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

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

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

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

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

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

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

Ligament augmentation in lateral ankle reconstructions got a big boost with the publication of a Level 1 paper showing superior two- and five-year outcomes when using a ligament augment. Since then, the market has expanded with offerings from Stryker ( Artelon ), Arthrex (Internal Brace), Conmed (BioRez), and Medline (ForceWeb). Augment use in ortho foot and ankle In an online survey of American Orthopaedic Foot & Ankle Society (AOFAS), 85.7% reported using ligamen

by Vince Vacketta, DPM Two recent studies shed light on early weightbearing and mobilization following ankle fracture ORIF: Study 1 – Hybrid cast and brace vs. traditional cast This study compared a hybrid approach (short cast followed by a functional brace) with the traditional six-week cast, evaluating function, pain, complications over two years. It found that rigid, long-duration immobilization is not necessarily superior. More flexible or functional approaches can matc

Surgeons often delay ankle fracture surgeries due to swelling, fearing it increases wound complications. However, there are no guidelines...

Hardware removal is a common but costly side of orthopedic and musculoskeletal care. Surgeons and hospitals disagree on allowing...

Gastrocnemius recession treats isolated gastrocnemius contracture (IGC), improving ankle dorsiflexion. However, recent anatomical...

by Vince Vacketta The problem: Medial gutter impingement following TAA results in pain and restricted movement, despite the implant being...

Most gait studies post-ankle surgery are performed with participants walking barefoot, which is not a realistic scenario. A notable ...

TTC arthrodesis is vital for treating severe hindfoot/ankle issues. Dynamic compression (DC) nails may outperform static compression (SC)...

by Vince Vacketta, DPM Total ankle arthroplasty (TAA) utilization continues to grow . Looking back and projecting forward helps us better...