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Category: Ankle; Midfoot/Forefoot Introduction/Purpose: The literature demonstrating outcomes after foot and ankle surgery has traditionally focused on clinical and functional outcomes. Recent interest has increased regarding the contribution of racial and ethnic factors on outcomes after foot and ankle surgery. However, the existing research is limited. The purpose of this systematic review and meta-analysis was to evaluate outcome metrics based on race and ethnicity after foot and ankle surgery. Methods: Outcomes after foot and ankle surgery based on race and ethnicity were searched in MEDLINE, Embase, Cochrane, Web of Science, SportsDISCUS, and Scopus from the date of inception to March 23, 2023. Inclusion criteria consisted of studies that directly evaluated the outcomes of race or ethnicity on foot and ankle surgery, including the risk or need for an index procedure. Manuscripts in non-English languages and isolated abstracts were excluded. We collected Visual Analog Scale (VAS), Patient-Reported Outcomes Information System (PROMIS) pain scale, and Short Musculoskeletal Function Assessment (SMFA) from the included studies for pooled meta-analysis. Results: The literature search identified 33 relevant studies from an initial pool of 3,451 references. These studies included a diverse demographic of 557,734 patients, assessing outcomes in foot and ankle surgery across various racial and ethnic groups. Due to heterogeneity in outcome reporting, only six studies were included in the finalmeta-analysis. Functional scores from the VAS, PROMIS pain scale, and SMFA varied in their assessment of pain and functional outcomes based on ethnicity. Resource utilization studies indicated disparities in the rates of surgical fixations and arthroplasties based on race. Conclusion: Non-White and minority patients exhibited higher rates of foot and ankle fractures, lower limb surgeries, worse functional outcomes, increased pain, longer hospital stays, and a higher incidence of complications compared to their White counterparts. While consistent with existing literature in various orthopaedic specialties, some studies contradicted these findings, suggesting the need for further research to better understand these discrepancies.

Category: Ankle Arthritis Introduction/Purpose: End-stage ankle osteoarthritis (OA) is a debilitating condition that adversely affects quality of life and causes considerable functional impairment. Total ankle arthroplasty (TAA) is growing in popularity as a motion-preserving option for ankle OA. A previously published meta-analysis evaluated the mid-term outcomes of TAA with a minimum average follow-up of 5 years, demonstrating excellent survivorship. To our knowledge, there is no such manuscript that evaluates the outcomes of TAA at the long-term, with a minimum follow-up of ten years or greater. Due to a lack of long-term follow-up of TAA implants in the current literature, the aim of this review was to aggregate findings from the most up-to-date analyses of the long-term outcomes of TAA via meta-analysis. Methods: We conducted a systematic review and meta-analysis according to the PRISMA guidelines. Electronic databases were searched from the date of inception to September 12, 2022. These databases included Medline, Embase, and Scopus. We included all studies that 1) involved patients that underwent uncemented TAA, and 2) all patients who had an average follow-up period of at least ten years. We excluded abstracts, as well as manuscripts written in languages other than English. We collected American Orthopaedic Foot and Ankle Score (AOFAS) and Visual Analog Scale (VAS) scores from the included studies for pooled meta- analysis. Due to the varying definition of survivability between studies, this metric was not assessed in our final evaluation. Results: Our data included a total of 2,562 patients and 2,895 ankles with an average follow-up of 10 years. Of the 25 studies included in the systematic review, 7 provided pre- and post-operative AOFAS means and 5 provided pre- and post-operative VAS means with associated measures of variability and were included in our meta-analysis. The weighted mean difference between pre- and post-operative AOFAS scores was -41.98 (95% CI: -48.28 to -35.69) (Fig. 1A), indicating that patients improved by almost 42 points between pre-and post-surgery. The weighted mean difference between pre-and postoperative VAS scores was 4.52 (95% CI: 2.26-6.43) (Fig. 1B), indicating patients improved by about 4.5 points on average between pre-and post-surgery. Survivability was not assessed due to the heterogeneity in survivability definition between studies. Conclusion: Outcomes following TAA are favorable and indicate patient-reported outcomes improve over long-term follow-up. Future, prospective, randomized research should be conducted to better assess TAA, and authors should work towards standardization of survivorship and complication reporting methodologies to allow for pooled metanalysis of these important outcome metrics.

Category: Ankle; Sports Introduction/Purpose: Social media platforms, like TikTok, have become popular options for the distribution of healthcare information. Due to the lack of scientific oversight, the quality of healthcare-related videos has become a focus of the current literature. However, orthopaedic surgery has lagged behind other fields in acknowledging the widespread utilization of TikTok videos for medical information consumption. This study aims to assess the quality and educational benefits of ankle sprain-related TikTok videos. Methods: TikTok was queried using the hashtag “#anklesprainexercises". 100 videos were included after applying the exclusion criteria. The number of views, likes, shares, comments, and favorites was recorded. The content was graded using DISCERN (a well-validated informational analysis tool) and ASEES (a self-designed tool for exercise evaluation). Results: The total number of views of the 100 videos included was 6,483,412, with a median of 5,377.5 (IQR = 1,074- 20,275). The videos collectively received 385,847 likes, 3,642 comments, 55,574 favorites, and 14,918 shares with a median of 267.5 (IQR=41.5-1,678.0), 4.0 (IQR= 0.0-23.0), 42.0 (IQR= 4.8-264.5), and 13.0 (IQR= 1.8-67.8), respectively. General users uploaded more videos (68%) in comparison to healthcare professionals (32%). The dissemination statistics between the general users and healthcare professionals were statistically insignificant. There were significant differences in DISCERN 1, DISCERN 3, TOTAL DISCERN, and ASEES between the two groups. General users had a higher percentage of videos graded as “very poor” (61.8%) in comparison to healthcare professionals (34.4%). Neither general users nor healthcare professionals had videos graded “good” or “excellent”. Conclusion: Although TikTok is a powerful tool for information distribution, the educational value of the videos related to ankle sprain injury exercises was poor. With only 2% of videos receiving a grade of ‘fair,’ and no videos reaching a score of ‘good’ or ‘excellent’, healthcare professionals should be aware of the low-quality content easily accessible on TikTok.

Category: Basic Sciences/Biologics; Ankle Arthritis Introduction/Purpose: The first stage of fracture healing consists of hematoma formation with recruitment of proinflammatory cytokines and matrix metalloproteinases. Unfortunately, when there is an intra-articular fracture, these inflammatory mediators are not retained at the fracture site, but instead, bathe the healthy cartilage of the entire joint via the synovial fluid fracture hematoma (SFFH). These inflammatory cytokines and matrix metalloproteinases are known factors in the progression of osteoarthritis and rheumatoid arthritis. Despite the known inflammatory contents of the SFFH, little research has been done on the effects of the SFFH on healthy cartilage with regard to cell death and alteration in gene expression that could lead to post- traumatic osteoarthritis (PTOA). Methods: SFFH was collected from 12 patients with intraarticular ankle fracture at the time of surgery. Separately, human chondrocytes were three-dimensionally cultured to create scaffold -free cartilage tissue analogues (CTAs) to simulate articular cartilage. Experimental CTAs (n=12) were exposed to 100% SFFH for 3 days, washed, and transferred to complete media for 3 days. Control CTAs (n=12) were simultaneously cultured in complete medium. Subsequently, CTAs were harvested and underwent biochemical, histological, and gene expression analysis. Results: Exposure of CTAs to ankle SFFH 3 days significantly decreased chondrocyte viability by 34% (p = .027). Gene expression of both COL2A1 and SOX9 were significantly decreased after exposure to SFFH (p= .012 and p=.0013 respectively). COL1A1 expression trended upward in the SFFH exposure group while there was no difference in RUNX2 and MMP13 gene expression. Quantitative analysis of Picrosirius red staining demonstrated increased collagen I deposition with poor ultrastructural organization in SFFH exposed CTAs. Conclusion: Exposure of an organoid model of healthy cartilage tissue to SFFH after intraarticular ankle fracture resulted in decreased chondrocyte viability, decreased expression of genes regulating normal chondrocyte phenotype, and altered matrix ultrastructure indicating differentiation toward an osteoarthritis phenotype.

Background: Social media platforms, like TikTok, have become popular options for the distribution of health care information. Because of the lack of scientific oversight, the quality of health care–related videos has become a focus of the current literature. However, orthopaedic surgery has lagged behind other fields in acknowledging the widespread utilization of TikTok videos for medical information consumption. This study aims to assess the quality and educational benefits of ankle sprain–related TikTok videos. Methods: TikTok was queried using the hashtag “#anklesprainexercises.” One hundred videos were included after applying the exclusion criteria. The number of views, likes, shares, comments, and favorites was recorded. The content was graded using DISCERN (a well-validated informational analysis tool) and ASEES (a self-designed tool for exercise evaluation). We hypothesized that information on TikTok related to ankle sprain exercises would be poor in quality. Results: The total number of views of the 100 videos was 6 483 412, with a median of 5377.5 (IQR = 1074-20 275). The videos collectively received 385 847 likes, 3642 comments, 55 574 favorites, and 14 918 shares with a median of 267.5 (IQR = 41.5-1678.0), 4.0 (IQR = 0.0-23.0), 42.0 (IQR = 4.8-264.5), and 13.0 (IQR = 1.8-67.8), respectively. General users had a higher percentage of their videos graded as “very poor” (61.8%) in comparison to the number of videos uploaded by health care professionals deemed “very poor” (34.4%). Neither general user nor health care professionals had videos graded as “good” or “excellent.” There were significant differences between the 2 groups for DISCERN 1, 3, and ASSES scores. Conclusion: Although TikTok is a powerful tool for information distribution, the educational value of the videos related to ankle sprain injury exercises was poor. With only 2% of videos receiving a grade of “fair,” and no videos reaching a score of “good” or “excellent,” health care professionals should be aware of the low-quality content easily accessible on TikTok. Level of Evidence: Level III, cross-sectional study.