American Orthopaedic Foot and Ankle Society

Chronic ankle instability often results from lateral ankle sprains, primarily affecting the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). When conservative treatments fail, surgical options include anatomic repair and reconstruction. The Broström-Gould and Karlsson techniques aim to restore native ligament structures, while reconstruction is necessary for irreparable cases. Both arthroscopic and percutaneous approaches have been explored. We present a promising minimally invasive nonanatomic reconstruction technique for the ATFL and CFL, offering a viable alternative for managing chronic ankle instability. Only one graft rupture was reported, ∼10 months postoperatively, following a traumatic event. No other intraoperative or postoperative complications were observed. This nonanatomic minimally invasive technique represents a reliable and promising approach for the reconstruction of chronic lateral ankle instability. Levels of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.

<h2>Abstract</h2> Injuries to the distal tibiofibular syndesmosis are less common than lateral ankle sprains but are frequently associated with persistent pain and functional impairment when not accurately diagnosed. Magnetic resonance imaging (MRI) is commonly used to evaluate suspected syndesmotic injury; however, its diagnostic accuracy in the setting of chronic pathology remains uncertain. A retrospective review was performed of patients who underwent both preoperative MRI and ankle arthroscopy between August 2022 and December 2024. MRI findings from official radiology reports were compared with intraoperative arthroscopic findings, which served as the reference standard. Fifty patients met inclusion criteria. MRI demonstrated a sensitivity of 100% and specificity of 28.57% for detecting syndesmotic tearing. For syndesmotic fibrosis or synovitis, MRI sensitivity was 100% with a specificity of 15.38%. All positive MRI findings correlated with intraoperative pathology; however, a substantial number of syndesmotic abnormalities identified during arthroscopy were not detected on preoperative MRI. These findings indicate that MRI demonstrates excellent sensitivity but limited specificity; while positive MRI findings reliably correlated with intraoperative pathology, negative MRI findings did not reliably exclude clinically significant syndesmotic injury. Integration of clinical examination and adjunctive diagnostic modalities may be necessary to accurately evaluate patients with persistent syndesmotic symptoms.

Social media has fundamentally altered how information is created, disseminated, and consumed, with growing impact on spine surgeons and professional societies. Traditional academic publishing remains the standard for research validation, but digital platforms now shape much of the real-time dialogue in spine care. To explore strategies for integrating spine surgeons' social media presence with traditional publishing channels to enhance knowledge dissemination, support clinical innovation, and improve member engagement within spine societies. This perspective reviews current patterns of social media use among spine surgeons, focusing on platforms such as X (formerly Twitter), Instagram, and LinkedIn. It analyzes benefits (reach, speed, interactivity) and challenges (variable quality, lack of peer review, potential bias), and proposes a conceptual hybrid model in which social media and peer-reviewed journals function in a complementary rather than competitive manner. Social media enables rapid sharing of clinical insights, techniques, and innovations, and facilitates engagement with both peers and patients. However, it often privileges observational data, lower-level evidence, and real-world experiences that do not easily fit into traditional high-level evidence frameworks. A hybrid approach is proposed in which professional societies (1) formally recognize curated social media content as a feeder for peer-reviewed work; (2) create more inclusive forums for lower-level evidence and case-based discussions; and (3) intentionally link digital dialogues to structured academic outputs. By aligning the dynamic, interactive nature of social media with the rigor and credibility of traditional publishing, spine societies can foster greater member engagement, accelerate innovation, and reinforce their role as thought leaders. A deliberate, hybrid communication strategy can bridge the gap between digital and print, creating a more collaborative and inclusive platform for advancing spine surgery. Integrating social media with traditional publishing can accelerate the dissemination of practical, real-world clinical insights, ultimately enhancing surgeon education and improving patient care in spine surgery.

Introduction: Ferroptosis therapy, despite its promise, encounters challenges such as compromised catalytic performance due to an inadequate H2O2 substrate, the robust antioxidant defense system within the tumor microenvironment (TME), and potential off-target adverse events, leading to suboptimal efficacy. Methods: To overcome these limitations, we propose a strategy for TME-mediated activation of a potent oxidative stress storm to enhance MRI-guided multiple-amplified ferroptosis therapy for tumors. Results: The synthesized Fe-LAP@HMON-TAM-PEOz nanoparticles demonstrate precise and highly effective tumor-specific catalysis for antitumor therapy. This is achieved through an improved tumor accumulation strategy driven by charge-reversal-mediated active targeting and a multiple amplification approach for ferroptosis therapy, involving H2O2 self-supplementation, GSH depletion, subsequent oxidative stress storm generation, and LPO accumulation, resulting in a robust antitumor response. Furthermore, the rapid degradation of nanoparticles in response to the H+/GSH stimulus within the TME facilitates the release of Mn2+ from Fe-LAP@HMON-TAM-PEOz. This released Mn2+ significantly enhances tumor brightness in T1-weighted MRI, characterized by a high r1 value. Conclusion: Consequently, our synthesized Fe-LAP@HMON-TAM-PEOz nanoparticles exhibit excellent biodegradability and minimal side effects, highlighting their tremendous potential for highly efficient tumor theranostics.

The purpose of this retrospective case series is to describe real-world clinical experience with DermaBind TL or FM, (HealthTech Wound Care, US), a dehydrated full-thickness placental membrane intended for homologous use as a protective wound covering in wounds of various aetiologies that failed to heal with standard of care (SoC). This retrospective observational, uncontrolled case series collected data from healthcare providers in the US. Eligible cases were patients, ≥18 years of age, with hard-to-heal wounds who received DermaBind TL or FM after having completed a minimum of four weeks of SoC without evidence of wound improvement. Data collected included patient demographics, wound characteristics and wound size. The cases of 27 patients encompassing 36 wounds were included. The average age of patients included was 72.4 years (range: 37-101 years). The majority of wounds were pressure ulcers (63.9%), followed by diabetic foot ulcers (19.4%) and venous leg ulcers (8.3%). Wound onset was, on average, 29 weeks prior to the first graft application with the placental membrane, and the average wound size was 34cm2. Graft applications occurred weekly, with an average duration of treatment of 6.7 weeks. The observed average percentage surface area reduction across the 36 wounds was 69.1% (range: -17.6-100%). No adverse events were reported by the provider across all patient cases. These observations describe the clinical use of DermaBind as a wound covering material consistent with its homologous natural protective role. Larger, prospective studies are warranted to further investigate its clinical use. The authors would like to stress that this non-randomised, retrospective uncontrolled case series was used to describe findings, such as number of grafts applied, observed percentage of surface area reduction and graft wasted, and not to demonstrate efficacy.