Risk factors for periprosthetic joint infection following total ankle replacement.

BACKGROUND: Identifying preoperative patient characteristics that correlate with an increased risk of periprosthetic joint infection (PJI) following total ankle replacement (TAR) is of great interest to orthopaedic surgeons, as this may assist with appropriate patient selection. The purpose of this study is to systematically review the literature to identify risk factors that are associated with PJI following TAR. METHODS: Utilizing the terms "(risk factor OR risk OR risks) AND (infection OR infected) AND (ankle replacement OR ankle arthroplasty)" we searched the PubMed/MEDLINE electronic databases. The quality of the included studies was then assessed using the AAOS Clinical Practice Guideline and Systematic Review Methodology. Recommendations were made using the overall strength of evidence. RESULTS: Eight studies met the inclusion criteria. A limited strength of recommendation can be made that the following preoperative patient characteristics correlate with an increased risk of PJI following TAR: inflammatory arthritis, prior ankle surgery, age less than 65 years, body mass index less than 19, peripheral vascular disease, chronic lung disease, hypothyroidism, and low preoperative AOFAS hindfoot scores. There is conflicting evidence in the literature regarding the effect of obesity, tobacco use, diabetes, and duration of surgery. CONCLUSIONS: Several risk factors were identified as having an association with PJI following TAR. These factors may alert surgeons that a higher rate of PJI is possible. However, because of the low level of evidence of reported studies, only a limited strength of recommendation can be ascribed to regard these as risk factors for PJI at this time.

Surgical approaches to the calcaneus and the sural nerve: There is no safe zone.

BACKGROUND: Sural nerve related symptoms following the extensile lateral approach to the calcaneus (ELA) and the sinus tarsi approach (STA) are a known postoperative complication despite awareness of the course the sural nerve. While the main trunk of the sural nerve and its location relative to the approaches have been previously described, the nerve gives rise to lateral calcaneal branches (LCBs) and an anastomotic branch (AB) that may be at risk of injury. The purpose of this study was to describe the course of the sural nerve, its LCBs and the AB in relation to the ELA and STA. METHODS: 17 cadaveric foot specimens were dissected, exposing the sural nerve, the LCBs and the AB. A line representing the ELA and STA incision was then created. It was noted if the line crossed the sural nerve trunk, any of the LCBs, and the AB, and at what distance they were crossed using the distal tip of the fibula as a reference. RESULTS: The sural nerve was identified in all specimens, and the main trunk was noted to cross the path of the ELA in no specimens and the path of the STA in 2 (12%) specimens. At least one LCB of the sural nerve was identified in all specimens. The ELA crossed the path of at least one LCB in 15 specimens (88%). An AB was present in 9 specimens (53%). If an AB was present, this was crossed by the STA in every instance. CONCLUSIONS: The ELA and the STA traverses the path of either the main trunk of the sural nerve, the LCBs, or the AB in the majority of specimens, potentially accounting for the presence of sural nerve postoperative symptoms regardless of the approach used.

Current concepts review: Arthroscopic treatment of anterior ankle impingement.

Anterior ankle impingement is a common cause of chronic ankle pain, particularly in athletic populations. Morris and McMurray provided the earliest descriptions of anterior impingement, coining the condition as "athlete's ankle" or "footballer's ankle". The pathology has since been a topic of considerable investigation and has been re-termed "anterior ankle impingement syndrome". Treatment with open surgery has provided good results historically, but at the price of significant complications. Advancements in ankle arthroscopy have decreased the risk of complication drastically and evidence in the literature indicates that anterior arthroscopy is an effective approach to treating osseous and soft tissue impingement. Effective clinical diagnosis and diagnostic imaging are critical for pre-surgical planning. Preoperative detection of anterior osteophytes has been correlated with outcomes. Factors such as joint space narrowing and large osteophytes may also influence outcomes. Therefore, a comprehensive understanding of diagnosis and surgical technique can influence patient outcomes, and patient expectations can be managed around prognostic indicators such as the presence of osteoarthritis. The purpose of this review is to discuss the etiology, clinical presentation, diagnosis, surgical technique, and postoperative rehabilitation of anteromedial and anterolateral anterior ankle impingement syndrome and to evaluate the evidence-based outcomes of arthroscopic management.

Adult-acquired flatfoot deformity.

Adult-acquired flatfoot deformity (AAFD) is a known and recognized cause of pain and disability. Loss of PTT function is the most important contributor to AAFD, and its estimated prevalence is thought to be over 3%. This review aims to summarize the current literature and encompass recent advances regarding AAFD.

Management of acute injuries of the tibiofibular syndesmosis.

The syndesmosis is important for ankle stability and load transmission and is commonly injured in association with ankle sprains and fractures. Syndesmotic disruption is associated with between 5 and 10% of ankle sprains and 11-20% of operative ankle fractures. Failure to recognize and appropriately treat syndesmotic disruption can portend poor functional outcomes for patients; therefore, early recognition and appropriate treatment are critical. Syndesmotic injuries are difficult to diagnose, and even when identified and treated, a slightly malreduced syndesmosis can lead to joint destruction and poor functional outcomes. This review will discuss the relevant anatomy, biomechanics, mechanism of injury, clinical evaluation, and treatment of acute injuries to the ankle syndesmosis.

Magnetic Resonance Imaging Evidence of Postoperative Cyst Formation Does Not Appear to Affect Clinical Outcomes After Autologous Osteochondral Transplantation of the Talus.

PURPOSE: To identify potential cysts using magnetic resonance imaging (MRI) after autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLTs) as well as to determine the effect of cysts on short-term clinical outcomes. METHODS: Eighty-nine MRI scans of 37 patients who had AOT for an OLT were evaluated. Radiographic variables examined included cyst presence, cyst location, bone edema, and cartilage integrity. Patient clinical variables recorded and examined for association with the presence of a cyst included gender, age, preoperative lesion size, size and number of osteochondral graft used, symptoms reported, and pre- and postoperative Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) scores measured at final follow-up. RESULTS: Twenty-four patients (64.8%) had MRI evidence of cystic change after AOT for an OLT at a mean MRI follow-up time of 15 months after surgery (range 2-54). Patients with presence of a cyst after surgery were older (mean age, 42.7 years) than those without cysts (mean age, 32.7 years) (P = .041), and among patients with a cyst, older patients more often had involvement of the subchondral plate (57.3 v 36.7 years) (P < .001). No other variables associated with cyst formation had statistical significance. Mean patient FAOS scores increased from 50 (±19) preoperatively to 87 (±8) postoperatively. Mean SF-12 scores increased from 52 (±18) preoperatively to 85 (±6) postoperatively. Patients not identified as having a cyst had lower SF-12 (P = .028) and FAOS (P = .032) preoperative scores and more improvement in SF-12 (P = .006) and FAOS (P = .016) scores than patients with cysts. CONCLUSIONS: Postoperative cyst formation on MRI was found to be a common occurrence after AOT for OLT. Although increasing age was related to increased cyst prevalence, the clinical impact of cyst formation was not found to be significant at short-term follow-up. Continued long-term longitudinal follow-up of postoperative cysts is needed. LEVEL OF EVIDENCE: Level IV, prognostic case series.

Arthroscopic Bone Marrow Stimulation and Concentrated Bone Marrow Aspirate for Osteochondral Lesions of the Talus: A Case-Control Study of Functional and Magnetic Resonance Observation of Cartilage Repair Tissue Outcomes.

PURPOSE: This study compares retrospective functional and magnetic resonance imaging (MRI) outcomes after arthroscopic bone marrow stimulation (BMS) with and without concentrated bone marrow aspirate (cBMA) as a biological adjunct to the surgical treatment of osteochondral lesions (OCLs) of the talus. METHODS: Twenty-two patients who underwent arthroscopic BMS with cBMA (cBMA/BMS group) for an osteochondral lesion (OCL) of the talus and 12 patients who underwent arthroscopic BMS (BMS alone) for an OCL of the talus were retrospectively reviewed. The Foot and Ankle Outcome Score (FAOS) pain subscale and Short Form 12 general health questionnaire physical component summary score (SF-12 PCS) provided patient-reported outcome scores pre- and postoperatively. MRI scans were assessed postoperatively using the magnetic resonance observation of cartilage repair tissue (MOCART) score. All patients had postoperative MRI performed at the 2-year postoperative visit, and quantitative T2 mapping relaxation time values were assessed in a subset of the cBMA/BMS group. RESULTS: The mean FAOS and SF-12 PCS scores improved significantly pre- to post-operatively (P < .01) at a mean follow-up of 48.3 months (range, 34 to 82 months) for the cBMA/BMS group and 77.3 months (range, 46 to 100 months) for the BMS-alone group. The MOCART score in the cBMA/BMS group was significantly higher than that in the BMS-alone group (P = .023). Superficial and deep T2 relaxation values in cBMA/BMS patients were higher in repair tissue compared with measurements in adjacent native articular cartilage (P = .030 and P < .001, respectively). CONCLUSIONS: BMS is an effective treatment strategy for treatment of OCLs of the talus and results in good medium-term functional outcomes. Arthroscopic BMS with cBMA also results in similar functional outcomes and improved border repair tissue integration, with less evidence of fissuring and fibrillation on MRI.

An atraumatic case of extensive Achilles tendon ossification.

BACKGROUND: Ossification of the Achilles tendon is rare with most cases of ossification or calcification consisting of small, focal lesions. This pathology is usually predisposed by surgery, trauma, or other factors. CASE DESCRIPTION: A case of extensive Achilles ossification and calcification, without prior surgery or trauma, is reported. Following removal of one of the largest ossific masses reported in the literature, measuring 11.0cm×2.5cm×2.0cm with additional 6.5cm calcifications, surgical reconstruction was required. PURPOSE AND CLINICAL RELEVANCE: The objective of this report was to describe an unusual case of Achilles tendon ossification and calcification that occurred without the presence of predisposing factors. When a large gap is present after removal of the ossification, direct repair may be impossible and V-Y lengthening plus flexor hallucis longus (FHL) transfer is a viable option for pain relief and return to function.

Platelet-rich plasma in tendon models: a systematic review of basic science literature.

PURPOSE: To perform a systematic review of the basic science literature on the use of platelet-rich plasma (PRP) in tendon models. METHODS: We searched the PubMed/Medline and Embase databases in June 2012 using the following parameters: ((tenocytes OR tendon OR tendinitis OR tendinosis OR tendinopathy) AND (platelet rich plasma OR PRP OR autologous conditioned plasma OR ACP)). The inclusion criteria for full-text review were in vivo and in vitro studies examining the effects of PRP on tendons and/or tenocytes. Clinical studies were excluded. Only studies published in peer-reviewed journals that compared PRP directly with a control were included. Data were extracted based on a predefined data sheet, which included information on PRP preparation, study methods, and results. Studies were analyzed for trends, comparing and contrasting the reported effects of PRP. RESULTS: The search yielded 31 articles for inclusion in our review. Of the studies, 22 (71%) reported platelet concentrations in the PRP; 6 (19%) reported cytology. Eight in vivo studies found decreased tendon repair time, increased fiber organization, or both with PRP treatment. Eight in vitro studies reported that PRP treatment increased cell proliferation; 7 reported an increase in growth factor expression. Three in vivo studies found increased vascularity, and 4 found increased tensile strength with PRP treatment. CONCLUSIONS: In the basic science studies evaluated, it appears that PRP confers several potential effects on tendon models compared with a control. However, the literature is inconsistent with regard to reporting the methods of preparation of PRP and in reporting platelet concentrations and cytology. CLINICAL RELEVANCE: Establishing proof of concept for PRP may lead to further high-quality clinical studies in which the appropriate indications can be defined.

Platelet-rich plasma in the pathologic processes of cartilage: review of basic science evidence.

PURPOSE: The purpose of this study was to systematically review the basic science evidence for the use of platelet-rich plasma (PRP) in the treatment of pathologic processes of cartilage, both as an adjunct to cartilage repair and as a conservative management strategy for osteoarthritis, with the intent of determining the effect of PRP and whether a proof of concept for its use has been established to facilitate further investigation at a clinical level. METHODS: Using the terms "platelet-rich plasma OR PRP OR autologous conditioned plasma OR ACP AND cartilage OR chondrocytes OR chondrogenesis OR osteoarthritis OR arthritis" we searched EMBASE and PubMed/Medline in April 2012. Two authors performed the search, 3 authors independently assessed the studies for inclusion, and 2 authors extracted the data. Extracted data included cytologic analysis of PRP, study design, and results. RESULTS: Twenty-one studies (12 in vitro, 8 in vivo, one in vitro and in vivo) met the inclusion criteria. The effects of PRP in these studies included increasing chondrocyte and mesenchymal stem cell proliferation, proteoglycan deposition, and type II collagen deposition. PRP was also found to increase the cell viability of chondrocytes and the migration and chondrogenic differentiation of mesenchymal stem cells (MSCs) and to inhibit the effect of catabolic cytokines. In vivo, PRP was used as an adjunct to concomitant surgical management, including microfracture surgery and implant, scaffold, and graft insertion. Not all studies concluded that PRP has a positive effect on cartilage repair. CONCLUSIONS: The current basic science evidence suggests that PRP has several potential effects on cartilage repair and osteoarthritis, and a proof of concept has been established. Well-designed randomized controlled trials (RCTs) are needed to extrapolate this evidence to the clinical setting.

Surgical treatment for posterior ankle impingement.

PURPOSE: This study aims to provide an overview of both the open and endoscopic procedures used to treat posterior ankle impingement, as well as an analysis, evaluation, and comparison of their outcomes. METHODS: A systematic literature search of the Medline, Embase (Classic), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases and the Cochrane Database of Clinical and Randomized Controlled Trials was performed. Quality of included studies was assessed by use of the Downs and Black scale. RESULTS: After we reviewed 783 studies, 16 trials met the inclusion criteria. Of these trials, 6 reported on open surgical techniques and 10 evaluated endoscopic techniques. The complication rate (15.9% v 7.2%) and time to return to full activity (16.0 weeks v 11.3 weeks) differed between the 2 groups, both favoring endoscopic surgery. CONCLUSIONS: Although the level of evidence of the included studies is relatively low, it can be concluded that the endoscopic technique is superior to the open procedure. LEVEL OF EVIDENCE: Level IV, systematic review of Level IV studies.

The deltoid ligament: an in-depth review of anatomy, function, and treatment strategies.

PURPOSE: A literature review of the deltoid ligament was conducted, examining the current literature on anatomy, function, and treatment strategies. In particular, anatomical inconsistencies within the literature were evaluated, and detailed anatomical dissections are presented. METHODS: A literature search was conducted on PubMed using keywords relevant to the deltoid ligament in the ankle and medial ankle instability. Primary research articles, as well as appropriate summary articles, were selected for review. RESULTS: While it is well defined that the deltoid is contiguous and divided into one superficial and one deep portion, the creation of the individual fibres may be artificial. Furthermore, while improvements in imaging techniques and arthroscopy have not led to a consensus on the anatomy of the ligament, they may help improve recognition of deltoid injuries. Once identified, the majority of deltoid injuries can be treated via conservative treatment. However, reparative and reconstructive treatment strategies can also be used for complex acute injuries or chronic medial ankle instability. CONCLUSION: Given the continuing evolution of the anatomical understanding of the ligament, the current treatment protocol for deltoid injuries requires further standardization, with an emphasis on proper diagnosis.

Treatment of chronic syndesmotic injury: a systematic review and meta-analysis.

PURPOSE: The purpose of this study is to systematically review and meta-analyse the available literature on the treatment of chronic syndesmotic injuries of the ankle. METHODS: A systematic review of the PubMed/MEDLINE and EMBASE databases was conducted in August 2012 utilizing the keywords (treatment OR intervention) AND (injury OR sprain OR rupture) AND (syndesmosis OR syndesmotic OR "high ankle" OR "anterior inferior tibiofibular ligament" OR AITFL OR "posterior inferior tibiofibular ligament" OR PITFL OR tibiofibular diastasis). Studies that reported the outcomes of the surgical treatment of chronic syndesmotic injury were included in our review. Chronic was defined as symptoms longer than 6 months. Meta-analysis based on random-effects models was performed to pool the rates of success for different treatment methods. RESULTS: The search yielded 416 publications from PubMed/MEDLINE and 473 publications from EMBASE. After abstract and full-text review, 15 articles were included in this review. Treatment methods were placed into three broad surgical treatment categories: screw fixation, arthrodesis and arthroscopic debridement. The most common treatment strategy employed was screw fixation. The pooled rates of success for screw fixation, arthrodesis and arthroscopic debridement were 87.9, 79.4 and 78.7 %, respectively. CONCLUSION: The current evidence on the treatment of chronic syndesmosis injuries in the ankle is limited to prospective and retrospective case series. The pooled success rates for screw fixation, arthrodesis and arthroscopic debridement each exceeded 78 %. Future high-level studies are required to discern the most appropriate treatment strategy(ies) for chronic syndesmotic injuries of the ankle.

A plantar closing wedge osteotomy of the medial cuneiform for residual forefoot supination in flatfoot reconstruction.

BACKGROUND: Residual forefoot supination is commonly encountered during a flatfoot reconstruction, and a new technique for its treatment is described. Contrary to the standard Cotton osteotomy, a plantar closing wedge osteotomy of the medial cuneiform (PCWOMC) was performed, which has a number of advantages. METHODS: We followed 10 feet in 9 patients who had a PCWOMC performed as the last step of a standard flatfoot reconstruction for the correction of residual forefoot supination. These patients were evaluated pre- and postoperatively by standardized radiographic parameters, Short Form-12 (SF-12), and Foot and Ankle Outcome Score (FAOS). RESULTS: Patients were followed for an average of 25.8 months with final radiographic analysis performed at an average of 9.9 months. A significant difference (P < .001) between pre- and postoperative parameters was demonstrated for both lateral talus-first metatarsal angle and medial-cuneiform-to-ground distance. Likewise, there was a statistically significant improvement in the SF-12 score and 4 out of 5 components of the FAOS. One patient developed internal hardware-related symptoms, which were relieved following implant removal. All osteotomies healed uneventfully. CONCLUSION: A PCWOMC can be considered an alternative to the Cotton osteotomy for the treatment of forefoot supination deformity in adult flatfoot reconstruction. The main advantage of this technique over the Cotton osteotomy was simplicity, as an additional dorsal incision and bone graft were not required. LEVEL OF EVIDENCE: Level IV, retrospective case series.

The Mandated Publication of Individual Hospital Charge Description Masters Does Not Permit the Estimation of Complex Procedure Charges.

BACKGROUND: As healthcare spending continues to rise, price transparency is crucial for patients to calculate a reasonable cost estimate for tests and procedures. Legislative efforts have been successful at mandating increased hospital price transparency, including publishing charge description masters (CDMs), but their usefulness in permitting patients to assess the cost for complex procedures is unclear. We sought to determine CDM and diagnosis-related group (DRG) prevalence and evaluate whether these are effective tools for patients to preemptively ascertain the costs for simple and complex tests and procedures. METHODS: Cross-sectional analysis of publicly available 2019 CDMs and DRGs from 122 hospitals in the United States, including the top-20 as ranked by the US News & World Report Honor Roll and two top-ranked hospitals per state. We first determined the availability of CDMs and DRGs and then determined the ability to estimate the hospital charge for a three-view knee radiograph and a primary total knee arthroplasty (TKA) using CDM and DRG data. RESULTS: One hundred fifteen of 122 (94.3%) hospitals published a CDM, and 78 (63.9%) published a DRG. Top-ranked hospitals published DRGs more frequently than those outside of the Honor Roll designation (P = 0.04). The estimated charge for a three-view knee radiograph could be calculated from 113/115 (98.3%) CDMs. The estimated total charge for a primary TKA could not be obtained from any of the available CDMs. By comparison, the estimated charge for a primary TKA could be obtained from 76/78 (97.4%) of the available DRGs. DISCUSSION: CDMs are available as currently mandated for most hospitals and generally can be used to identify the charges for simple procedures, but they are ineffective tools for patients to estimate the charges associated with a multifaceted healthcare procedure, such as TKA. Although DRGs are less frequently available, they are a more effective resource for patients to estimate charges.

Biomechanical Comparison of Hook Plate vs Headless Compression Screw Fixation of Large Fifth Metatarsal Base Avulsion Fractures.

BACKGROUND: Debate exists on the optimum fixation construct for large avulsion fractures of the fifth metatarsal base. We compared the biomechanical strength of 2 headless compression screws vs a hook plate for fixation of these fractures. METHODS: Large avulsion fractures were simulated on 10 matched pairs of fresh-frozen cadaveric specimens. Specimens were assigned to receive two 2.5-mm headless compression screws or an anatomic fifth metatarsal hook plate, then cyclically loaded through the plantar fascia and metatarsal base. Specimens underwent 100 cycles at 50%, 75%, and 100% physiological load for a total of 300 cycles. RESULTS: The hook plate group demonstrated a significantly higher number of cycles to failure compared with the screw group (270.7 ± 66.0 [range 100-300] cycles vs 178.6 ± 95.7 [range 24-300] cycles, respectively; P = .039). Seven of 10 hook plate specimens remained intact at the maximum 300 cycles compared with 2 of 10 screw specimens. Nine of 10 plate specimens survived at least 1 cycle at 100% physiologic load compared with 5 of 10 screw specimens. CONCLUSION: A hook plate construct was biomechanically superior to a headless compression screw construct for fixation of large avulsion fractures of the fifth metatarsal base. CLINICAL RELEVANCE: Whether using hook plates or headless compression screws, surgeons should consider protecting patient weight-bearing after fixation of fifth metatarsal base large avulsion fracture until bony union has occurred.

The Use of a Synthetic Cartilage Implant for Hallux Rigidus: A Systematic Review.

Background. Hallux rigidus is a common pathology afflicting the foot, for which various joint salvage techniques have been described with a multitude of different implants. Recently, a synthetic cartilage implant composed of polyvinyl alcohol (PVA) received FDA premarket approval for the treatment of arthritis of the great toe. The purpose of this study was to (1) systematically review the clinical evidence supporting the use of a PVA implant in hallux rigidus and (2) determine the strength of the recommendation that can be made supporting the use of a PVA implant by evaluating the quality of evidence available. Methods. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Using the terms "cartiva OR polyvinyl alcohol OR synthetic cartilage OR hemiarthroplasty AND hallux rigidus OR great toe arthritis OR first toe arthritis" we searched the PubMed/Medline database. The quality of the included studies was evaluated using the American Academy of Orthopaedic Surgeons Clinical Practice Guideline and Systematic Review Methodology. Results. Seven studies met the inclusion criteria, 6 of these were derived from a single randomized controlled trial. A moderate recommendation can be given for the use of a PVA implant for hallux rigidus based on short-term outcomes. A limited recommendation can be given for the use of a PVA implant for hallux rigidus based on mid-term outcomes. Conclusion. There are limited studies available detailing the outcomes of a PVA implant for hallux rigidus; however, the results that are available demonstrate a high level of evidence.Levels of Evidence: Level I: Systematic review.

Consumer Prices for Surgical Management of End-Stage Hallux Rigidus.

Background. Hallux rigidus is the most prevalent arthritic condition of the foot. Treatment of end-stage disease traditionally consists of a first metatarsophalangeal joint (MTPJ) arthrodesis; however, the use of a synthetic cartilage implant is becoming more common. With the high prevalence of disease and implementation of new treatment modalities, health care consumers should be aware of the costs associated with management. The purpose of this study was to determine access to the cost and variability in price of first MTPJ arthrodesis and synthetic cartilage implantation. Methods. Forty academic centers were contacted using a standardized patient script. The patient was a 59-year-old female who had failed conservative treatment of hallux rigidus. Each institution was contacted up to 3 times in an attempt to obtain a full bundled operative quote for a first MTPJ arthrodesis and synthetic cartilage implantation. Results. Twenty centers (50%) provided a quote for first MTPJ arthrodesis and 15 centers (38%) provided a quote for synthetic cartilage implantation. Only 14 centers (35%) were able to provide a quote for both procedures. The mean bundled price for MTPJ arthrodesis was $21 767 (range $8417 to $39 265). The mean bundled price for synthetic cartilage implantation was $21 546 (range $4903 to $74 145). There was no statistically significant difference between the bundled price for first MTPJ arthrodesis and synthetic cartilage implantation. Conclusions. There was limited availability of consumer prices for first MTPJ arthrodesis and synthetic implantation, thus impeding health care consumers' decision making. There was a wide range of quotes for both procedures, indicating potential cost savings.Levels of Evidence: IV, basic science.

Operative Reports in Orthopaedic Surgery: The Need for Assessment and Education.

BACKGROUND: The ability to complete an operative report is a vital skill for an orthopaedic surgeon. We hypothesized that most programs do not have formal operative report teaching, that resident operative reports at our institution are incomplete, and that a formal teaching program would improve operative reports. METHODS: A survey of residencies in the United States was conducted assessing the state of operative report education. In addition, resident operative reports were collected at our institution both pre and post a formal educational session. Scores were given for each report out of a possible 35 points. RESULTS: Total 54 institutions responded to the survey, of which 83% indicated that they had no formal resident operative report teaching. Within our institution, 100 resident operative dictations were assessed prior to instituting a formal education session, with a mean score of 24.5. The most commonly missed items in the report were preoperative antibiotics, deep venous thrombosis prophylaxis, and tourniquet time. The mean score of 100 resident operative dictations following the educational session improved to 31.8. CONCLUSION: Most residency programs do not conduct formal resident operative report teaching. Formal instruction on how to complete a comprehensive operative report resulted in a significant improvement in their quality.

Platelet-Rich Plasma Versus Corticosteroids for Plantar Fasciitis: A Systematic Review of Randomized Controlled Trials.

BACKGROUND: Plantar fasciitis is the most common cause of plantar heel pain. Several recent randomized control trials (RCTs) have been published comparing the use of platelet-rich plasma (PRP) and corticosteroids (CSs) for the treatment of plantar fasciitis. PURPOSE: To perform a systematic review of RCTs to compare whether PRP or CS injections result in decreased pain levels and improved patient outcomes in the treatment of plantar fasciitis. STUDY DESIGN: Systematic review; Level of evidence, 1. METHODS: Medline, EMBASE, and the Cochrane Library were screened according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify RCTs comparing PRP and CS injections for plantar fasciitis. The visual analog scale (VAS) pain scores and the American Orthopaedic Foot and Ankle Society (AOFAS) scores were compared between groups at 1, 1.5, 3, 6, and 12 months, where possible. Statistical analysis was performed using RevMan, and P < .05 was considered to be statistically significant. RESULTS: A total of 9 RCTs were identified comparing 239 patients with PRP with 240 patients with CS injections. At the follow-up time points, including 1-1.5, 3, 6, and 12 months, there were statistically significant differences in VAS scores in favor of PRP (P = .004, P < .00001, P < .00001, and P < .00001, respectively). At 1 and 3 months, there was no difference in AOFAS scores (P = .76 and P = .35, respectively). However, at 6 and 12 months, there was a difference in AOFAS scores in favor of PRP (P < .00001 and P < .00001, respectively). CONCLUSION: In patients with chronic plantar fasciitis, the current clinical evidence suggests that PRP may lead to a greater improvement in pain and functional outcome over CS injections.