Excisional Debridement for Chronic Achilles Insertional Tendinosis: A Novel Technique and Case Review.

BACKGROUND: Operative treatment of chronic Achilles insertional tendinosis (AIT) involves tendon debridement, removal of the retrocalcaneal bursitis, and excision of the calcaneal exostosis, often followed by repair of the Achilles tendon and deep tendon transfer. The literature describes a variety of techniques without a single standard of care. METHODS: This is a retrospective review of 57 patients treated with an excisional debridement of the central portion of the Achilles tendon. The novelty of this technique is that instead of complete detachment of the tendon from its insertion, only the central portion is debrided and excised. This allows for enhanced visibility of the calcaneal exostosis and increased healing with apposition of viable tendon during side-to-side repair. RESULTS: Patient-reported outcome scores and pain significantly improved from preoperatively to a minimum of 2 years postoperatively. Complications were similar to those previously reported, with superficial wound breakdown being the most common. CONCLUSION: In conclusion, the use of this reliable, reproducible, and effective technique for the treatment of patients with chronic AIT is encouraged because it provides both enhanced visibility and allows complete resection of all pathological tissue. LEVELS OF EVIDENCE: Level IV: Retrospective case series.

Burnout Rates Among General Orthopedic Surgeons and Subspecialists: A Pilot Study.

Burnout among physicians is a syndrome of emotional exhaustion, de-personalization, and reduced sense of personal accomplishment that can negatively affect personal relationships, physician well-being, and patient outcomes. Although burnout rates of up to 50% to 60% among orthopedic surgeons have been reported, no studies have evaluated burnout among orthopedic generalists and subspecialists. The primary goal of this study was to examine the prevalence of burnout among orthopedic disciplines. We conducted a multicenter study from March 2019 through December 2019 involving 149 orthopedists. An abbreviated Maslach Burnout Inventory-Human Services Survey was used to measure burnout. Demographic information, personal characteristics, professional characteristics, family life and spousal support, and depression were also assessed. The mean rate of burnout among all respondents was 62%, whereas 16.77% screened positive for depression. Subspecialties with the highest rates of burnout were oncology (100%), sports medicine (68%), and trauma (63%). Similarly, trauma (50.00%), oncology (40.00%), and general orthopedics (20.00%) had the highest positive depression screening rates. In contrast, shoulder and elbow (50%), pediatric (52%), and foot and ankle (54%) specialists had the lowest rates of burnout, whereas shoulder and elbow (0.00%), spine (0.00%), and sports medicine (6.50%) specialists had the lowest rates of positive depression screening. Older age, higher debt load, and oncology subspecialty were associated with increased burnout risk. This study sought to determine burnout rates within each orthopedic discipline, with a secondary aim of disclosing contributing factors. Trauma and oncology had the highest rates of burnout and positive depression screening. Because this study represents a small orthopedic cohort, larger studies are needed to appropriately manage burnout in the future. [Orthopedics. 2022;45(6):333-339.].

Morbidity After Metal Allergy to a Total Ankle Implant.

Metal allergy to total ankle arthroplasty is rare but can be both an unpredictable and devastating complication. Current literature describing metal allergy in orthopaedics is limited with there being no report to date on metal allergy after total ankle arthroplasty. Our patient underwent a total ankle arthroplasty and developed a diffuse rash 7 weeks postoperatively. The patient then tested positive for a metal allergy and ultimately was converted to an arthrodesis. In the setting of postoperative pain, swelling, erythema, or rash, it is important that metal allergy be on the differential diagnosis. Interestingly, when the patient here underwent allergy testing, only the articulating sides of the implant caused a positive reaction. Thus, allergy testing of both the articular and nonarticular sides of the component is of the utmost importance, as evidenced by the discrepancy found in this case.Levels of Evidence: Level IV: Case report.