Subchondral insufficiency (SI) of the knee manifests as pain, with imaging showing edema in the femur or tibia. SI represents bone failure beneath cartilage in early to moderate osteoarthritis, and current surgical options are limited short of joint replacement. A February 2025 study introduces a novel structural solution adapted from construction engineering: a "rafter" arrangement of biointegrative, fiber-reinforced nails designed to internally support the failing bone. Raf

by Vince Vacketta, DPM A national database study published last month compared outcomes between two surgical treatments for end-stage ankle arthritis: primary TAA and AA. The analysis included 69,627 propensity-matched patients in each group. The study found that TAA was associated with better outcomes and lower healthcare costs compared with arthrodesis: Reoperations, Revisions, and Reoperations: The overall reoperation rate was 3.1% after TAA compared with 7.7% after arthr

We all want an effective approach to improve outcomes with osteochondral lesions of the talus. CBMA, rich in stem cells and cartilage-promoting factors, has emerged as a potential solution, but clinical evidence remains limited. A systematic review of 15 studies (PubMed, Scopus, Cochrane) examining functional and pain outcomes after CBMA-assisted surgical treatment of osteochondral talus lesions in adults. CBMA improved pain and function across multiple applications – standa

Since infection is a common indication for TMA, patients undergoing this procedure face a high risk of developing surgical site infections. Study design and scope A systematic review of global databases identified five studies (two clinical trials, three observational) covering 378 procedures and four interventions to reduce surgical site infections following TMA. Key outcomes Antibiotic beads embedded in tissue before closure reduced infection rates. Negative Pressure Woun

Surgeons drop implants more often than you'd think. When this happens, it’s not just embarrassing, it’s a genuine safety risk. The uncomfortable truth is that operating room floors are microbial party venues. Pathogens readily colonize these surfaces, so a dropped implant is a potential post-op surgical infection waiting to happen. What surgeons do when an implant is dropped Most delay surgery over using a contaminated implant. Some soak the implant in antiseptic solution to

by Vince Vacketta, DPM Does the time of day a cervical spinal fusion begins, or whether the surgery crosses an operating room shift change, affect patient outcomes? Researchers conducted a study examining three timing factors – case start time, operating room shift changes, and case order – to determine whether scheduling and workflow influence outcomes after cervical spinal fusion in patients with similar demographics and comorbidities. Key study findings Intraoperative shif

by Vince Vacketta, DPM The allograft space in foot and ankle fusion is crowded and confusing. Every company has a portfolio of products, and every product claims to be “best.” But what moves the needle in fusion? The evidence An April 2026 propensity-matched TriNetX study compared iliac crest autograft to rhPDGF-BB. Consistent with existing literature, key findings included: rhPDGF-BB is noninferior to autograft, meaning it demonstrates equivalent performance. There was no

GLP-1s appear to be more than weight loss drugs, potentially offering direct joint protection and dramatically reducing surgical risk. By the numbers  Recent research demonstrates significant clinical benefits across multiple measures: 40% of obese patients with known hip arthritis prescribed a GLP-1 showed a reduced risk of hip replacement within one year, based on data from 239,000+ patients. 25% of obese patients with known knee arthritis on a GLP-1 demonstrated a reduce

For severe hallux values deformity, MTPJ arthrodesis offers definitive correction, but outcome data is sparse. The study A single-center retrospective case series between 2016–2021, reviewed 62 feet with a mean preoperative hallux valgus angle of 40.2° and intermetatarsal angle of 15.9°. Researchers found that patient-reported outcomes improved significantly by 26 weeks. Foot function composite scores (MOxFQ) improved by 33.0 points. Quality-of-life scores (EQ5D time trade-o

by Vince Vacketta, DPM A patient asks: “Doctor, my ankle hurts too much to exercise and lose weight. Can we fix it first? Then I can lose weight.” The study Researchers conducted a retrospective cohort study examining TAR outcomes in obese patients with a minimum ten-year follow-up period. They compared results between obese patients and non-obese control groups, stratified by body mass index. Because surgical techniques and implant designs evolved during the study peri

A simple look at the preoperative X-ray can flag which ankle fracture patients are headed for serious trouble – before the first incision. It seems obvious, but having a visual trigger for additional testing and discussion with patients is key. The big picture According to a March 2026 study , patients with peripheral arterial calcifications (PACs) visible on injury X-rays, fa ed significantly higher rates of wound complications and return trips to the OR after ankle open r

U.S. veterans face elevated limb-loss risk due to high rates of diabetes and peripheral arterial disease (PAD), and a minor amputation is often not the end of the story. The big picture In a March 2026 study , researchers followed 62,295 veterans with both diabetes and PAD. Among those who had a minor amputation (toe or forefoot), 20.4% required a major amputation (below- or above-knee) within five years. Key details Black and male veterans experienced disproportiona

by Vince Vacketta, DPM Geriatric ankle fractures carry high morbidity. Fixation choice influences early weight-bearing, mobilization, complication risk, and functional recovery – all critical in frail patients where prolonged immobility can be devastating. Study overview In a recent prospective multicenter study , researchers compared fibular nailing (FN) versus locking plate fixation (ORIF) in 55 elderly, medically complex patients with unstable ankle fractures across two t

Does insertional reattachment surgery deliver durable pain relief, function, and return to sport at two and five years? In a retrospective cohort study , researchers reviewed 39 patients (mean age 45; 92% male) who had the procedure between 2011 and 2019. The results were encouraging across multiple measures. Pain, function improvements, and return to activity At the five-year follow-up, the treatment demonstrated these improvements: Pain scores improved, dropping from 4.7

A randomized controlled trial investigated whether the deltoid ligament augmentation (DLA) could replace trans-syndesmotic screw fixation (TSSF). Study design and results The study enrolled 59 patients, including 30 receiving DLA and 29 receiving TSSF, and followed them for one year. The AOFAS score was the primary outcome measure. Key findings: At one year, both approaches produced equivalent AOFAS scores. At three months, the DLA group showed better AOFAS scores and bet

Pilon fractures frequently lead to ankle arthritis. However, the risk and severity of posttraumatic subtalar arthritis is not well documented. This is relevant considering the evolving trend of acute of tibiotalocalcaneal (TTC) arthrodesis as a treatment option. Study design To better understand subtalar arthritis after pilon fractures, researchers conducted a retrospective review of 473 patients with pilon fractures treated by open reduction internal fixation. Patients were

by Vince Vacketta, DPM Does injury type influence how well total ankle replacement restores function? Researchers conducted a biomechanical gait analysis comparing patients with post-fracture arthritis to those with post-sprain arthritis, measuring a nkle motion, walking forces, and step patterns. What the study found Both groups experienced pain relief and improved PROMS. However, biomechanical outcomes differed:  Post-fracture arthritis patients showed limited ankle rang

Foot injuries in polytrauma patients are often overlooked because life-threatening injuries take priority. A recent retrospective registry analysis conducted at Tampere University Hospital from 2016 to 2023 assessed the frequency and timing of foot injuries in polytrauma patients and identified factors that lead to delays in diagnosis. The methods involved included: Selecting polytrauma patients with NISS of 16 or higher Screening for specific types of foot fractures, such a

Strict BMI cutoffs for total ankle arthroplasty (TAA) may unintentionally restrict who gets surgery. A recent study of 1,215 TAA patients from the ACS-NSQIP database (2011–2020) found that applying common BMI eligibility cutoffs (<50, <45, <40, <35) disproportionately affected certain racial, ethnic, sex, and age groups. What they found The analysis revealed notable disparities in eligibility across these demographic groups: The tighter the BMI cutoff, the bigger the di

by Vince Vacketta, DPM As winter sets in, for many of us, both snow and your patients may be falling. ‘Tis the season to review some recent literature on ankle fractures. Center-center clamp placement study : CT quality reduction without the hassle? The study was a cadaveric investigation designed to identify the optimal position for clamp placement on fluoroscopy. It found that a fluoroscopic “center-center” view for clamp placement accurately aligns with established CT-b

While genomics studies the full set of genes, proteomics studies the proteins those genes produce, which can more directly reflect a cell’s physiologic state. In this study , using proteomics, authors asked: Why do treatment responses differ between traditional tenopathy and tenopathy associated with diabetes? The study Researchers analyzed Achilles tendon tissue using mass spectrometry to quantify thousands of proteins, comparing patterns from three groups: Tendinopathy (n

In the spirit of Thanksgiving, when many of us add a little extra to our plates, a new study looked at how body mass index (BMI) influences recovery after lower-extremity fracture surgery. Using a 20-year national dataset, adults with BMI ≥30 were compared to those with BMI <30, all followed for two years. Short-term risks (first 90 days)  Obesity increased complications across the board: Pulmonary embolism: +55% Deep vein thrombosis: +30% Renal failure: +22% Wound disrup

by Vince Vacketta, DPM To examine whether adding a second metatarsal shortening (Weil) osteotomy is truly needed to address transfer metatarsalgia in patients undergoing first MTPJ arthrodesis, a new study compared outcomes between patients who had first MTPJ fusions alone and those who received the fusion combined with a second metatarsal Weil osteotomy. Study results A second metatarsal Weil osteotomy is not needed Pain and functional outcomes were similar between both gro

For surgeons and patients with end-stage arthritis, the choice between joint replacement and fusion isn’t always clear. A new study offers direct comparison by analyzing 100 INFINITY ® total ankle arthroplasty (TAA) patients (2008-2021) and 200 fusion patients (2013-2021), all with at least one year of follow up. Adults ≥19 years reported outcomes using the Ankle Osteoarthritis Scale, MODEMS, and SF-36, providing a head-to-head look at pain relief and long-term function. R