AANA25 Foot & Ankle Access Pass *Non-CME*-CONCURRENT SESSION 3H: Sports Ankle Update

Video Transcription

Video Summary

This transcript captures a closing session from an orthopedic foot-and-ankle meeting focused on 2025 management trends and athlete recovery.<br /><br />Eric Ferkel reviews evaluation and arthroscopic management of osteochondral lesions of the talus (OLT): exam plus X‑ray, MRI, often CT, then diagnostic arthroscopy. He emphasizes safe portal placement (protecting the superficial peroneal nerve), debridement of synovitis/impingement, and tailoring treatment to lesion size, containment, cysts, edema, and chronicity. For smaller lesions, bone marrow stimulation aims to form fibrocartilage; newer “nanofracture”/small-needle techniques may reduce bone compaction and improve marrow access versus awls/K-wires. Outcomes data show functional improvement, with biologic augmentation (BMAC/PRP, extracellular matrix scaffolds) supported by consensus statements and improved imaging (MOCART) scores. For larger/hemitalar defects, bulk talar osteochondral allograft can yield high survivorship and patient satisfaction; a case illustrates graft prep, fixation, and good 1‑year outcome.<br /><br />A VCU medical student presents a systematic review on “return to sport” (RTS) after foot/ankle surgery: across 151 studies, 54% lacked an explicit RTS definition and many used inconsistent binary or time-based endpoints, limiting comparability and patient counseling. Standardized staged definitions (training, clearance, competition) are recommended.<br /><br />Guillermo (Buenos Aires) reports that anterior ankle impingement does best long-term when arthroscopic spur resection is paired with etiology-based procedures (instability repair, hindfoot varus correction), showing improved AOFAS scores and no recurrence in a small retrospective series.<br /><br />Dr. Gainey summarizes syndesmotic injuries: prioritize stable vs unstable, use MRI clues (e.g., deltoid + PITFL tears, fluid tracking), consider arthroscopy/stress testing, ensure accurate reduction, and often repair deltoid/associated lateral ligaments.<br /><br />Ian Elliott discusses Lisfranc injuries in high-level athletes, favoring ORIF (often with medial column stabilization) for many indirect athletic patterns, reserving fusion for joint destruction; flexible fixation is an emerging area.<br /><br />Richard Ferkel closes with “future tech”: AI (still needs validation), wearables/GPS systems for workload and asymmetry, markerless motion analysis (DARI), and 3D-printed custom braces for performance and rehab. The panel debates fusion vs fixation in athletes and strategies to reduce reinjury and optimize wound healing.

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Keywords

osteochondral lesion of the talus (OLT)

ankle arthroscopy

bone marrow stimulation

nanofracture technique

biologic augmentation (BMAC/PRP)

talar osteochondral allograft

return to sport (RTS) definitions

anterior ankle impingement

syndesmotic injury management

Lisfranc injury ORIF in athletes

wearables and markerless motion analysis in rehab