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Multiple open and endoscopic techniques have been described for recalcitrant cases of plantar fasciitis. Compared with open techniques, endoscopic plantar fasciotomy has been shown to be safe and effective with decreased postoperative pain and quicker recovery, as well as decreased risk of soft tissue and neurovascular injury, while retaining the ability to provide direct visualization of the plantar fascia to facilitate proper release. Single-portal endoscopic techniques may offer additional advantages including less portal site and postoperative pain, earlier return to activities, and cost-effectiveness and higher patient satisfaction when performed in the office setting. This Technical Note describes the authors’ technique for nanoscopic plantar fasciotomy using a single-portal needle arthroscopy system, as well as advantages and limitations of this technique.

Irrigated agriculture is the dominant user of water globally, but most water withdrawals are not monitored or reported. As a result, it is largely unknown when, where, and how much water is used for irrigation. Here, we evaluated the ability of remotely sensed evapotranspiration (ET) data, integrated with other datasets, to calculate irrigation water withdrawals and applications in an intensively irrigated portion of the United States. We compared irrigation calculations based on an ensemble of satellite-driven ET models from OpenET with reported groundwater withdrawals from hundreds of farmer irrigation application records and a statewide flowmeter database at three spatial scales (field, water right group, and management area). At the field scale, we found that ET-based calculations of irrigation agreed best with reported irrigation when the OpenET ensemble mean was aggregated to the growing season timescale (bias = 1.6–4.9 %, R2 = 0.53–0.74), and agreement between calculated and reported irrigation was better for multi-year averages than for individual years. At the water right group scale, linking pumping wells to specific irrigated fields was the primary source of uncertainty. At the management area scale, calculated irrigation exhibited similar temporal patterns as flowmeter data but tended to be positively biased with more interannual variability. Disagreement between calculated and reported irrigation was strongly correlated with annual precipitation, and calculated and reported irrigation agreed more closely after statistically adjusting for annual precipitation. The selection of an ET model was also an important consideration, as variability across ET models was larger than the potential impacts of conservation measures employed in the region. From these results, we suggest key practices for working with ET-based irrigation data that include accurately accounting for changes in soil moisture, deep percolation, and runoff; careful verification of irrigated area and well-field linkages; and conducting application-specific evaluations of uncertainty.

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

Purpose: To assess outcomes following Achilles in-office needle tendoscopy (IONT) for the treatment of chronic Achilles tendinopathy (cAT) at a minimum 12-month follow-up. Methods: A retrospective case series was conducted to evaluate patients who underwent Achilles IONT for cAT between January 2019 and December 2022. Inclusion criteria were patients ≥18 years of age and clinical history, physical history, and magnetic resonance imaging findings consistent with cAT who did not respond to a minimum of 3 months of conservative management for which each patient underwent Achilles IONT and had a minimum 12-month follow-up. Clinical outcomes were evaluated using the Victorian Institute of Sport Assessment–Achilles and visual analog scale scores. Patient satisfaction was measured at the final follow-up visit with a 5-point Likert scale. Results: Twelve patients (13 Achilles) with a mean age of 50.9 ± 14.6 years were included in the study. The mean follow-up time was 26.3 ± 6.3 months. The mean Victorian Institute of Sport Assessment–Achilles scores improved from a preoperative score of 35.6 ± 5.9 to a postoperative score of 83.6 ± 14.1 (P < .001). The mean visual analog scale score improved from a preoperative score of 6.6 ± 1.0 to a postoperative score of 1.3 ± 1.7 (P < .001). There were 10 patients (83.3%) who participated in sports activities before the IONT procedure. Within this group, 9 patients (90.0%) returned to play at a mean time of 5.9 ± 2.6 weeks. The mean time to return to work was 4.2 ± 1.2 days. Patients reported an overall positive IONT experience with a mean rating scale of 4.5 ± 0.9. Conclusions: This retrospective review demonstrated that Achilles IONT for the treatment of cAT results in significant improvements in subjective clinical outcomes and a low complication rate together with high patient satisfaction scores at short-term follow-up. Level of Evidence: Level IV, therapeutic case series.

Introduction/Purpose: The purpose of this systematic review was to evaluate the clinical and radiographic outcomes in patients who received extracellular matrix cartilage allograft (EMCA) during surgical intervention for osteochondral lesions of the talus (OLT). Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies evaluating outcomes in patients who received EMCA during surgical intervention for osteochondral lesions of the talus. Data regarding lesion characteristics, surgical characteristics, subjective clinical outcomes, radiographic outcomes, complication rates, failure rates and secondary surgical procedure rates were extracted and analysed. In total, 5 clinical studies were included in this review. Results: In total, 162 patients received EMCA during surgical intervention for OLT at a weighted mean follow-up of 23.8 ± 4.2 months. The weighted mean lesion area was 77.9 ± 42.6 mm 2 . Overall, 111 (68.5%) of OLTs were located medially, 45 (27.8%) of OLTs were located laterally and 6 (3.7%) OLTs were located centrally. Four studies performed arthroscopic debridement and bone marrow stimulation with ECMA, 3 studies utilized concentrated bone marrow aspirate and 1 study performed autologous osteochondral transplantation. Improvements were noted in AOFAS, FAOS and VAS scores following surgical intervention. The weighted mean post-operative MOCART score was 76.3 ± 2.9. In total, 17 (10.5%) complications were reported across the 5 studies. Twelve failures (7.4%) were recorded, all of which required further surgical intervention. Conclusion: This systematic review demonstrated improvements in subjective clinical outcomes and radiological outcomes at short-term follow-up following surgical intervention for OLTs augmented with ECMA. A low failure rate and moderate complication rate was noted. However, there was marked heterogeneity between the included studies with regards to surgical technique utilized, lesion size and patient cohort size. Further research is warranted to determine the optimal role of ECMA in the management of OLT.

Category: Ankle Arthritis Introduction/Purpose: End-stage ankle osteoarthritis is a debilitating pathology and is most commonly preceded by trauma. Surgical intervention via ankle arthrodesis or ankle arthroplasty is the mainstay management option. Heterotopic ossification (HO) is a common finding following joint arthroplasty. However, no consensus regarding the impact of heterotopic ossification on clinical outcomes following total ankle arthroplasty has been reached to date. The purpose of this systematic review and meta- analysis was to evaluate the prevalence and clinical outcomes of heterotopic ossification following total ankle arthroplasty. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies reporting heterotopic ossification following TAA. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, failure rates and complications were extracted and analysed. Results: Twenty-seven studies with 2639 patients (2695 ankles) at a weighed mean follow-up time of 52.8 ± 26.9 months were included. The pooled prevalence rate was 45% (0.25; 0.66). The implant with the highest rate of HO was the INBONE I (100%) and BOX (100%) implants. The most common modified Brooker staging was grade 1 (120 patients, 33.9%). Random effects models of standardized mean differences found no difference in AOFAS, VAS and ROM between patients with HO and patients without HO. Random effects models of correlation coefficients found no correlation between AOFAS, VAS and ROM and the presence of HO. The surgical intervention rate for symptomatic HO was 10.5%. Conclusion: This systematic review and meta-analysis found that HO is a common finding following TAA that is not associated with inferior clinical outcomes. Surgical intervention was required only for moderate-severe, symptomatic HO following TAA. This study is limited by the significant heterogeneity and low level and quality of evidence of the included studies. Further higher quality studies are warranted to determine the precise prevalence and impact of HO on outcomes following TAA.

Category: Other Introduction/Purpose: The purpose of this study was to utilize finite element analysis to evaluate progressive bone removal from the calcaneus at various angles and its effect on the mechanical stress distribution at the calcaneus, and potential increase in fracture risk. Methods: A calcaneus CT scan was imported into Autodesk Fusion360 (Autodesk, v.2.0.14569). After rendering the initial mesh body using tetrahedral elements, a copy of the calcaneus was made. A simulated force equal to the average weight of person (876N) was applied to the middle and posterior talus facets while the calcaneus was oriented in the heel strike position during gait, with constraints applied around the heel. The initial harvest site was modelled as a 6mm diameter 30mm deep cylinder. From this center point, the diameter of the harvest site was increased to 8, and 10mm, with the depth being adjusted such that there was no risk of breaching the cortex on the opposite side. For each iteration, the safety factor, stress (MPa), and strain were recorded. This was repeated at an angle of 90°, 45° and a combination of 45° and 90°. Results: The 90° model demonstrated that as the diameter of the harvest site increased, there was a reciprocal increase in stress across the calcaneus. The number of cycles to failure (fracture) for all diameters was 10^6-10^7. The 45° model demonstrated that as the diameter of the harvest site increased, there was a reciprocal increase in stress applied across the calcaneus with a corresponding decrease in stress at the harvest site. The number of cycles to failure increased from 10^3 at 6mm to 10^4-10^5 at 10mm. The combination of the 45°-90° model demonstrated that as the diameter of the harvest site increased, there was a reciprocal increase in stress applied across the calcaneus. The cycles to failures decreased as the diameter of the harvest site increased. Conclusion: This finite element analysis demonstrated that an increase in the diameter of the harvest site led to an increase in stress along the calcaneus. There was variation in the correlation between size of the diameter and the number of cycles to failure depending on the angle of the harvest. The greatest amount of stress applied at the calcaneus was with the 45°-90° model. It was determined that harvesting at an angle of 45° at 6mm produced the lowest number of cycles to failure.

Category: Lesser Toes; Other Introduction/Purpose: The purpose of this systematic review was to compare the clinical and radiological outcomes between K- Wire fixation and implant device fixation for the management of hammertoe deformity. Methods: During November 2022, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following either K-Wire fixation and implant device fixation for the treatment of hammertoe deformity at a minimum of 1-year follow-up. Data regarding surgical characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. 19 studies were included for quantitative analysis, of which 4 studies were included for qualitative analysis. Results: In total, 1343 patients (3468 feet) underwent K-Wire fixation and 456 patients (664 feet) underwent implant device fixation for the management of hammertoe deformity.The osseous union rate in the K-wire cohort was 71.3% versus 74.8% in the implant device cohort. The complication rate in the K-wire cohort was 9.7% versus 29.3% in the implant device cohort. The failure rate in the K-wire cohort was 8.6% versus 6.5% in the implant cohort. The secondary surgical procedure rate in the K-wire cohort was 8.3% versus 3.6% in the device cohort. Qualitative analysis found no difference in osseous union rates (RR=0.5832; 0.0830-4.0985; p=0.3562), complication rates (RR=1.12; 0.11-11.34; p=0.8571), failure rates (RR=0.87; 0.04-21.86; p=0.8746) nor secondary surgical procedure rates (RR=1.05; 0.06-18.32; p=0.9487) between the K-wire cohort and device cohort. Conclusion: This systematic review and meta-analysis demonstrated improvement in clinical and radiographic outcomes following both K-wire fixation and implant device fixation for hammertoe deformity. Qualitative analysis found no significant difference in osseous union rates, complication rates, failure rates nor secondary surgical procedure rates between the 2 cohorts. However, the marked heterogeneity between the included studies and few high level comparative studies limits the generation of any robust conclusions. Further research is warranted to determine the optimal role of both K-wire fixation and implant device fixation in the management of hammertoe deformity.

Category: Ankle Arthritis; Other Introduction/Purpose: The purpose of this systematic review and meta-analysis was to evaluate potential predictors of failure following total ankle arthroplasty (TAA) for the management of end stage ankle arthritis. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to evaluate potential predictors of failure following total ankle arthroplasty for the management of end stage ankle arthritis. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, odds ratios, hazard ratios, correlation coefficients, failure rates and complications were extracted and analysed. Results: In total, 15117 patients (15198 ankles) underwent TAA at a weighted mean follow-up of 64.0 ± 21.8 months. Pooled Odds ratio found that diabetes was a statistically significant predictor of failures following TAA (OR: 2.1; [1.9861, 2.2284], p = 0.003). Other variables such as age, gender, body mass index, implant type and arthritis aetiology were not associated with failure. Conclusion: This systematic review and meta-analysis found that the presence of diabetes mellitus was a statistically significant predictor of failure following TAA. However, there was marked heterogeneity between the included studies with regards to statistical data collection which significantly limits the robustness of the conclusions of this study. Thus, further higher quality research with more consistent data collection is warranted to identify potential predictors of failure post TAA.

Category: Ankle Arthritis; Other Introduction/Purpose: End stage ankle osteoarthritis is a significantly debilitating pathology that is most commonly preceded by trauma. The emergence of 3rd and 4th generation total ankle arthroplasty (TAA) implant designs have led to more favorable outcomes compared to its predecessors. TAA implants can be broadly divided into fixed bearing and mobile bearing implant designs, however, no consensus has been reached regarding the optimal TAA implant design for the management of end stage ankle arthritis. The purpose of this systematic review and meta-analysis was to compare outcomes between patients who received fixed bearing TAA implants and mobile bearing TAA implants. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies comparing outcomes between patients who underwent fixed bearing TAA implant and patients who underwent mobile bearing TAA implant for the management of end stage ankle arthritis. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, failure rates and complications were extracted and analysed. Results: Overall, 13 studies were included in this review. In total, 2793 patients underwent mobile bearing TAA implant and 2241 patients underwent fixed bearing TAA implant for the management of end stage ankle arthritis. No difference existed between the 2 cohorts with regards to post-operative subjective clinical outcome scores nor radiological outcomes. The mobile bearing TAA implant cohort was associated with higher complications (RR = 1.4710; [1.0375-2.0857]; p = 0.0373) and failures (RR = 1.3916; [1.2038 - 1.6086]; p = 0.0032) compared to the fixed bearing TAA implant cohort. Conclusion: This systematic review and meta-analysis found no difference in subjective clinical outcomes and radiological outcomes between patients who underwent mobile bearing TAA implant and fixed bearing TAA implant for the management of ankle arthritis. Interestingly, the mobile bearing TAA implant cohort was associated with higher complications and failures compared to the fixed bearing TAA implant cohort. Due to the marked under-reporting of data and significant heterogeneity between the included studies, further high quality research is warranted to determine the optimal TAA implant type for the management of end stage ankle arthritis.

Category: Lesser Toes; Other Introduction/Purpose: The purpose of this systematic review was to evaluate the clinical and radiological outcomes together with the complication rates and failure rates following surgical intervention for Freiberg's Infraction. Methods: During December 2022, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following surgical intervention for the management of Freiberg's Infraction. Data regarding study characteristics, patient demographics, lesion characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. In addition, the level of evidence and quality of evidence for each individual study was also assessed. Results: Eighteen studies were included. In total, 299 patients (302 feet) underwent surgical intervention for the management of Freiberg's Infraction at a weighted mean follow-up of 49.9±45.1 months. The distribution of patients by Smillie's (SI-V) classification was recorded in as follows: SI (0 patients), SII (20 patients), SIII (42 patients), SIV (69 patients), SV (54 patients). The most common surgical procedure was dorsal closing wedge metatarsal osteotomy. The weighted mean AOFAS score improved from a pre-operative score of 60.3±9.0 to a post-operative score of 84.3±24. The weighted mean total ROM improved from 46.4±11.7° pre-operatively to 66.2±15.1° post-operatively. The weighted mean time to osseous union was 7.4±3.6. The complication rate was 5.2%, the most common of which was pain. Four failures (1.6%) were observed. Conclusion: This systematic review found improvements in subjective and objective clinical outcomes together with a low complication rate following surgical intervention for Freiberg's infraction at mid-term follow-up. However, the level and quality of evidence of the included studies were low and there was marked heterogeneity and under-reporting of data between the included studies. Although surgical intervention appears to is the mainstay treatment option for Freiberg's infraction, further higher quality comparative studies are warranted to determine the optimal surgical technique for Freiberg's infraction.

Category: Midfoot/Forefoot; Other Introduction/Purpose: The purpose of this systematic review and meta-analysis is to compare outcomes between patients who underwent open chevron osteotomy (OCO) and minimally invasive Chevron osteotomy (MICA) for the management of hallux valgus deformity. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies comparing outcomes between patients who underwent open chevron osteotomy (OCO) and minimally invasive Chevron osteotomy (MICO) for the management of hallux valgus deformity. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, failure rates and complications were extracted and analysed. In total, 6 comparative studies were included in this review. Results: In total, 183 patients (208 feet) underwent OCO and 209 patients (244 feet) MICA for the management of hallux valgus deformity. Meta-analysis demonstrated no difference in post-operative MOFXQ scores (SMD: 0.0849, [-0.2584, 0.4282], p = 0.6277), hallux valgus angle (SMD: -0.1245, [-0.4204, 0.1715], p = 0.4099), intermetatarsal angle (SMD:-0.2565, [-0.5539, 0.0408], p = 0.909) and failures (RR: 1.0765, [0.0993, 11.6760], p = 0.9278) between the OCO cohort and the MICO cohort. There was a lower complication rate in the OCO cohort compared to the MICO cohort (RR: 0.2614, [0.1453, 0.4704], p < 0.0001). Conclusion: This systematic review found comparable improvements in subjective clinical outcomes, functional outcomes and radiographic outcomes following both OCO and MICO at short-term follow-up. However, a lower RR with respect to complications was found in the OCO cohort compared to the MICO cohort. Despite the significant heterogeneity across the included studies, the similar outcomes between the 2 cohorts reinforces that further research is warranted to determine the optimal role of OCO and MICO in the management of hallux valgus deformity.

Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: The purpose of this systematic review was to evaluate the clinical outcomes, complication rates and failure rates at short-term follow-up following hyaluronic acid (HA) injection for the management of various soft tissue foot and ankle pathologies. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following HA injection for the management of various soft tissue foot and ankle pathologies. Data regarding study characteristics, patient demographics, pathological characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. In addition, the level of evidence and quality of evidence for each individual study was also assessed. Results: Studies examining outcomes following HA injection included the following pathologies: Achilles tendinopathy (AT) (6 studies, 126 patients, weighted mean follow-up of 2.9 months), plantar fasciitis (PF) (2 studies, 54 patients, 4.3), lateral ankle sprains (LAS) (2 studies, 119 patients, follow-up of 11.4 months) and Morton's neuroma (MN) (1 study, 83 patients, follow-up of 12 months). Seven different HA formulations were utilised across 10 studies. Weighted mean pain and functional scores improved significantly in all 4 cohorts. The complication rates for the AT cohort, PF cohort, LAS cohort and MN include: 3.2%, 1.9%, 2.5% and 20.5%, respectively. The failure rates for the AT cohort, PF cohort, LAS cohort and MN include: 1.6%, 0%, 0% and 0%, respectively. Conclusion: This systematic review demonstrated improvements in subjective clinical outcomes together with low complication and failure rates following HA injections for various soft tissue foot and ankle pathologies at short term follow-up. However, the heterogeneity between the studies, low number of high quality studies and short-term follow-up limits the generation of any robust conclusions. Further research is warranted to assess the optimal role of HA in the management of foot and ankle soft tissue pathologies.

Category: Midfoot/Forefoot; Other Introduction/Purpose: The purpose of this systematic review was to evaluate the clinical and radiological outcomes together with the complication rates and failure rates following surgical intervention for hallux varus deformity. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following surgical intervention for hallux varus deformity. Data regarding study characteristics, patient demographics, osteoarthritis severity, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. In addition, the level of evidence and quality of evidence for each individual study was also assessed. Results: Twelve studies were included. In total, 168 patients (186 feet) underwent surgical intervention for hallux varus deformity. at a weighted mean follow-up of 49.6±36.6 months. The weighted mean AOFAS score improved from a pre-operative score of 60.5±18.4 to a post-operative score of 83.9±9.0. The weighted mean hallux valgus angle improved from a pre-operative angle of 16.9±6.5° of varus to a post-operative angle of 5.9±6.6° of valgus. The weighted mean inter-metatarsal angle improved from a pre- operative angle of 12.7±10.0° to a post-operative angle of 7.7±3.4°. The complication rate was 21.5%, the most common of which was 1st MTPJ joint pain and stiffness. Eleven failures (5.9%) were observed at a mean time of 25.0 months following the index procedure. Conclusion: This systematic review demonstrated improvements in subjective clinical outcomes together with a low failure rate following surgical intervention for hallux varus deformity at mid-term follow-up. A high complication rate was recorded. However, the marked heterogeneity between included studies and paucity of high quality comparative studies limits the generation of any robust conclusions. Further research with a longer follow-up is warranted to determine the optimal surgical technique for hallux varus deformity correction.

Category: Other; Ankle Introduction/Purpose: The purpose of this systematic review was to evaluate the clinical and radiological outcomes at short-term follow-up following peroneal tendoscopy for the treatment of peroneal tendon disorders. Methods: During October 2022, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following peroneal tendoscopy for the treatment of peroneal tendon disorders. Data regarding patient demographics, pathological characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. Results: Nine studies were included. In total, 264 patients (269 tendons) underwent peroneal tendoscopy for the treatment of peroneal tendon disorders at a weighted mean follow-up of 30.5±11.4 months. The peroneal tendon disorders included: peroneal tendon tear (89 patients), peroneal tenosynovitis (85 patients), low lying muscle belly (54 patients) and peroneal tendon subluxation (17 patients). The weighted mean AOFAS score improved from a pre-operative score of 76.0 to a weighted mean post-operative score of 96.0. The complication rate was 3.8%, the most common of which was persistent lateral ankle pain (1.1%). Two failures (0.007%) were reported, both of which underwent repeat peroneal tendoscopy, tenosynovectomy and low lying muscle belly resection. Conclusion: This systematic review demonstrated improvement in subjective clinical outcomes together with a low complication rate and low failure rate at short-term follow-up following peroneal tendoscopy for the treatment of peroneal tendon disorders. However, the level of evidence was low and the quality of evidence was poor. In addition, there was significant heterogeneity between the included studies. Further higher quality studies are warranted to determine the optimal role of peroneal tendoscopy for the management of peroneal tendon disorders.

Category: Midfoot/Forefoot; Other Introduction/Purpose: The purpose of this systematic review was to evaluate outcomes following polyvinyl alcohol hydrogel implant for the management of hallux rigidus. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies evaluating outcomes in patients who underwent polyvinyl alcohol hydrogel implant for the management of hallux rigidus. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, failure rates and complications were extracted and analysed. In total, 15 studies were included in this review. Results: In total, 1536 patients (1578 feet) underwent polyvinyl alcohol hydrogel implant for the management of hallux rigidus at a weighted mean follow-up of 39.4 ± 17.3 months. The weighted mean VAS score improved from a pre-operative score of 6.2 ± 1.3 to a post-operative score of 3.0 ± 1.6. There was limited data regarding improvements in range of motion. The complication rate was 15.7% and the failure rate was 9%. Conclusion: This systematic review demonstrated improvement in subjective clinical outcomes following PVA hydrogel implant for the management of hallux rigidus. A moderate complication rate and failure rate was noted at short term follow-up. Further studies with longer follow-up periods are warranted to elucidate the precise outcomes following PVA hydrogel implant for the management of hallux rigidus.

Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment modality that is utilized in the treatment of chronic Achilles tendinopathy (AT). The purpose of this study was to retrospectively assess outcomes following ESWT for both NAT and IAT at greater than 1-year follow-up, and to identify potential predictors of outcomes. Methods: Chart review was conducted to identify patients who underwent ESWT for AT with a minimum of 1-year follow-up. Data collected and assessed included: patient demographics, pathological characteristics, treatment characteristics, Victorian Institute of Sports Assessment-Achilles (VISA-A) and visual analog scale (VAS) scores and failures. Linear regression was performed to identify potential predictors of outcomes. Survival analysis was conducted using Kaplan Meier curves. Fifty-two cases of IAT and 34 cases of NAT were included. The mean follow-up in the NAT cohort was 22.3±10.2 months and the mean follow-up time in the IAT cohort was 26.8±15.8 months. Results: Improvements in VISA-A and VAS scores were observed in the NAT cohort at 6 months follow-up and at final follow-up (p < 0.01). Improvements in VISA-A scores and VAS scores were recorded in the IAT cohort at 6 months follow-up which subsequently deteriorated at final follow-up. In the NAT cohort, the failure rate at 6 months follow-up was 11.8% which increased to 29.4% at final follow-up. In the IAT cohort, the failure rate at 6 months follow-up was 32.7% which increased to 59.6% at final follow-up. Predictors of poor outcomes in the NAT cohort included pre-ESWT subjective clinical score, male, presence of cardiovascular risk factor, and increasing MRI severity. Predictors of poor outcomes in the IAT cohort included pre-ESWT subjective clinical score and increasing MRI severity. Conclusion: This study found that superior subjective clinical outcomes together with a lower failure rate maintained over 1 year in the NAT cohort compared to the IAT cohort. This may implicate ESWT as a temporising treatment in IAT and a longer term solution in patients with NAT.

Category: Midfoot/Forefoot; Other Introduction/Purpose: The purpose of this systematic review was to examine the clinical and radiological outcomes of various surgical treatments for symptomatic accessory naviculars. Methods: During February 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following surgical treatment for symptomatic accessory navicular. Data regarding surgical characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analyzed. 26 studies were included for review. Results: In total, 520 patients (614 feet) underwent surgical treatment for the management of symptomatic accessory navicular. The weighted mean age was 28.18 ± 8.18 and the weighted mean follow-up time was 46.23 ± 34.76 months. The mean AOFAS score was 49.9 ± 7.39 preoperatively and 88.9 ± 5.61 postoperatively. The mean complication rate at final follow-up was 9.02% and the failure rate was 4.23%, with only 2.7% of patient ultimately requiring a further procedure. We also compared outcomes in patient who underwent a Kidner or Modified Kidner procedure (n=245) with those treated with a different surgical technique such as fusion or simple excision (n=275). There was no significant difference in outcome scores, complication rates, failure rates, or secondary surgical procedure rates between these cohorts. Conclusion: This systematic review demonstrated improvement in clinical outcomes following surgical treatment for symptomatic accessory naviculars. The markedly low complication and failure rates further indicate that surgical intervention is beneficial in the management of symptomatic accessory naviculars. Kidner and Modified Kidner procedures resulted in equivocally good outcomes compared with other surgical approaches such as fusion and simple excision. However, the marked heterogeneity between the included studies and few high level comparative studies limits the generation of any robust conclusions for optimal surgical technique. Further research is warranted to determine whether the Kidner procedure confers any particular advantages over other approaches.

Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: The purpose of this systematic review was to evaluate the clinical and radiological outcomes together with the complication rates and failure rates at short-term follow-up following Particulated Juvenile Allograft Cartilage (PJAC) for the management of osteochondral lesions of the talus (OLT). Methods: During November 2022, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following PJAC for the management of OLTs. Data regarding study characteristics, patient demographics, lesion characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. In addition, the level of evidence and quality of evidence for each individual study was also assessed. Results: Twelve studies were included. In total, 241 patients underwent PJAC for the treatment of OLT at a weighted mean follow-up of 29.0±24.9 months. The weighted mean lesion size was 138.3±59.6 mm 2 and 69.4% of OLTs were located at the medial talar dome. Prior surgical intervention was recorded in 7 studies, the most common of which was microfracture (65.9%). Concentrated bone marrow aspirate was utilized in 66 patients (27.3%). The weighted mean AOFAS score improved from a pre- operative score of 58.5±3.2 to a post-operative score of 83.9±5.3. The weighted mean post-operative MOCART score was 48.2±3.3. The complication rate was 16.5%, the most common of which was graft hypertrophy (7.0%). Thirty failures (12.4%) were observed at a weighted mean time of 9.8±9.6 months following the index procedure. Conclusion: This systematic review demonstrated a moderate improvement in subjective clinical outcomes following PJAC for the treatment of OLT at short term follow-up. However, post-operative MOCART scores were reported as poor. In addition, a moderate complication rate (16.5%) and a moderate failure rate (12.4%) was observed, calling into question the efficacy of PJAC for the treatment of large OLTs. Further studies are warranted to identify the optimal role of PJAC in the management of OLTs.

Category: Ankle; Sports Introduction/Purpose: Chronic ankle instability occurs in 15-20% of patients with ankle sprains who do not recover following conservative management and typically requires surgical intervention. There is recent interest in Anterior Talofibular Ligament (ATFL) Repair techniques that may improve outcomes and expedite recovery. Evidence for the use of suture-tape as an internal in ATFL Repair is limited in the literature. The purpose of this study was to retrospectively assess outcomes and return to sport following ATFL Repair with and without suture-tape (ST) augmentation at greater than 1-year follow-up. Methods: Chart review was conducted to identify patients who underwent Anterior Talofibular Ligament (ATFL) Repair with a minimum of 1-year follow-up. Data collected and assessed included: patient demographics, pathological characteristics, treatment characteristics, Foot and Ankle Outcome Score (FAOS), visual analog scale (VAS) scores, return to sport (RTS), complications, and failures. Linear regression was performed to identify potential predictors of outcomes. Results: Eighteen cases of ATFL repair augmented with suture-tape (ST) and 20 cases of ATFL repair alone were included. The mean follow-up in the ST cohort was 20.8 ± 7.9 months and the mean follow-up time in the ATFL repair alone cohort was 25.3 ± 13.2 months. Improvements in FAOS and VAS scores were observed in both cohorts at final follow-up (p < 0.01). No statistically significant difference in FAOS and VAS scores at final follow up was found between the 2 cohorts. The mean time to RTS was 8.6 ± 3.3 weeks in the ST cohort and 13.3 ± 2.7 weeks in the ATFL repair alone cohort (p < 0.01). No statistically significant difference in complication rates nor failure rates was observed between the 2 cohorts. Conclusion: This retrospective study found that ATFL Repair with and without suture-tape augmentation produced comparable subjective clinical outcomes, complication rates and failure rates at short-term follow-up. A superior mean time to RTS was found in the ST cohort. The early results of this surgical technique are promising, but further studies with larger patient cohorts and longer follow-up times are needed to determine the optimal role of suture-tape augmentation of ATFL repair.

Category: Midfoot/Forefoot; Other Introduction/Purpose: The purpose of this systematic review was to evaluate outcomes following intra-articular 1st MTPJ hyaluronic acid injection for the management of hallux rigidus. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies evaluating outcomes in patients who underwent intra-articular 1st MTPJ hyaluronic acid injection for the management of hallux rigidus. Data regarding injection characteristics, subjective clinical outcomes, failure rates and complications were extracted and analysed. Results: In total, 5 studies were included in this review. In total, 209 patients underwent intra-articular 1st MTPJ hyaluronic acid injection for the management of hallux rigidus at a weighted mean follow-up of 4.4 ± 1.4 months. The weighted mean VAS improved from a pre-injection score of 6.4 ± 0.3 to a post-injection score of 2.8 ± 0.4. A 10.1% complication rate was noted, the most common of which was transient 1st MTPJ swelling. One infection (0.5%) was reported. A symptomatic recurrence rate of 18.6% was observed at a weighted mean time of 7.3 ± 4.2 months Conclusion: This systematic review demonstrated that intra-articular 1st MTPJ hyaluronic acid injection for the management of hallux rigidus led to a reduction in pain and a moderate complication rate at short-term follow-up. In addition, intra-articular 1st MTPJ hyaluronic acid injection for the management of hallux rigidus produced a symptomatic recurrence rate of 18.6% at approximately 7.3 months, suggesting that HA provides short-term relief. The lack of quality comparative studies limits the generation of robust conclusions, reinforcing the need for further research to identify the optimal role of HA in the management of hallux rigidus.

Category: Ankle Arthritis Introduction/Purpose: The purpose of this systematic review and meta-analysis was to compare the volume of blood loss, transfusion rates and complication rates between patients who were administered tranexamic acid (TXA) versus patients who were not administered TXA during total ankle arthroplasty (TAA). Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies comparing outcomes between patients who were administered TXA versus patients who were not administered TXA during TAA. Data regarding surgical characteristics, subjective clinical outcomes, total blood loss, intra-operative blood loss, total complications and wound complications rates were extracted and analysed. In total, 5 comparative clinical studies were included in this review. Results: 194 patients received TXA and 187 patients did not receive TXA during TAA. There was a statistically significant reduced volume of total blood loss in favor of patients who received TXA compared to patients who did not receive TXA during TAA (SMD:-0.7832; p< 0.0001). A statistically significant reduced volume of intra-operative blood loss between the TXA cohort and the control cohort was also observed in favor of the TXA cohort (SMD:-1.14; p< 0.0001]. A statistically significant reduced volume of hemoglobin loss was found in favor of patients who received TXA compared to the control cohort (SMD: -0.9548; p< 0.02). A higher transfusion rate was found in the control cohort (1.1%) compared to the TXA cohort. No difference in complication rates was observed between the cohorts. Conclusion: This systematic review and meta-analysis found that patients who received peri-operative TXA had statistically significant reduced total blood volume loss, intra-operative blood volume loss, hemoglobin loss together with no statistically significant difference in complication rates following TAA. Further randomised control trials with improved data collection are necessary to elucidate the optimal dosage, frequency and role of TXA in the peri-operative setting for TAA.

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

Substantial storage reductions by irrigation pumping in many of the world’s major aquifers jeopardize future food production. As a result, new conservation measures are being utilized to reduce pumping and extend aquifer lifespans. The key question is how effective are these practices in attaining true water conservation (i.e., water use reduction) for a given area? Relationships between pumping and precipitation help provide an answer, as precipitation explains most of the variation in annual irrigation water use for aquifers in semi-arid to sub-humid climates when surface water supplies are limited. Our objective is to utilize correlations between radar precipitation and irrigation groundwater use at a range of spatial scales to assess the effectiveness of conservation approaches in the High Plains aquifer in the central USA. Linear regressions between pumping and precipitation for a conservation area established in 2013 in northwest Kansas indicate that water use and water use per irrigated area were over 27 % less and 25 % less, respectively, during 2013–2021 compared to the same climatic conditions during 2005–2012. Similar regressions found over a 38 % reduction and 23 % reduction in irrigation water use and use per irrigated area, respectively, during 2018–2021 compared to the same conditions during 2005–2017 in a west-central Kansas county with conservation areas. A decrease in irrigated area accounted for most of the difference between these reductions. Higher R2 values after conservation area establishment imply that irrigation tracks precipitation better due to use of soil moisture sensors and other measures as part of increased irrigation efficiency and enhanced water management. The precipitation and water use relationships, which are statistically significant for a wide range of spatial scales, have great potential for assessing the effectiveness of conservation practices in areas with high-quality water use and precipitation data.

Category: Sports; Other Introduction/Purpose: The Achilles tendon is the most commonly ruptured tendon in the lower limb, and when left untreated for at least 4 weeks, these are classified as chronic or 'neglected' Achilles tendon ruptures (CATR). There is discordance on the optimal surgical treatment to treat CATR. Given the prevalence of this injury, there is a need to determine the best treatment modality. In this study, we performed a systematic review of the literature to compare the different treatment options for CATR, analyze the level of evidence (LOE) and quality of evidence (QOE) of the included studies, and recommend a literature-based algorithmic approach to the treatment of CATR. Methods: In July 2019, MEDLINE, EMBASE, and Cochrane Library databases were systematically reviewed by 2 independent reviewers based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Full-length peer-reviewed studies in English with a sample size of 10 participants that reported functional outcome scores with a minimum follow-up of 24 months were included. We excluded systematic reviews, meta-analyses, review articles, cadaveric and animal studies, and case reports. The LOE and QOE of the included studies were evaluated using the Journal of Bone and Joint Surgery Criteria and the Modified Coleman Methodology Score, respectively. Patient demographic data, surgical procedure type, subjective outcomes, postoperative strength, range of motion, postoperative imaging, return to sports and work data, complications, failures, and reoperations were evaluated. Continuous variables were reported as weighted mean and estimated standard deviation, whereas categorical variables were reported as frequencies with percentages. Results: Thirty-one studies with 653 CATRs were included. Three studies were LOE III and 28 studies were LOE IV. A large variety of repair techniques were described and analyzed, and semitendinosus tendon grafting was the most frequently utilized technique (6 of 31 studies). The most commonly reported clinical outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) score (58.6%). Most studies reported good postoperative subjective outcomes, strength outcomes, and return to sports data at mid-term follow-up. In total, 14.6% of patients experienced postoperative complications, where the most common was surgical wound complications (10.8%). Conclusion: Surgical management of CATR produces good clinical outcomes at mid-term follow-up, but a high complication rate (14.6%) was noted. This systematic review found that no evidence-based treatment guidelines exist for CATR. Future studies of higher QOE and LOE which focus on specific risk factors are warranted to determine in which case one particular technique would be suitable for CATR repair. Our proposed treatment algorithm (Figure 1) may assist in shared decision-making for this complex problem.

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: Ankle; Trauma Introduction/Purpose: Chronic Achilles tendon ruptures (CATR) are an uncommon injury compared to acute ruptures. Currently, no evidence-based guidelines exist for treating CATR. The purpose of this systematic review was to present the outcomes of the current treatment options for CATR and to analyze the level of evidence (LOE) and quality of evidence (QoE) of the included studies. Methods: In July 2020, MEDLINE, EMBASE and Cochrane Library databases were systematically reviewed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The LOE and QOE of the included studies was evaluated using the Modified Coleman Methodology Score. Studies reporting outcomes following repair of CATR were included. Results: Thirty-one studies with 653 CATRs were included. Three studies were LOE III and 28 studies were LOE IV. Six studies reported dual technique procedures and 23 studies reported single technique procedures. Semitendinosus graft was the most frequently utilized single technique procedure amongst the included studies. Most studies reported good postoperative subjective outcomes, strength outcomes, and return to sports data at mid-term follow-up. In total, 14.6% of patients experienced postoperative complications. The most common complication was surgical wound complications (10.8%). Conclusion: This systematic review found that no evidence-based treatment guidelines exists for CATR. Surgical management of CATR produces good clinical outcomes at mid-term follow up, but a high complication rate (14.6%) was noted. Future studies of higher QOE and LOE with improved data reporting are warranted to determine the optimal treatment strategy for CATR.

Satellite imagery and data are playing an increasingly important role in scientific studies of the Earth and its climate. The scientific community has been demanding ever-increasing capabilities and accuracy from the data provided by these satellites. One key instrument on board a series of satellite platforms is the Visible Infrared Imaging Radiometer Suite (VIIRS), which provides high-quality data of the Earth from low Earth orbit covering the visible to long-wave infrared parts of the spectrum. The fourth build in the series, set to be launched on the Joint Polar-orbiting Satellite System 3 (JPSS-3) platform, has recently completed its main ground calibration program and is set to be integrated into the satellite bus in the near future. This calibration program covered a comprehensive series of performance metrics designed to demonstrate the quality of the science data and ensure the instrument can maintain its calibration successfully once on-orbit. The subject of this work covers the radiometric calibration metrics including dynamic range, signal-to-noise ratio/noise equivalent differential temperature (SNR/NEdT), polarization sensitivity, scattered light response, relative spectral response, response versus scan angle, and uniformity, as well as uncertainties; all key metrics met or exceeded their design requirements with some minor exceptions. Comparisons to previous builds will also be provided.

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.

The MODIS is a key instrument for NASA’s EOS program, currently operated onboard the Terra and Aqua spacecraft launched in 1999 and 2002, respectively. The VIIRS is a MODIS follow-on instrument for the JPSS program. Adding to the ones operated onboard the S-NPP and NOAA-20 satellites launched in 2011 and 2017, respectively, three nearly identical VIIRS instruments will also be launched. This will enable the data records from MODIS and VIIRS to be extended beyond 2040. In addition to various applications and scientific studies of the Earth’s system, long-term data records from MODIS and VIIRS observations will greatly benefit the space-based climate observing system. This is attributed to the high-quality measurements and extensive calibration efforts, from pre-launch to post-launch. This paper provides an overview of MODIS and VIIRS calibration history and approaches applied to establish and maintain sensor calibration traceability and accuracy. It illustrates calibration and performance issues through different phases of the mission using examples derived from ground testing equipment, on-board calibrators, and other calibration targets. Moreover, discussed in this paper are outstanding challenges and future efforts to maintain and improve sensor calibration stability and long-term data quality, and to better support the space-based climate observing system.