October 2024

ORTHOPAEDICS

HIGHLIGHTS FROM AOFAS 2024

Featuring: Anish R. Kadakia, MD
Northwestern Medicine Orthopaedics faculty members and trainees traveled to Vancouver, British Columbia, Canada, in September to present their latest research and clinical insights at the 2024 American Orthopaedic Foot and Ankle Society (AOFAS) Annual Meeting. Below are the highlights from our team at this year’s conference.
 
Anish R. Kadakia, MD, and Steven M. Hadley, a second-year medical student at Northwestern University Feinberg School of Medicine, delivered two impactful podium presentations.
 
Does Pre-Injury Level of Activity Impact Post-Recovery Activity Level Regardless of Ankle Fracture Type?
 
In their presentation titled “Does Pre-Injury Level of Activity Impact Post-Recovery Activity Level Regardless of Ankle Fracture Type?” Dr. Kadakia and Hadley presented results of their study that explored whether pre-injury activity level is associated with post-recovery activity level in patients with surgically treated ankle fractures, regardless of fracture subtype based on the Weber classification.
 
The results showed that 70% of patients reported returning to their pre-injury activity level. Fear of reinjury was significantly associated with the inability to return to activity (p<0.001), with two-thirds of those who did not return citing fear as the primary reason. Pre-injury activity level was significantly associated with return to activity (p=0.02), with the highest return rate (81.9%) among those with sedentary or light activity levels and the lowest (60.5%) among those with high activity levels. Notably, pre-injury activity level was not associated with return to activity in patients without fear of reinjury.
 
The presentation concluded that proper surgical fixation and anatomic reduction enable most patients (70%) to return to pre-injury activity levels, regardless of pre-injury activity levels and fracture subtype, when fear of reinjury is not considered. When fear is eliminated, 88% of patients return to pre-injury activity levels. Gender differences were also observed, with 61% of females versus 88% of males returning to baseline activity levels, and fear of reinjury affecting females more significantly (26% of females vs. 9% of males). The study underscores the importance of addressing psychological factors, particularly fear of reinjury, in the recovery process to improve postoperative outcomes for patients with ankle fractures.
 
Patient-Reported Outcomes of Minimally Invasive Achilles Rupture (PROMIS) Repair
 
In their presentation titled “Patient Reported Outcomes of Minimally Invasive Achilles Rupture Repair,” Dr. Kadakia and Hadley presented their findings from a study comparing the patient-reported outcomes of two minimally invasive techniques for Achilles tendon rupture repair:
  • The Percutaneous Achilles Repair System (PARS)
  • The Midsubstance Speedbridge Implant System (MSB)
 
The study found no significant differences between the two techniques in terms of PROMIS physical function and pain interference scores, as well as the Achilles Tendon Total Rupture Score. Both techniques resulted in physical function scores higher than the population mean and pain interference scores lower than the population mean.
The time to return to pre-injury activity levels was similar for both techniques, averaging 9.3 months for PARS and 9.4 months for MSB. Complication rates were low overall with MSB having lower rates of infection and re-rupture, though MSB had a significantly higher incidence of heel pain at final follow-up, prompting a modification in the technique to adjust anchor placement.
 
The presentation concluded that both PARS and MSB are effective and safe strategies for the surgical management of Achilles ruptures, with patients achieving better physical function and lower pain interference compared to the population mean.
 
Despite the higher incidence of heel pain with MSB, both techniques demonstrated low overall complication rates, with re-rupture rates of 2.6% for PARS and 0% for MSB. These findings highlight:
  • The efficacy of minimally invasive techniques in achieving favorable patient-reported outcomes
  • The importance of technique modifications to address specific complications.
 
With the anchor modification with the lower rates of wound complications and re-rupture with MSB, Dr. Kadakia and Hadley have adopted this technique as their preferred method for Achilles rupture repair. They are working on a prospective study to evaluate this technique.
Anish R. Kadakia, MD, professor of Orthopaedic Surgery at Northwestern Medicine

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