoperations, and revisions were also evaluated. Results: Twenty-eight studies were included in this review spanning a total of 761 patients and 765 fractures. The weighted mean age of the study population was 24 years, and the mean follow-up was 33.8 months. Surgical techniques and fracture types varied across the studies, but the majority (18) used internal fixation. Nonunion occurred in 5.8% (11/190) of patients who received a surgical treatment other than internal fixation, but only in 2.3% (11/480) of patients who received surgical treatment with internal fixation. Patients presenting with acute 5th MTP fractures returned to play significantly faster than those with delayed union 5th MTP fractures (7.6 weeks vs. 11.2 weeks) (p

Category: Other Introduction/Purpose: Endoscopic plantar fascia release (EPFR) is an established operative treatment for recalcitrant plantar fasciitis. The purpose of this systematic review is to provide a comprehensive review on the outcomes of endoscopic plantar fascia release in the treatment of plantar fasciitis at mid- and long-term follow-up. Methods: A systematic review was performed using, MEDLINE, EMBASE, and Cochrane library databases in May 2020 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included were evaluated with regards to the level of evidence (LOE) and quality of evidence (QoE) using the Coleman methodological score. Clinical outcomes and complications were also evaluated. Results: Twenty-five studies including 729 feet were included in this systematic review with a mean follow-up of 25.1 months. 18 papers used the American Orthopaedic Foot & Ankle Society (AOFAS) score. The weighted mean preoperative AOFAS score was 55.6 and the postoperative score was 89.6 out of 100. The total number of patients who had complications was 117 of 729 (16.1%). The most common complication was a recurrence of pain experienced by 6.5% of patients (47 of 117). Conclusion: Endoscopic plantar fascia release provides good clinical and functional outcomes in patients with refractory plantar fasciitis. However, this procedure is associated with a moderately high complication rate.

Category: Ankle; Sports Introduction/Purpose: There is minimal literature on the use of suture-tape augmentation in the treatment of chronic lateral ankle instability (CLAI), prompting an investigation on its use and effect during surgery of the lateral ankle. The purpose of this systematic review is to evaluate the evidence for the use of suture-tape augmentation in the treatment of CLAI, and the outcomes following this technique. Methods: A literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they evaluated the use of suture-tape for CLAI. Quantitative and qualitative analysis was performed. Results: There were 11 studies (LOE II: 2, LOE III: 1, LOE IV: 8) with 334 patients and 334 ankles, and 66.7% were females. The mean age of patients was 27.3 years. The mean follow-up was 27.6 months (range: 11.5-38.5). Overall, 9 recurrent instability events (4.1%) were reported for suture-tape augmentation, with no significant difference between Modified Broström repair and suture-tape augmentation (MD;.81, 95% CI,.19, 3.50, I2 = 0%, p = 0.78). There was no significant difference in talar tilt angle (TTA) improvement between Modified Broström repair and suture-tape augmentation (MD; -0.07, 95% CI, -0.68, 60.54, I2 = 0%, p = 0.82). There was no significant difference in anterior talar translation (ATT) improvement between Modified Broström repair and suture-tape augmentation (MD; -0.06, 95% CI, -0.69, 0.56, I2 = 0%, p = 0.84). Conclusion: Suture-tape augmentation did not significantly improve clinical or radiological outcomes in the setting of Modified Broström repair for CLAI. Quicker return to play was the single most important advantage of the suture-tape augmentation procedure identified in the current study. This indicates that there is a role for suture-tape augmentation in ATFL repair for athletes and high-demand patients.

Category: Ankle Introduction/Purpose: Ankle injuries commonly result in damage to the articular cartilage of the talus. The use of cylindrical osteochondral allografts (OCA) for osteochondral lesions of the talus (OLT) smaller than 1.5cm is increasingly common, particularly in cases whereby autologous osteochondral transplantation (AOT) is contraindicated. The primary aim of this study is to systematically review the outcomes of cylindrical OCA for OLT. The secondary aim of this study is to compare the outcomes of cylindrical OCA and AOT in the management of similar cases of OLT. Methods: Two independent reviewers searched the literature based on PRISMA guidelines, utilizing the EMBASE, MEDLINE, and The Cochrane Library Databases. Only studies that reported outcomes of cylindrical OCA in the management of OLT were included. Results: Overall, 4 studies with 100 patients including 101 ankles were included in this review. Pre-operative OLT characteristics showed 69.3% of OLT lesions were located medially, with a mean lesion size of 1.47cm 2 (0.46 - 4.2 cm 2 ). Overall, 16.8% of ankles required surgical revision following cylindrical OCA; 1.0% (1/101) underwent subsequent arthrodesis, 6.9% (7/101) underwent revision osteochondral grafting and 7.9% (8/101) underwent subsequent arthroscopic debridement. Radiological outcomes between the graft failure were reported as 10.0% (3/30), joint space narrowing as 30.4% (14/46), and cysts as 42.9% (27/63). Significantly higher revision rates were reported following cylindrical OCA when compared to AOT at over two years follow up (28.1% versus 6.7%, p = 0.02). Conclusion: Our systematic review established that although there are high rates of patient satisfaction following cylindrical OCA for OLT, these are less than those reported with AOT for the same condition. Concerns regarding the rates of radiological deterioration as well as the need for surgical revision may represent harbingers for poorer long-term outcomes.

Category: Ankle Introduction/Purpose: The purpose of this study is to evaluate the effectiveness of Extracellular Matrix Cartilage Allograft (EMCA) as an adjuvant to bone marrow stimulation (BMS) compared to BMS alone in the treatment of osteochondral lesions of the talus (OLT). Methods: A retrospective cohort study comparing patients treated with BMS with EMCA (BMS-EMCA group) and BMS alone (BMS group) between 2013 and 2019 was undertaken. 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 χ2 or Fisher exact test for categorical variables. Results: Twenty-four patients underwent BMS with EMCA (BMS-EMCA group) and 24 patients underwent BMS alone (BMS group). The mean age was 40.8 years (range, 19 to 60 years) in BMS-EMCA group and 47.8 years (range, 24 to 60 years) in BMS group (p=0.060). The mean follow-up time was 20.0 months (range, 12-36 months) in BMS-EMCA group and 26.9 months (range, 12 to 55 months) in BMS group (p=0.031). Both groups showed significant improvements in all FAOS subscales. No significant differences between groups were found in all postoperative FAOS. The mean MOCART score in BMS-EMCA group was higher (76.3 vs 66.3), but not statistically significant (p=0.176). The MRI analysis showed that 87.5% of BMS-EMCA group had complete infill of the defect with repair tissue, however less than half (46.5%) of BMS group had complete infill (p=0.015). Conclusion: BMS with EMCA is an effective treatment strategy for the treatment of OLT and provides better cartilage infill in the defect on MRI. However, this did not translate to improved functional outcomes compared with BMS alone in the short-term.

Purpose: The purpose of this study is to evaluate the patient-reported outcomes of open Latarjet (OL) compared to arthroscopic Latarjet (AL) for anterior shoulder instability. Methods: A retrospective review of patients who underwent either OL or AL for anterior shoulder instability between 2011 and 2019 was performed. Recurrent instability, visual analog scale (VAS) score, Shoulder Instability-Return to Sport after Injury (SIRSI), Subjective Shoulder Value (SSV), Western Ontario Shoulder Instability (WOSI) score, patient satisfaction, willingness to undergo surgery again, and return to work/sport (RTW/RTS) were evaluated. A P value of < .05 was considered to be statistically significant. Results: Our study included 102 patients in total; 72 patients treated with OL, and 30 treated with AL. There were no demographic differences between the two groups (P > .05 for all). At final follow up (mean of 51.3 months), there was no difference between those that underwent OL or AL in the reported WOSI, VAS, VAS during sports, SSV, and SIRSI scores, nor in patient satisfaction, or whether they would undergo surgery again (P > .05). Overall, there was no significant difference in the total rate of RTP (65% vs 60.9%; P = .74), or timing of RTP (8.1 months vs 7 months; P = .35). Additionally, there was no significant difference in the total rate of RTW (93.5% vs 95.5%; P = .75). Overall, 3 patients in the OL group and 2 patients in the AL group had recurrent instability events (6.9% vs 6.7%; P = .96), with no significant difference in the rate of recurrent dislocation (4.2% vs 3.3%; P = .84). Conclusion: In patients with anterior shoulder instability, both the OL and AL are reliable treatment options, with a low rate of recurrent instability, and similar patient-reported outcomes.

Purpose: To quantify the magnetic resonance arthrography (MRA) findings in rugby players during preoperative workup for anterior surgical stabilization for glenohumeral instability. Methods: All patients who underwent glenohumeral instability surgery in our institution between 2008 and 2018 were considered for inclusion. Rugby players were identified using the patient’s medical notes, with subsequent identification of all professional players. All rugby player’s preoperative MRA findings were recorded and analyzed. Results: Overall, 267 rugby players were included, 261 of whom were male (97.8%), with a mean age of 22.7 years (range 13-55 years). There were 58 professional rugby players (21.7%). The mean number of pathologies in nonprofessional rugby players was 5.0 pathologies versus 6.2 pathologies in the professional rugby players, with a significant difference in nonprofessional rugby players with up to 3 pathologies versus professional rugby players (26.3% vs 10.3%, P = .01). Professional rugby players had a statistically significant increased incidence of bicipital tendon lesions (25.9% vs 13.9%, P = .009), acromioclavicular joint degeneration (60.3% vs 42.1%, P = .016), glenohumeral bone loss (87.9% vs 69.9%, P = .006), and degenerative changes (67.2% vs 44.0%, P = .002) on their MRAs. Conclusions: Rugby players undergoing surgical stabilization for glenohumeral instability often have a significant number of pathologies identified on MRA at the time of surgery. Professional rugby players showed concerningly greater frequencies of early degenerative changes when compared with nonprofessional rugby players. Level of Evidence: III; Retrospective Cohort Study

Purpose: To systematically review the literature and assess the reported rehabilitation protocols, return-to-play guidelines, and reported rates of return-to-play after meniscal repair. Methods: MEDLINE, EMBASE, and the Cochrane Library were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies on meniscal repair. Studies were included if return-to-play data and/or rehabilitation protocols were reported. The rate and timing of return-to-play was assessed. The rehabilitation protocols were documented, in addition to when to start range of motion (ROM), full ROM, partial weight-bearing (WB), and full WB. Results: Overall, 88 studies met our inclusion criteria. Thirteen studies, including 507 patients, cited a range of 71.2% to 100% of return-to-play, with 53.9% to 92.6% returning to the same/greater level, ranging between 3.3 and 10 months. There was considerable variability in the reported rehabilitation protocols, but the most frequently reported time to begin ROM exercises was within the first week (78.9%) and full ROM at 6 weeks (33.3%). Partial WB was typically begun during the first week (61.0%), and full WB between the fourth and sixth week (65.6%) postoperatively. Following surgery, time elapsed was the most commonly cited criteria for return-to-play (97.0%), with 6 months being the most common time point applied (46.9%). No study advised against returning to competitive or contact sports after meniscal repair. Conclusions: In conclusion, there was a high rate of return-to-play following meniscal repair, with 60% of patients returning to the same level of play. However, there was considerable diversity in the reported rehabilitation protocols and insufficient reporting on return-to-play criteria in the literature. This demonstrates the need for further research and formulation of an evidence-based consensus statement for this patient population. Level of Evidence: Level IV, systematic review of Level I to IV studies.

Purpose: To ascertain the rate and timing of return to play (RTP) and the availability of specific criteria for safe RTP after arthroscopic posterior shoulder stabilization. Methods: Medline, EMBASE, and the Cochrane Library were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to find studies on arthroscopic posterior shoulder stabilization. Studies were included if they reported RTP data or rehabilitation protocols and excluded if concomitant procedures influenced the rehabilitation protocol. Rate and timing of RTP, along with rehabilitation protocols, were assessed. Results: This review found 25 studies, including 895 cases, meeting the study’s inclusion criteria. The majority of patients were male (82.7%), with an age range of 14 to 66 years and a follow-up range of 4 to 148.8 months. The overall RTP rate ranged from 62.7% to 100.0%, and 50.0% to 100.0% returned to the same level of play. Among collision athletes, the overall rate of RTP was 80.0% to 100.0%, with 69.2%-100.0% returning to the same level of play. In overhead athletes, the overall rate of RTP was 85.2% to 100.0%, with 55.6% to 100.0% returning to the same level of play. Four studies (128 patients) specifically addressed the timing of RTP, and the range to RTP was 4.3 to 8.6 months. Specific RTP criteria were reported in a majority of studies (60%), with the most reported item being restoration of strength (44%). Conclusion: There is a high rate of return to sport after arthroscopic posterior shoulder stabilization, ranging from 4.3 to 8.6 months after surgery. Return to preinjury level is higher for collision athletes compared with overhead athletes. However, there is inadequate reporting of RTP criteria in the current literature, with no clear timeline for when it is safe to return to sport. Level of Evidence: IV, systematic review of level II to IV studies

Purpose: To evaluate the clinical outcomes and rate of return to play (RTP) in patients who underwent arthroscopic Bankart repair and open subpectoral biceps tenodesis. Methods: A retrospective review of patients who underwent combined arthroscopic Bankart repair and open subpectoral biceps tenodesis by a single surgeon between 2012 and 2016 was performed. RTP, the level of return, and the timing of return were assessed. Visual analog scale for pain, Rowe score, Shoulder Instability-Return to Sport after Injury score, and Subjective Shoulder Value were evaluated. Results: The study included 14 patients, with a mean follow-up of 34.2 ± 12.1 months. Of the 14 patients, 13 (92.9%) returned to sport at a mean of 4.8 ± 1.2 months and 9 (64.3%) returned to the same or higher level of sport. At final follow-up, the mean Rowe was 80.0 ± 16.3, the mean Subjective Shoulder Value was 81.0 ± 15.1, the mean Shoulder Instability-Return to Sport after Injury was 57.3 ± 25.6, and the mean visual analog scale score was 2.6 ± 1.5. One patient had a recurrent dislocation, whereas no patients underwent a further operation on the ipsilateral shoulder. Conclusion: Patients undergoing arthroscopic Bankart repair combined with open subpectoral biceps tenodesis had a high rate of RTP with a low rate of recurrent instability. Level of Evidence: IV, Therapeutic Case Series.

Purpose: To systematically review the comparative studies in the literature to compare joint stability, clinical outcomes, and complications of acromioclavicular joint fixation using a hook plate versus arthroscopic suture-button (SB) fixation. Methods: A literature search was performed in accordance with the PRISMA guidelines to identify clinical studies comparing the hook plate and arthroscopic SB techniques for acromioclavicular joint injuries. Qualitative statistical analysis was performed using SPSS, and a P value of ≤.05 was considered to be statistically significant. Results: Six clinical studies including 285 patients were included in the systematic review. In 3 of the studies, there was a significant difference in favor of SB for Constant score. Patients treated with the SB technique had a lower visual analog scale score at final follow-up in 2 of the 4 studies that measured this outcome. In addition, there were no significant difference in the rate of complications, revisions, or joint malreduction in any of the included studies. Conclusions: The arthroscopic SB procedure resulted in lower postoperative pain scores, and improved postoperative functional outcomes, although this was not a clinically significant difference. In addition, there were no significant differences in the rate of complications, revisions, or joint malreduction. Level of Evidence: Level III, systematic review of Level I, II, and III studies.

Category: Midfoot/Forefoot; Basic Sciences/Biologics Introduction/Purpose: A polyvinyl alcohol hydrogel implant (Cartiva Synthetic Cartilage Implant) has recently been developed, which has a water content comparable to healthy cartilage and a compressive modulus and tensile strength similar to human articular cartilage. These biomechanical features have been thought to be an ideal material for use in hemiarthroplasty of the first MTP joint. The purpose of this study is to evaluate the clinical, functional and radiological outcomes following a polyvinyl alcohol hydrogel implant for the treatment of hallux rigidus. Methods: A retrospective cohort study investigating patients treated with polyvinyl alcohol hydrogel implant for hallux rigidus was performed. Patients who had grade 2, 3 or 4 hallux rigidus based on Coughlin classification were indicated. Clinical outcomes were evaluated with the Foot and Ankle Outcomes Score (FAOS) and Visual Analog Score (VAS) preoperatively and at final follow-up. Plain radiographs were assessed postoperatively at 2, 4, 8 weeks and final follow-up. Results: Fifteen patients (15 feet) with mean follow-up of 19.0 months (12-26 months) were included. The mean age was 61.1 years. FAOS-reported symptoms, pain, daily activities, sports activities, and quality of life were 62.3, 69.8, 74.5, 49.7, and 36,3 post-operatively, respectively. Of 14 patients who had taken adequate postoperative plain radiographs, implant subsidence was observed in 9 patients (64%) at 4 weeks after surgery and 11 patients (79%) at final follow-up. . Eight patients (57%) showed radiologic lucency around the implant. Six patients (40%) had erosion of the proximal phalanx of great toe. Six patients(43%) reported no improvement following surgery at final follow up. Three patients required additional surgery, including debridement and fixation of implant using fibrin glue for loosening. Conclusion: Our current study revealed a high failure rate with the polyvinyl alcohol hydrogel implant in patients with Hallux Rigidus. Significant radiologic subsidence with lysis around the implant, erosion of the proximal phalynx countersurface as well as recorded implant wear are harbingers for concern in the long term.

Category: Ankle; Sports; Trauma Introduction/Purpose: Osteochondral lesions of the talus (OLTs) account for the majority of osteochondral lesions (OCLs) of the tibiotalar joint, with osteochondral lesions of the tibial plafond (OLTP) being less commonly reported. The purpose of this systematic review was to evaluate the topographical characteristics of OLTPs, and outcomes following surgical intervention. Methods: A systematic review 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. Studies reporting clinical data for OLTPs were included. The level and quality of evidence of the included studies was evaluated using the Modified Coleman Methodology Score. Results: Nineteen studies with 395 OLTPs were included. Overall, 75.9% of OLTPs were associated with a traumatic history and/or previous ankle sprain. OLTPs were most commonly located in the centromedial region of the tibial plafond (30.4%), with the fewest number of OLTPs found in the anterolateral region of the tibial plafond (3.9%). In total, 46.9% of OLTPs were associated with co-existing osteochondral lesions of the talus. Microfracture was the most frequently utilised surgical technique amongst the included studies, and reported good clinical outcomes at mid-term follow up. Four studies were level of evidence II and 15 studies were level of evidence IV. Conclusion: This systematic review has found that osteochondral lesions of the tibial plafond are not a rare clinical finding in the setting of ankle trauma and are often associated with co-existing osteochondral lesions of the talus. Clinical outcomes following arthroscopic intervention appear to produce good results in the mid-term, but the low level of evidence, poor quality of evidence, marked heterogeneity and underreporting of the data confounds any recommendation based on this systematic review.

Category: Ankle; Arthroscopy; Sports Introduction/Purpose: Microfracture (Mfx) is typically indicated for patients who have symptomatic osteochondral lesions of the talus (OLT) which are smaller in size. However, there is scant literature focusing exclusively on female patients, who may require specific consideration as compared to male counterparts. The purpose of this study was to evaluate the outcomes of Mfx in the treatment of OLT in the females population. Methods: A retrospective analysis comparing patients treated with Mfx for OLT was performed, to include all patients treated between 2007 and 2015. Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS) and Short-Form 12 (SF-12). Magnetic resonance imaging (MRI) at final follow-up was evaluated with the modified magnetic resonance observation of cartilage repair tissue (MOCART) score. Results: Thirty-one females were included. The mean patient age was 39.6 +- 17.2 years with mean follow-up of 48.4 +- 24.8 months. The mean preoperative and postoperative FAOS score was 53.3 +- 22.9 and 73.2 +- 18.2 (p < 0.001), and the mean preoperative and postoperative SF-12 score was 40.6 +- 11.1 and 56 +- 15.1 (p < 0.001). The final MOCART score was 59.3 +-24.5. Overall, 6 (19.4%) patients required a further surgery, 4 patients (12.9%) were considered failures, 2 (6.5%) patients required a distraction arthroplasty and 2 patients (6.5%) required a repeat bone marrow stimulation. Conclusion: The outcomes following Mfx for OLT in females were good at mid term follow up. However, the final MOCART scores were poor, indicating poor cartilage repair tissue and a poor harbinger for long term outcomes.

Category: Ankle; Sports Introduction/Purpose: Anatomical reconstruction has gained increased attention in recent years and is indicated for patients with poor-quality ligaments, previously failed lateral ligament repair, generalized ligamentous laxity, or in patients with a high BMI. The purpose of this systematic review was to evaluate the current literature on anatomical reconstruction of the lateral ligaments in the treatment of chronic ankle instability. Methods: A systematic search of Pubmed, EMBASE and Cochrane Library databases was performed during October 2019. The studies included were carefully evaluated with regard to level of evidence (LOE) and quality of evidence (QOE), clinical and radiological outcomes, complications, revision rates and return to sport. Results: Thirteen studies including a total of 296 ankles were included; 92% of studies were LOE III or IV and the QOE in all studies was of poor or fair quality. Within the autograft group, the AOFAS improved from 66.9 to 95.9, KPSSAF scores improved from 48 to 92.2, VAS scores improved from 6.8 to 0.2 at a follow up of 33.5 months, and the complication rate was 7.7%. Within the allograft group the AOFAS improved from 53.7 to 89.3, KPSSAF scores improved from 42.8 to 90.4, VAS scores improved from 7.3 to 1.9, and the complication rate was 7%. The overall rate of return to sport was 89%. Conclusion: The current systematic review demonstrated favorable results for both autograft and allograft reconstruction techniques in the treatment of chronic ankle instability. On comparing autograft and allograft techniques, minor differences were found both clinically and radiologically, with no overall evidence supporting one technique over the other

Category: Sports Introduction/Purpose: Extracorporeal shock wave therapy (ESWT) may be a viable non-invasive treatment modality for patients suffering from Achilles Tendinopathy. There seems to be a relationship between the ESWT protocol and patient outcomes. Data suggest that higher energy levels of shock waves together with adequate treatment delivery to the affected area is necessary to achieve favorable outcomes. The aim of this study is present our experience with the use of electrohydraulically produced unfocused extracorporeal shock waves for the treatment of Achilles Tendinopathy. Methods: A retrospective analysis of prospectively collected data was performed, including all patients who had received ESWT for plantar fasciitis heel pain between January 2013 and September 2018. The primary outcomes included change in pain intensity on the visual analog pain scale and patient satisfaction at final follow-up. Pre and post-procedure Foot and Ankle Outcome Scores were also assessed for change. Results: A total of 158 patients (179 heels) were followed-up for a mean duration of 17 +- 6.8 months post ESWT. The mean pre-ESWT pain VAS improved from 7.2 +- 1.4 to 2.3 +- 2.1 (p< 0.001) at final follow-up. The FAOS Symptoms, Pain, Function of Daily Living, Function of Sports and Recreational activities and Quality of Life domains improved from 57.7 +- 12.7 to 79.7 +- 13.6 (p< 0.001), from 35 +- 15.8 to 72.6 +- 22 (p< 0.001), from 43.8 +- 15.3 to 81.4 +- 11 (p< 0.001), from 41.2 +- 21.3 to 66.4 +- 18.3 (p< 0.001) and from 33.9 +- 17.4 to 78 +- 24.4 (p< 0.001), respectively. Overall, 85.4% were satisfied with the procedure at final follow-up. Conclusion: For patients with Achilles tendinopathy, unfocussed extracorporeal shock wave therapy appears to be a safe and viable non-invasive treatment option with a patient satisfaction rate of 85.4% and a 68% reduction in patient reported pain intensity.

Category: Ankle; Trauma Introduction/Purpose: It is controversial whether routine arthroscopy is beneficial at the time of ankle fracture fixation. This may be, in part, due to sparse information regarding the incidence of chondral injury in the setting of ankle fractures.The purpose of this study is to systematically review the incidence of chondral injures in patients with ankle fractures and to further characterize intra-articular chondral injuries of the talus, tibial plafond, medial malleolus, and lateral malleolus in patients who undergo ankle arthroscopy following an ankle fracture. Methods: The literature search was performed based on the PRISMA guidelines. Studies evaluating the incidence of chondral lesions at the time of arthroscopy for ankle fractures were included. The incidence of intraarticular chondral lesions was recorded, as well as location within the ankle, ankle fracture type, time of arthroscopy, characterization of chondral injury, complications, and outcome if available. All statistical analyses were carried out with statistical software package SPSS 24.0 (SPSS, Chicago, IL, USA). Multiple comparisons were used to compare incidence rates of chondral injury based on Weber classification, malleolar fracture type, and Lauge-Hansen classification, using Pearson chi-square test. For all analyses, p < 0.05 was considered statistically significant. Results: Fifteen studies with 1,355 ankle fractures were included. Of those ankles, 738 demonstrated evidence of chondral or osteochondral lesion (54.5%). Overall, 648 ankles had chondral lesions on the talus (47.8%), 207 ankles had lesions on the tibial plafond (15.3%), 165 has lesions of the lateral malleolus (12.2%), and 133 had lesions of the medial malleolus (9.8%). Weber C group had significantly higher incidence than Weber A group (p=0.015). Trimalleolar and isolated lateral malleolar fracture groups had significantly higher incidence of chondral injury than bimalleolar and isolated medial malleolar fracture groups (p

Purpose: To evaluate the rate of return to sport following arthroscopic repair of 270° labral tears. Methods: We performed a retrospective review of patients with 270° labral tears treated arthroscopically between 2013 and 2017 by a single surgeon. Patients were followed-up to assess whether they were able to return to sport, the level to which they returned and the timing of return. Complications, the Visual Analogue Scale for pain (VAS), the Rowe score, the Shoulder Instability-Return to Sport after Injury (SIRSI) score, and the Subjective Shoulder Value (SSV) were recorded. Results: The study included 25 patients, with a mean follow-up of 42.2 ± 16.5 months. Of the 25 patients, 19 (76.0%) returned to sport at a mean of 6.8 ± 2.6 months, while 15 (60%) returned at the same or a higher level. At final follow-up, the mean Rowe score was 80.6 ± 14.2; the mean SIRSI score was 61.8 ± 25.4; the mean SSV was 86.4 ± 15.2; and the mean VAS score was 2.2 ± 2.0. One patient reported recurrent subluxation, but no patients suffered a recurrent dislocation during the study period. No revision surgeries were performed within the study period. Conclusion: Patients with 270° labral tears who were treated with arthroscopic repair showed an overall high rate of return to sport. Despite a low rate of recurring instability, not all patients were able to return to their previous levels of sports. Level of evidence: Level IV, therapeutic case series.