What's Hot: Minimally Invasive Forefoot Surgery

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The adoption of minimally invasive surgery (MIS) is rapidly expanding from Europe to North America, fueled by technological advancements, increased surgeon expertise, and an increasing volume of research. 

 

Patients like it

 

Kaufmann et al. conducted a study where they randomly assigned 47 patients scheduled for bunion correction using distal osteotomies into two groups: 25 patients underwent MIS, while 22 patients received open chevron (OC) surgery. Post-operatively, there were no significant differences between the groups in terms of the intermetatarsal angle and the hallux valgus (HV) angle. At 12 weeks post-surgery, however, patients in the MIS group demonstrated a clear preference for their MIS side, showing a statistically significant advantage over those who underwent open surgery.

 

Surgeons must master the learning curve 

 

In a systematic review, Baumann et al. (2023) concluded that, on average, 35.5 surgeries (ranging from 27 to 40) are required to reach the plateau phase for MIS for HV. The learning curve is characterized by a significant increase in operating room time and fluoroscopy usage. Despite the small sample size in this study, the initial phase of the learning curve for MIS for HV is not associated with decreased outcomes or higher complication rates.

 

 

What's Not Hot: Platelet-Rich Plasma (PRP) for Achilles Tendinopathy​

In the treatment of the painful, non-ruptured Achilles tendinopathy, the primary focus is on achieving pain relief and maintaining that relief over time. Barreto et al. (2024) conducted a systematic review and meta-analysis aimed to assess the effectiveness of PRP in improving both pain and function, as measured by the VISA-A score at intervals of three months, six months, and one-year after treatment. Additionally, they evaluated the impact of PRP on VAS pain scores three months after treatment in patients with chronic Achilles tendinopathy.

 

No benefit to PRP

 

They found no benefit of PRP over placebo at three months, six months, or one year. PRP did not improve VAS pain scores at three months. 

 

Strong conclusions

 

The authors concluded that PRP should not be used to treat Achilles tendinopathy until future high-quality randomized controlled trials show a clear clinical benefit. They found that PRP did not improve pain or function compared to a placebo, and there is also considerable publication bias that exaggerates the perceived benefits of PRP.

 

SameJoin Line Considerations in Total Ankle Arthoplasty (TAA)

by Vince Vacketta, DPM

 

Joint line height has been established as an influential parameter in TAA, with previous research showing that an elevated joint line (JL) has a negative impact on patient outcomes. Although radiographic tools have been developed to help understand JL restoration in TAA, the question remains: how effective is patient-specific instrumentation (PSI) in tackling this issue?

 

PSI works, but does it matter?

 

According to a recent retrospective analysis, PSI was more effective than standard instrumentation (SI) in lowering and restoring native JL in patients undergoing TAA. More interestingly, contrary to previous reports, changes in JL height showed no significant difference on clinical outcomes or postoperative range of motion. 

 

Takeaway

 

Despite this report, JL height continues to be a relevant consideration in TAA. PSI has proven to be effective in managing JL height, and preoperative PSI plans can still be beneficial, even for surgeons who typically prefer to use SI. 

 

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