October 2025

ORTHOPAEDICS

NORTHWESTERN MEDICINE AT AOFAS 2025: INNOVATIONS IN FOOT AND ANKLE CARE

At the 2025 American Orthopaedic Foot & Ankle Society Annual Meeting, Northwestern Medicine physicians and students delivered a series of podium and poster presentations that spotlighted their leadership in clinical outcomes research, surgical technique optimization and more.
 
Fear of Reinjury Limits Patient Functional Outcomes as Measured by PROMIS Following Augmented Broström Procedure
Podium Presentation
 
Authors: Steven M. Hadley Jr., Rachel Bergman, MD, Sarah J. Westvold, Tanja Kukreja, Carolyn J. Hu, Ryan Filler, MD, Muhammad Y. Mutawakkil, MD, Milap S. Patel , DO, Anish R. Kadakia, MD
Presenting author: Steven M. Hadley Jr.

In a study published in Foot & Ankle Orthopaedics, the investigators found that 64% of patients undergoing augmented Broström procedures experience fear of reinjury, which correlates with lower physical function and ankle stability scores to clinically relevant degrees. These findings underscore the need to address psychological factors in post-operative care to optimize recovery.
 
Does Deltoid Ligament Repair Reduce Complications and Improve Functional Outcomes Measured by PROMIS Scores Following Ankle Fracture Surgery?
Podium Presentation
 
Authors: Steven M. Hadley Jr., Rachel Bergman, MD, John J. Peabody, MD, Sarah J. Westvold, Ryan Filler, MD, Milap S. Patel , DO, Anish Kadakia, MD
Presenting author: Steven M. Hadley Jr.
 
In a study of 265 patients published in Foot & Ankle Orthopaedics, deltoid ligament repair (DR) was associated with zero radiographic complications, compared to a 14.4% complication rate in non-repair cases, including notably higher rates of degenerative joint disease and syndesmotic malreduction. While PROMIS scores did not show statistically significant differences, adjusted models suggested a trend toward improved outcomes with DR. The study suggests a role for deltoid ligament repair in ankle fracture surgery when clinically indicated.
 
Broström with InternalBrace Augmentation Significantly Improves Ankle Stability Measured by the Cumberland Ankle Instability Tool Compared to Broström without Augmentation
Poster Presentation
 
Authors: Steven M. Hadley Jr., Rachel Bergman, MD, Sarah J. Westvold, Tanja Kukreja, Carolyn J. Hu, Ryan Filler, MD, Muhammad Y. Mutawakkil, MD, Milap S. Patel , DO, Anish Kadakia, MD
Presenting author: Steven M. Hadley Jr.
 
This study, recently accepted for publication in the Journal of the American Academy of Orthopaedic Surgeons, compared ankle stability outcomes between patients who had a Broström procedure with InternalBrace™ augmentation and those who underwent Broström without augmentation. Using the Cumberland Ankle Instability Tool, researchers found that patients with the augmentation had significantly better postoperative stability compared to non-augmented Broström. The benefit of augmentation was most pronounced in patients with more severe postoperative instability.
 
 
Augmented Broström Enables Patients with Anatomic Ankle Deformities to Achieve Population Mean Function and Pain as Measured by PROMIS
e-Poster Presentation
 
Authors: Steven M. Hadley Jr., Rachel Bergman, MD, Sarah J. Westvold, Tanja Kukreja, Carolyn J. Hu, Ryan Filler, MD, Muhammad Y. Mutawakkil, MD, Milap S. Patel , DO, Anish Kadakia, MD
Presenting author: Steven M. Hadley Jr.
 
 
This study assessed whether Broström surgery with InternalBrace™ augmentation improves outcomes for patients with ankle deformities. Using PROMIS measures of physical function (PF) and pain interference (PI) and CAIT as a measure of ankle stability, researchers found that patients with deformities typically had worse outcomes. However, those who received augmentation showed significantly better PF and PI scores and improved ankle stability compared to those who received non-augmented Broström. Therefore, augmentation may serve as an effective surgical management strategy for patients with structural deformities.
 
 
Augmented Broström is Associated with Improved Functional Outcomes as Measured by PROMIS Scores Compared to Broström Without Augmentation
e-Poster Presentation
 
Authors: Steven M. Hadley, Jr., Rachel Bergman, MD, Sarah J. Westvold, Tanja Kukreja, Carolyn J. Hu, Ryan Filler, MD, Muhammad Y. Mutawakkil, MD, Milap S. Patel , DO, Anish Kadakia, MD
Presenting author: Steven M. Hadley, Jr.
 
This study compared functional outcomes between Broström procedures with and without InternalBrace™ augmentation using PROMIS scores of physical function (PF) and pain interference (PI). Among 127 patients, those who received augmentation had significantly better PF and PI scores. Augmentation was associated with clinically meaningful improvements in PROMIS PF and PI. Higher BMI and varus deformity were linked to worse outcomes. Overall, augmented Broström may enhance functional outcomes in patients with chronic lateral ankle instability.
 
 
Is Insurance Type Associated with Patient Reported Outcomes as Measured by PROMIS Following Ankle Fracture Surgery?
e-Poster Presentation
 
Authors: Steven M. Hadley Jr., John J. Peabody, MD, Sarah J. Westvold, Rachel Bergman, MD, Shaun Chang, MD, Milap S. Patel , DO, Anish Kadakia, MD
Presenting author: Steven M. Hadley Jr.

A study examining 182 patients with anatomically reduced ankle fractures found that Medicaid patients reported significantly higher PROMIS pain interference and greater fear of reinjury, despite similar PROMIS physical function scores across insurance types. These disparities highlight the importance of addressing psychosocial and systemic factors in orthopaedic recovery.
 
What is the Mean Achilles Tendon Total Rupture Score (ATRS) in a Healthy Population?
e-Poster Presentation
 
Authors: Steven M. Hadley Jr., Rom Brown, Rachel Bergman, MD, Sarah J. Westvold, Ryan Filler, MD, Augustus Demanes, MD, Stephen M. Gryzlo, MD, Michael A. Terry, MD, Vehniah K. Tjong, MD, Muhammad Y. Mutawakkil, MD, Milap S. Patel , DO, Anish Kadakia, MD
Presenting author: Steven M. Hadley Jr.

When evaluating outcomes after Achilles rupture repair, reported Achilles Tendon Total Rupture Scores (ATRS) range from 82 to 89, which is considerably lower than the reported ATRS healthy population mean. Yet, following surgical repair of the Achilles rupture, these patients score above the population mean on other validated metrics, including PROMIS scores.
 
A prior study that determined a healthy ATRS was based on only 52 patients. Therefore, this study aimed to determine the healthy population mean. In a healthy cohort twice the size of the prior study, researchers found that the mean ATRS was 81, notably lower than the previously cited 99.8. These findings suggest that Achilles rupture repair may indeed produce satisfactory functional outcomes. This study also underscores the need to further investigate ATRS, as current literature may overestimate a healthy population mean. It also may be helpful to evaluate the ATRS in context of activity level, as activity level was a key variable influencing ATRS scores.

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