Worcestershire Acute Hospitals NHS Trust

Hallux valgus (HV) is a common deformity of the foot, for which various forms of surgical treatment are available. A recent think tank highlighted a lack of understanding about which key outcomes matter most to patients who undergo surgery for HV. The aim of this systematic review was to synthesize the existing evidence to establish whether commonly used outcome measures in foot and ankle surgery adequately reflect what is important to patients. We conducted a systematic review of qualitative studies in which methods such as patients' interviews, questionnaires, or focus groups were used to understand which outcomes are important to adults undergoing surgery for HV. The following databases were searched: CINAHL (Cumulative Index to Nursing and Allied Health Literature), PubMed, MEDLINE, Embase, Emcare, and Cochrane Library, in addition to the reference lists of the studies which were included. The review was prospectively registered with the PROSPERO database and conducted following PRISMA guidelines. Ten studies were included. The four most common themes which were identified as being important to patients were improvements in pain over the hallux, footwear restrictions, restrictions in daily activities and the function of the foot, and cosmesis. The Manchester-Oxford Foot Questionnaire was found to be the only outcome measure which specifically addresses these themes, while also including questions about the psychosocial impact. Cosmesis is under-represented in the outcome measures. Further research is needed to explore the psychosocial factors which are important to patients so that they can be included within the measures which are used to assess outcome after the surgical treatment for HV.

To assess the safety, effectiveness, and postoperative outcomes of medial collateral ligament (MCL) pie-crusting (PC) in arthroscopic meniscus surgery. This systematic review was conducted in accordance with PRISMA guidelines. Three databases (PubMed, EMBASE and MEDLINE) were searched from inception to 21 January 2025, for studies evaluating the use of MCL PC during arthroscopic meniscus or anterior cruciate ligament (ACL) surgery. Data on patient demographics, medial joint space measurements, postoperative instability, patient reported outcome measures (PROMs), and complications were extracted. Fifteen studies comprising 1009 patients were included, with 723 undergoing PC. PC significantly increased medial joint space width by a mean of 5.7 mm intraoperatively (p < 0.05), with no residual laxity reported at mean final follow-up of 16.5 months. The most common complications of PC were transient medial knee pain (12.7%) and ecchymosis (12.9%). There were five reports of saphenous nerve irritation (0.8%), all resolved by final follow-up of 31.6 months. In contrast, iatrogenic chondral injury was reported in 9.0% of patients undergoing meniscal repair without PC. MCL PC is a safe and effective technique to improve visualisation and outcomes in arthroscopic meniscus surgery. It is associated with improved joint access and low complication rates without long-term instability. While current evidence supports its use, further high-quality, long-term comparative studies are needed to validate its safety and efficacy, as this study primarily used retrospective data without long-term follow-up. Level IV.

The diagnosis of early-stage osteoarthritis (eOA) is important in disease management and outcomes. Herein we report the clinical validation of a blood test for the diagnosis of eOA in a large patient cohort using trace-level glycated and oxidized amino acid analytes. Subjects were recruited and enrolled in two study groups: subjects with eOA of the hip (n = 110) and asymptomatic controls (n = 120). Their plasma was analyzed for glycated and oxidized amino acids by quantitative liquid chromatography-tandem mass spectrometry. Algorithms were developed using plasma hydroxyproline and 12 glycated and oxidized amino acid analyte features to classify the subjects with eOA and asymptomatic controls. The accuracy was defined as the percentage of the subjects correctly classified in the test set validation. The minimum number of analyte features required for the optimum accuracy was five glycated amino acid analytes: Nω-carboxymethyl-arginine, hydroimidazolones derived from glyoxal, methylglyoxal and 3-deoxyglucosone, and glucosepane. The classification performance metrics included an accuracy of 95%, sensitivity of 96%, specificity of 94%, area under the curve of the receiver operating characteristic curve of 99%, and positive and negative predictive values of 94% and 97%. We concluded that an assay of five trace-level glycated amino acids present in plasma can provide a simple blood test for the screening of eOA. This is predicted to improve the case identification for expert referral 9-fold.